Leflunomide interactions

It is uncertain whether the occurrence of HSTCL is related to use of a TNF blocker or a TNF blocker in combination with these other immunosuppressants [see Warnings and Precautions (5.2) ] . (Adalimumab label, Boxed warning)

About 13 percent of the cases of neutropenia have ended fatally, but almost all fatalities were in patients with serious illness, having collagen vascular disease, renal failure, heart failure or immunosuppressant therapy, or a combination of these complicating factors. (Captopril label, Warnings)

In kidney, liver, and heart transplant patients Neoral may be administered with other immunosuppressive agents. (Cyclosporine label, Boxed warning)

Chicken pox and measles, for example, can have a more serious or even fatal course in children on immunosuppressant corticosteroids. (Fludrocortisone label, Warnings)

Immunosuppressants Everolimus Sirolimus Temsirolimus (IV) Not recommended during and 2 weeks after TOLSURA treatment. (Itraconazole label, Drug interactions)

…methylergonovine • HMG-CoA reductase inhibitors: lovastatin, simvastatin (these drugs can be temporarily discontinued to allow PAXLOVID use [see Table 2 , Drug Interactions (7.3) ] ) • Immunosuppressants: voclosporin • Microsomal triglyceride transfer protein inhibitor: lomitapide • Migraine medications: eletriptan, ubrogepant • Mineralocorticoid receptor antagonists:… (Nirmatrelvir and ritonavir label, Contraindications)

…IN TRANSPLANT PATIENTS; AND INCREASED MORTALITY IN FEMALE LIVER TRANSPLANT PATIENTS • Increased risk for developing serious infections and malignancies with ASTAGRAF XL ® or other immunosuppressants that may lead to hospitalization or death. [see Warnings and Precautions ( 5.1 , 5.2 )] • Increased mortality in female liver transplant patients with ASTAGRAF XL. (Tacrolimus label, Boxed warning)

Patients being treated with teriflunomide [see Drug Interactions (7) ] . (Leflunomide label, Contraindications)

If used with concomitant methotrexate and/or other potential immunosuppressive agents, chronic monitoring should be monthly. (Leflunomide label, Warnings and precautions)

In patients taking ARAVA, exposure of drugs metabolized by CYP1A2 (e.g., alosetron, duloxetine, theophylline, tizanidine) may be reduced. (Leflunomide label, Drug interactions)

In patients taking ARAVA, exposure of drugs metabolized by CYP1A2 (e.g., alosetron, duloxetine, theophylline, tizanidine) may be reduced. (Leflunomide label, Drug interactions)

Immunosuppressants Amlodipine may increase the systemic exposure of cyclosporine or tacrolimus when co-administered. (Amlodipine label, Drug interactions)

In patients taking ARAVA, exposure of drugs which are OAT3 substrates (e.g., cefaclor, cimetidine, ciprofloxacin, penicillin G, ketoprofen, furosemide, methotrexate, zidovudine) may be increased. (Leflunomide label, Drug interactions)

In patients taking ARAVA, exposure of drugs which are OAT3 substrates (e.g., cefaclor, cimetidine, ciprofloxacin, penicillin G, ketoprofen, furosemide, methotrexate, zidovudine) may be increased. (Leflunomide label, Drug interactions)

In patients taking ARAVA, exposure of drugs which are OAT3 substrates (e.g., cefaclor, cimetidine, ciprofloxacin, penicillin G, ketoprofen, furosemide, methotrexate, zidovudine) may be increased. (Leflunomide label, Drug interactions)

For other substrates of BCRP (e.g., mitoxantrone) and drugs in the OATP family (e.g., methotrexate, rifampin), especially HMG-Co reductase inhibitors (e.g., atorvastatin, nateglinide, pravastatin, repaglinide, and simvastatin), consider reducing the dose of these drugs and monitor patients closely for signs and symptoms of increased exposures to the drugs while… (Leflunomide label, Drug interactions)

If used with concomitant methotrexate and/or other potential immunosuppressive agents, chronic monitoring should be monthly. (Leflunomide label, Warnings and precautions)

In patients taking ARAVA, exposure of drugs metabolized by CYP1A2 (e.g., alosetron, duloxetine, theophylline, tizanidine) may be reduced. (Leflunomide label, Drug interactions)

In patients taking ARAVA, exposure of drugs which are OAT3 substrates (e.g., cefaclor, cimetidine, ciprofloxacin, penicillin G, ketoprofen, furosemide, methotrexate, zidovudine) may be increased. (Leflunomide label, Drug interactions)

