What is Lefumide 20?

Lefumide 20 refers to tablets containing 20 mg of leflunomide, a disease-modifying antirheumatic drug (DMARD) used to treat rheumatoid arthritis (RA) and psoriatic arthritis.

It works by suppressing the immune system to reduce joint inflammation and damage.

Approved by the FDA in 1998, it’s supported by clinical trials (e.g., in Arthritis & Rheumatology) showing it slows RA progression in 50-70% of patients.

It’s a prescription medication, often used when NSAIDs or other DMARDs are insufficient, but it requires monitoring due to liver toxicity risks.

Manufacturer

Lefumide 20 is manufactured by Cipla Ltd., a leading Indian pharmaceutical company. It’s available in India and exported globally.

Generic leflunomide 20 mg may be produced by other companies like Sanofi (Arava) or Torrent Pharmaceuticals, but always check the label for the exact manufacturer and batch details.

Composition

Each Lefumide 20 tablet contains:

• Active Ingredient: Leflunomide (20 mg).
• Inactive Ingredients: Typically include lactose monohydrate, maize starch, povidone, magnesium stearate, and film-coating agents. Some formulations may contain lactose or dyes—verify for allergies.

Working

Leflunomide inhibits dihydroorotate dehydrogenase, an enzyme involved in pyrimidine synthesis, which is essential for rapidly dividing cells like immune cells.

• Mechanism: It reduces the proliferation of activated lymphocytes, decreasing inflammation and joint destruction in autoimmune diseases. Its active metabolite (A77 1726) provides long-lasting effects, with a half-life of 15-18 days.
• Efficacy: Clinical studies (e.g., US301 trial) show it improves ACR20 response (20% improvement in RA symptoms) in 50-60% of patients within 3-6 months, slowing radiographic progression.

How Lefumide 20 Works

Leflunomide inhibits an enzyme called dihydroorotate dehydrogenase (DHODH).
This reduces the activity of overactive immune cells (lymphocytes), leading to:

✔ Reduced joint inflammation
✔ Decreased swelling
✔ Slower progression of arthritis
✔ Less pain and stiffness

It is a long-term disease-modifying drug.

How to Use Lefumide 20?

• Take orally with a full glass of water, with or without food.
• Swallow the tablet whole; do not crush or chew.
• Use consistently at the same time each day.
• Loading dose may be required initially (higher dose for first 3 days), followed by maintenance.
• If you miss a dose, take it as soon as possible, but skip if it’s close to the next dose—do not double up.

Dosage

• Standard Dose: 20 mg once daily after a loading dose of 100 mg/day for 3 days (for RA).
• Adjustments: Lower doses (10 mg) for side effects or renal impairment; not recommended for severe liver disease. Dosing is individualized based on response and monitoring.
• Duration: Long-term for chronic conditions; may be tapered or discontinued if ineffective or intolerable.

Avoid Taking Lefumide 20 If You

Are you pregnant or planning a pregnancy

Have severe liver disease

Are you allergic to Leflunomide

Have active infection (TB, hepatitis, severe viral illness)

Are you using methotrexate without a doctor’s approval

Warnings and Precautions

• Consult a doctor if you have liver disease, infections, or blood disorders.
• Regular monitoring required: Liver function tests (LFTs) every 4-8 weeks initially, then every 3-6 months; complete blood counts and blood pressure checks.
• Avoid pregnancy (Category X; can cause birth defects)—use effective contraception during treatment and for 2 years after stopping.
• Not for breastfeeding; interactions with live vaccines or other immunosuppressants.
• Inform healthcare providers about all medications, as they can interact with CYP2C9 substrates.

Benefits

• Primary Benefits: Reduces joint pain, swelling, and stiffness in RA; slows disease progression and improves physical function.
• Additional Benefits: May be used off-label for other autoimmune conditions like lupus; enhances quality of life by delaying joint damage.
• Evidence: Backed by trials like those in Annals of the Rheumatic Diseases, showing sustained remission in 30-50% of patients over 2 years.

Avoid Taking Lefumide 20

• If you have severe liver impairment, active infections, or hypersensitivity to leflunomide.
• During pregnancy or if planning pregnancy without contraception.
• With other hepatotoxic drugs or if you have uncontrolled hypertension.
• If breastfeeding or if you have a history of severe allergic reactions.
• Do not use for non-autoimmune conditions without a prescription.

Side Effects

Common side effects (affecting 10-40% of users, per clinical data):

• Diarrhea, nausea, or abdominal pain.
• Hair loss or rash.
• Elevated liver enzymes (asymptomatic in many cases).

Serious side effects (seek immediate help):

• Severe liver toxicity (jaundice, dark urine).
• Infections or pancytopenia (low blood counts).
• Peripheral neuropathy or allergic reactions.
• Interstitial lung disease (rare but serious).

Side effects are often dose-related; most resolve with dose adjustment or discontinuation.

Where to Store

• Store in a cool, dry place at room temperature (15-25°C/59-77°F), away from moisture and direct sunlight.
• Keep in the original blister pack or container.
• Out of reach of children and pets.
• Do not refrigerate; discard expired tablets safely.

Conclusion

Lefumide 20 (Leflunomide) is an effective long-term treatment for rheumatoid and psoriatic arthritis. It reduces inflammation, prevents joint damage, and improves quality of life.
However, because of its strong effects and potential risks, it must be taken only under medical supervision with regular monitoring.

Leflunomide 20 is a potent DMARD for managing rheumatoid arthritis, offering significant benefits in controlling inflammation and joint damage. However, its risks, particularly to the liver, require strict monitoring and adherence to precautions.

Always use under a rheumatologist’s supervision, with regular blood tests, to balance efficacy and safety. If diagnosed with RA, discuss with your doctor for personalized treatment options.

FAQS

What is the loading dose for Lefumide 20?

Typically, 100 mg daily for the first 3 days to reach therapeutic levels quickly, then 20 mg maintenance.

Can Lefumide 20 be taken with methotrexate?

Yes, it’s often combined for better RA control, but under close monitoring for liver toxicity.

How long does it take to work?

Improvements may start in 4-8 weeks, with full effects in 3-6 months.

Is Lefumide 20 safe for the elderly?

It can be used, but lower doses and frequent monitoring are advised due to the higher risk of side effects.

Does it affect fertility?

It can reduce sperm count in men and affect ovulation in women; reversible after stopping.

What if I have a cold while on Lefumide 20?

It’s okay, but report severe infections, as it suppresses immunity.

Can I drink alcohol with Lefumide 20?

Limit alcohol, as it increases liver risk—consult your doctor.

Is there a way to speed up elimination if needed?

Cholestyramine can accelerate clearance in cases of toxicity.

Does Lefumide 20 cause weight gain?

Not typically; some users report mild changes, but it’s not a common side effect.

What should I do if I experience hair loss?

It’s common and usually temporary; discuss with your doctor for management options.