ARAVA

Arava is a brand name for the generic medicine Leflunomide. It is a prescription drug developed by Safoni Aventis and approved by the US FDA in 1998 for the treatment of active rheumatoid arthritis in adults. It suppresses the immune system and reduces inflammation and swelling in the joints- the symptoms of rheumatoid arthritis. Furthermore, it helps prevent new or worsening structural damage of the joints as evidenced by X-ray erosions, inhibits joint space narrowing, and improves physical functioning.   

Arava contains Leflunomide as its active ingredient and the following inactive ingredients: hypromellose, starch, talc, colloidal silicon dioxide, polyethylene glycol, crospovidone, lactose monohydrate, povidone, titanium dioxide, magnesium stearate, and yellow ferric oxide. Leflunomide is chemically named N-(4´-trifluoromethylphenyl)-5-methylisoxazole-4-carboxamide. It is classified as a disease-modifying antirheumatic drug (DMARD) and is primarily used for the treatment of rheumatoid arthritis (RA), a chronic autoimmune disease that causes joint inflammation and damage.

The function of leflunomide is to suppress the excessive immune response that occurs in rheumatoid arthritis. In RA, the immune system mistakenly attacks the body's tissues, particularly the joints, leading to inflammation, pain, and progressive joint damage.

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Arava belongs to the pharmacological classes: Selective immunosuppressants; and Modifying Anti-Rheumatic Drugs (DMARDs). It is a pyrimidine synthesis inhibitor. Selective immunosuppressants are drugs that selectively target and suppress the activity of the immune system. In the case of Arava, it modulates the immune response specifically to reduce inflammation and joint damage in rheumatoid arthritis (RA).

As a DMARD, Arava is used for the long-term management of rheumatoid arthritis, a chronic autoimmune disease characterized by persistent joint inflammation. DMARDs work by modifying the course of the disease and slowing the progression of joint damage, alleviating symptoms, and enhancing the quality of life for individuals with rheumatoid arthritis.

Arava comes with three strengths:

• 10mg: These are available as round, white, film-coated tablets printed with “ZBN” on one side.
• 20mg: These are triangular, light yellow, film-coated tablets having “ZBO” embossed on one side.
• 100mg: These are round, white, film-coated tablets having one-sided embossed with “ZBP”.

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• Arava is indicated for the treatment of Adult Rheumatoid Arthritis (RA). Active rheumatoid arthritis is an inflammatory, autoimmune disease that results in stiffness, swelling, pain, and damage in the joints.
• Autoimmune disease occurs when the immune system mistakenly attacks the healthy cells within the body. In the case of Rheumatoid Arthritis, the immune system cells attack the synovium- the lining of the joints.
• Arava can even be taken for the treatment of Psoriatic Arthritis. Psoriatic Arthritis is a type of inflammatory arthritis in people suffering from a skin condition called Psoriasis.

• The suggested loading dose of Arava is 100mg once a day for three consecutive days. The treatment may not necessarily be started with a loading dose. Loading dosage provides more rapid steady-state concentrations within the body.
• The maximum prescribed maintenance dose of Arava is 20mg taken orally once a day, with or without food. Patients can initiate their treatment with loading dosage and subsequently have maintenance dosage if they are at low risk of ARAVA-associated myelosuppression and ARAVA-associated hepatotoxicity. In case of high risk, they must start straight with a recommended maintenance dose.
• If patients show intolerance to 20mg strength, the strength of the daily maintenance dose must consider lowering of dosage to 10mg.

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• Arava is available in the form of tablets that one takes by mouth. It is generally recommended to take Arava tablets with or without food, or as directed by the healthcare professional.
• It's important to follow the specific instructions provided by your healthcare provider or the information included in the medication packaging. They will guide the recommended dosage, timing, and any additional instructions for taking Arava.
• Swallowing the tablet whole is important to ensure that the medication is properly absorbed and distributed in the body. It is not recommended to crush, chew, or break the tablet unless specifically instructed to do so by the healthcare provider, as it can affect the medication's effectiveness.

Arava can result in minor or severe side effects. The common side effects of taking Arava are:

• Headache,
• Thinning hair,
• Stomach pain, diarrhea, nausea, vomiting;
• Abnormal liver function tests,
• Low energy level or weakness,
• Loss of appetite,
• Backache,
• Dizziness,
• Skin rashes or itching,
• Hypertension.

Some of the serious side effects of Arava that require prompt medical help include:

• Severe skin reactions
• Liver problems- rarely fatal liver disease
• Nerve damage
• Allergic reaction
• Lower immunity and serious infections.
• Sudden chest pain or discomfort, dry cough, wheezing, and shortness of breath.
• Burning pain, numbness, or tingling in feet or hands.
• Abnormal bleeding from nose, mouth, rectum, or vagina; easy bruising; or red pinpoint spots under the skin.

Some of the drugs that may interact with Arava include:

• Antifungals, antibiotics, or sulfa drugs.
• Seizure medications
• Cholesterol-lowering medications.
• Heart or blood pressure medications.
• Birth control pills or Hormone replacement therapy.
• Anabolic steroids
• Other immunosuppressants
• Cancer medication
• Acetaminophen, Aspirin, other arthritis or gout medication.

Arava is not safe for use by:

• Patients suffering from severe hepatic impairment
• Patients being treated with other medications known to cause drug interactions with Arava
• Patients having known hypersensitivity to ingredients of Arava
• Patients who are pregnant, planning to be pregnant, or are breast-feeding
• Small children.

• Avoid coming in contact with any sick person who has a contagious illness like a cold or flu as you can easily fall ill. If developing signs of infections, immediately seek medical help.
• Do not go for live vaccination while taking Arava as it can cause a serious infection.
• If you miss a dose, do not go beyond the daily recommended dosage to make up for it. 
• Do not use the drug if pregnant or nursing a child.
• Make sure that Arava is safe for you by informing your doctor about your allergies, current intake of medications or supplements, and illnesses (if any). 
• Avoid alcohol consumption while on Arava medication.

• Store Arava at controlled room temperature, specifically at 25℃ deviations permitted to 15-30℃.
• Protect the tablets from direct light, moisture, and heat. Do not freeze them and keep them out of reach of small children.

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