In patients taking ARAVA, exposure of drugs which are OAT3 substrates (e.g., cefaclor, cimetidine, ciprofloxacin, penicillin G, ketoprofen, furosemide, methotrexate, zidovudine) may be increased. (Leflunomide label, Drug interactions)

Effect on Oral Contraceptives Teriflunomide may increase the systemic exposures of ethinylestradiol and levonorgestrel. (Leflunomide label, Drug interactions)

Other risk factors for the development of ONJ include immunosuppressive therapy, treatment with angiogenesis inhibitors, systemic corticosteroids, diabetes, and gingival infections. (Denosumab label, Warnings and precautions)

In patients taking ARAVA, exposure of drugs which are OAT3 substrates (e.g., cefaclor, cimetidine, ciprofloxacin, penicillin G, ketoprofen, furosemide, methotrexate, zidovudine) may be increased. (Leflunomide label, Drug interactions)

If used with concomitant methotrexate and/or other potential immunosuppressive agents, chronic monitoring should be monthly. (Leflunomide label, Warnings and precautions)

Effect on Oral Contraceptives Teriflunomide may increase the systemic exposures of ethinylestradiol and levonorgestrel. (Leflunomide label, Drug interactions)

In patients taking ARAVA, exposure of drugs metabolized by CYP1A2 (e.g., alosetron, duloxetine, theophylline, tizanidine) may be reduced. (Leflunomide label, Drug interactions)

Effect on Oral Contraceptives Teriflunomide may increase the systemic exposures of ethinylestradiol and levonorgestrel. (Leflunomide label, Drug interactions)

If used with concomitant methotrexate and/or other potential immunosuppressive agents, chronic monitoring should be monthly. (Leflunomide label, Warnings and precautions)

If used with concomitant methotrexate and/or other potential immunosuppressive agents, chronic monitoring should be monthly. (Leflunomide label, Warnings and precautions)

…(e.g., mitoxantrone) and drugs in the OATP family (e.g., methotrexate, rifampin), especially HMG-Co reductase inhibitors (e.g., atorvastatin, nateglinide, pravastatin, repaglinide, and simvastatin), consider reducing the dose of these drugs and monitor patients closely for signs and symptoms of increased exposures to the drugs while patients are taking ARAVA [see… (Leflunomide label, Drug interactions)

In patients taking ARAVA, exposure of drugs metabolized by CYP1A2 (e.g., alosetron, duloxetine, theophylline, tizanidine) may be reduced. (Leflunomide label, Drug interactions)

Immunosuppressants Clinical Impact: Immunosuppressants such as cyclosporine and tacrolimus can produce nephrotoxicity with decreases in creatinine clearance and rises in serum creatinine, and because renal excretion is the primary elimination route of fibrate drugs including fenofibrate, there is a risk that an interaction will lead to deterioration of renal… (Fenofibrate label, Drug interactions)

If used with concomitant methotrexate and/or other potential immunosuppressive agents, chronic monitoring should be monthly. (Leflunomide label, Warnings and precautions)

In patients taking ARAVA, exposure of drugs which are OAT3 substrates (e.g., cefaclor, cimetidine, ciprofloxacin, penicillin G, ketoprofen, furosemide, methotrexate, zidovudine) may be increased. (Leflunomide label, Drug interactions)

If used with concomitant methotrexate and/or other potential immunosuppressive agents, chronic monitoring should be monthly. (Leflunomide label, Warnings and precautions)

If used with concomitant methotrexate and/or other potential immunosuppressive agents, chronic monitoring should be monthly. (Leflunomide label, Warnings and precautions)

Immunosuppressants everolimus, rapamycin (also known as sirolimus), temsirolimus budesonide, ciclesonide, cyclosporine, dexamethasone, fluticasone, methylprednisolone, tacrolimus Rapamycin (sirolimus): Ketoconazole tablets 200 mg daily for 10 days increased the C max and AUC of a single 5 mg dose of sirolimus by 4.3 fold and 10.9 fold, respectively in 23 healthy… (Ketoconazole label, Drug interactions)

Teriflunomide may increase exposure of ethinylestradiol and levonorgestrel. (Leflunomide label, Drug interactions)

Teriflunomide may increase exposure of ethinylestradiol and levonorgestrel. (Leflunomide label, Drug interactions)

Effect on Oral Contraceptives Teriflunomide may increase the systemic exposures of ethinylestradiol and levonorgestrel. (Leflunomide label, Drug interactions)

Effect on Oral Contraceptives Teriflunomide may increase the systemic exposures of ethinylestradiol and levonorgestrel. (Leflunomide label, Drug interactions)

If ARAVA and methotrexate are given concomitantly, follow the American College of Rheumatology (ACR) guidelines for monitoring methotrexate liver toxicity with ALT, AST, and serum albumin testing. (Leflunomide label, Warnings and precautions)

If used with concomitant methotrexate and/or other potential immunosuppressive agents, chronic monitoring should be monthly. (Leflunomide label, Warnings and precautions)

If used with concomitant methotrexate and/or other potential immunosuppressive agents, chronic monitoring should be monthly. (Leflunomide label, Warnings and precautions)

Effect on Oral Contraceptives Teriflunomide may increase the systemic exposures of ethinylestradiol and levonorgestrel. (Leflunomide label, Drug interactions)

Effect on Oral Contraceptives Teriflunomide may increase the systemic exposures of ethinylestradiol and levonorgestrel. (Leflunomide label, Drug interactions)

Effect on Oral Contraceptives Teriflunomide may increase the systemic exposures of ethinylestradiol and levonorgestrel. (Leflunomide label, Drug interactions)

If used with concomitant methotrexate and/or other potential immunosuppressive agents, chronic monitoring should be monthly. (Leflunomide label, Warnings and precautions)

In patients taking ARAVA, exposure of drugs which are OAT3 substrates (e.g., cefaclor, cimetidine, ciprofloxacin, penicillin G, ketoprofen, furosemide, methotrexate, zidovudine) may be increased. (Leflunomide label, Drug interactions)

In patients taking ARAVA, exposure of drugs which are OAT3 substrates (e.g., cefaclor, cimetidine, ciprofloxacin, penicillin G, ketoprofen, furosemide, methotrexate, zidovudine) may be increased. (Leflunomide label, Drug interactions)

In patients taking ARAVA, exposure of drugs metabolized by CYP1A2 (e.g., alosetron, duloxetine, theophylline, tizanidine) may be reduced. (Leflunomide label, Drug interactions)

If used with concomitant methotrexate and/or other potential immunosuppressive agents, chronic monitoring should be monthly. (Leflunomide label, Warnings and precautions)

In patients taking ARAVA, exposure of drugs metabolized by CYP2C8 (e.g., paclitaxel, pioglitazone, repaglinide, rosiglitazone) may be increased. (Leflunomide label, Drug interactions)

In patients taking ARAVA, exposure of drugs metabolized by CYP2C8 (e.g., paclitaxel, pioglitazone, repaglinide, rosiglitazone) may be increased. (Leflunomide label, Drug interactions)

…other substrates of BCRP (e.g., mitoxantrone) and drugs in the OATP family (e.g., methotrexate, rifampin), especially HMG-Co reductase inhibitors (e.g., atorvastatin, nateglinide, pravastatin, repaglinide, and simvastatin), consider reducing the dose of these drugs and monitor patients closely for signs and symptoms of increased exposures to the drugs while patients… (Leflunomide label, Drug interactions)

Effect on Oral Contraceptives Teriflunomide may increase the systemic exposures of ethinylestradiol and levonorgestrel. (Leflunomide label, Drug interactions)

In patients taking ARAVA, exposure of drugs metabolized by CYP2C8 (e.g., paclitaxel, pioglitazone, repaglinide, rosiglitazone) may be increased. (Leflunomide label, Drug interactions)

Concomitant use of ARAVA and rifampin, a potent inducer of CYP and transporters, increased the plasma concentration of teriflunomide by 40%. (Leflunomide label, Drug interactions)

Immunosuppressants: cyclosporine, tacrolimus, sirolimus (rapamycin) ↑ immunosuppressants Therapeutic concentration monitoring is recommended for immunosuppressant agents when co-administered with ritonavir. (Ritonavir label, Drug interactions)

If used with concomitant methotrexate and/or other potential immunosuppressive agents, chronic monitoring should be monthly. (Leflunomide label, Warnings and precautions)

Rosuvastatin: The dose of rosuvastatin should not exceed 10 mg once daily in patients taking ARAVA. (Leflunomide label, Drug interactions)

If used with concomitant methotrexate and/or other potential immunosuppressive agents, chronic monitoring should be monthly. (Leflunomide label, Warnings and precautions)

…(e.g., mitoxantrone) and drugs in the OATP family (e.g., methotrexate, rifampin), especially HMG-Co reductase inhibitors (e.g., atorvastatin, nateglinide, pravastatin, repaglinide, and simvastatin), consider reducing the dose of these drugs and monitor patients closely for signs and symptoms of increased exposures to the drugs while patients are taking ARAVA [see… (Leflunomide label, Drug interactions)

If used with concomitant methotrexate and/or other potential immunosuppressive agents, chronic monitoring should be monthly. (Leflunomide label, Warnings and precautions)

HBV reactivation has also been reported in patients receiving certain immunosuppressant or chemotherapeutic agents; the risk of HBV reactivation associated with treatment with HCV direct-acting antivirals may be increased in these patients. (Sofosbuvir and velpatasvir label, Warnings and precautions)

In patients taking ARAVA, exposure of drugs metabolized by CYP1A2 (e.g., alosetron, duloxetine, theophylline, tizanidine) may be reduced. (Leflunomide label, Drug interactions)

Cyclosporine, tacrolimus: Monitor for toxicities of these immunosuppressive drugs ( 7.1 ) (Tinidazole label, Drug interactions)

In patients taking ARAVA, exposure of drugs metabolized by CYP1A2 (e.g., alosetron, duloxetine, theophylline, tizanidine) may be reduced. (Leflunomide label, Drug interactions)

If used with concomitant methotrexate and/or other potential immunosuppressive agents, chronic monitoring should be monthly. (Leflunomide label, Warnings and precautions)

If used with concomitant methotrexate and/or other potential immunosuppressive agents, chronic monitoring should be monthly. (Leflunomide label, Warnings and precautions)

If used with concomitant methotrexate and/or other potential immunosuppressive agents, chronic monitoring should be monthly. (Leflunomide label, Warnings and precautions)

If used with concomitant methotrexate and/or other potential immunosuppressive agents, chronic monitoring should be monthly. (Leflunomide label, Warnings and precautions)

Warfarin: Monitor INR as teriflunomide may decrease INR. (Leflunomide label, Drug interactions)

Effect on CYP2C8 Substrates Teriflunomide is an inhibitor of CYP2C8 in vivo . (Leflunomide label, Drug interactions)

Effect on CYP1A2 Substrates Teriflunomide, the active metabolite of ARAVA, may be a weak inducer of CYP1A2 in vivo . (Leflunomide label, Drug interactions)

Elimination can be accelerated by the following procedures: Administer cholestyramine 8 grams orally 3 times daily for 11 days. (Leflunomide label, Warnings and precautions)

Effect on CYP2C8 Substrates Teriflunomide is an inhibitor of CYP2C8 in vivo . (Leflunomide label, Drug interactions)

IMNM is characterized by proximal muscle weakness and elevated serum CK, which persist despite discontinuation of statin treatment; positive anti-HMG CoA reductase antibody, muscle biopsy showing necrotizing myopathy, and improvement with immunosuppressive agents. (Fluvastatin label, Warnings and precautions)

Effect on CYP2C8 Substrates Teriflunomide is an inhibitor of CYP2C8 in vivo . (Leflunomide label, Drug interactions)

IMNM is characterized by: proximal muscle weakness and elevated serum creatine kinase, which persist despite discontinuation of statin treatment; positive anti-HMG CoA reductase antibody; muscle biopsy showing necrotizing myopathy; and improvement with immunosuppressive agents. (Lovastatin label, Warnings)

In some cases, vasculitis resolved/improved with drug discontinuation; however, more severe cases required treatment with additional measures including corticosteroids, immunosuppressant therapy, and plasmapheresis. (Methimazole label, Warnings)

Effect on CYP2C8 Substrates Teriflunomide is an inhibitor of CYP2C8 in vivo . (Leflunomide label, Drug interactions)

IMNM is characterized by proximal muscle weakness and elevated serum creatine kinase that persist despite discontinuation of statin treatment; positive anti-HMG CoA reductase antibody; muscle biopsy showing necrotizing myopathy; and improvement with immunosuppressive agents. (Pitavastatin label, Warnings and precautions)

CYP3A Substrates Immunosuppressants that are CYP3A4 Substrates Mechanism and Clinical Effect(s) Posaconazole is a strong CYP3A4 inhibitor. (Posaconazole label, Drug interactions)

In some cases, vasculitis resolved/improved with drug discontinuation; however, more severe cases required treatment with additional measures including corticosteroids, immunosuppressant therapy, and plasmapheresis. (Propylthiouracil label, Warnings)

Effect on CYP2C8 Substrates Teriflunomide is an inhibitor of CYP2C8 in vivo . (Leflunomide label, Drug interactions)

Effect on CYP2C8 Substrates Teriflunomide is an inhibitor of CYP2C8 in vivo . (Leflunomide label, Drug interactions)

…Repaglinide, Rosiglitazone: [See Warnings and Precautions ( 5.4 ) and Adverse Reactions ( 6.2 )] Insulin Insulin: [See Warnings and Precautions ( 5.4 ) and Adverse Reactions ( 6.2 )] Immunosuppressants: Cyclosporine Use With Caution Cyclosporine: There have been spontaneous or published reports of CYP3A based interactions of clarithromycin with cyclosporine. (Clarithromycin label, Drug interactions)