Generic Arava

Introduction

Arava is a systemic medication whose active ingredient is leflunomide, a synthetic pyrido‑pyrimidine. It belongs to the ‘general health’ therapeutic group, but its primary clinical use is for inflammatory rheumatic disorders. In the United Kingdom, Arava is prescribed mainly for adults with active rheumatoid arthritis (RA) and for certain cases of psoriatic arthritis (PsA) where conventional disease‑modifying antirheumatic drugs (DMARDs) have proved insufficient. The drug is marketed by H. R. Pharma (the manufacturer listed in the EMA’s European public assessment report) and is distributed through licensed overseas pharmacies that supply the UK market.

What is Arava?

Arava is the trade name for a oral formulation that contains the immunomodulatory compound leflunomide. It is classified as a conventional synthetic DMARD (csDMARD) and was developed to inhibit the proliferation of activated lymphocytes that drive joint inflammation. The preparation is supplied as film‑coated tablets containing 10 mg, 20 mg, or 40 mg of leflunomide, together with standard excipients such as lactose monohydrate, magnesium stearate, and povidone.

Arava is the generic version of the original brand Leflunomide (e.g., the branded product Arava‑Leflunomide or Afinitor in other markets), containing the same active compound leflunomide. Our online pharmacy provides this generic alternative as a cost‑effective treatment option.

How Arava Works

Leflunomide, the active component of Arava, is a pro‑drug that is rapidly converted in vivo to its pharmacologically active metabolite, A771726 (also called teriflunomide). The metabolite blocks the mitochondrial enzyme dihydroorotate dehydrogenase (DHODH), a key enzyme in de novo pyrimidine synthesis. Inhibition of DHODH reduces the production of uridine monophosphate, limiting the ability of activated T‑ and B‑lymphocytes to proliferate.

Because the drug targets a metabolic step that is relatively non‑essential for resting cells, it preferentially suppresses the expansion of immune cells that are driven by chronic antigen stimulation—such as those seen in the synovial tissue of RA and PsA patients. The clinical effect is a reduction in joint swelling, pain, and structural damage. Pharmacokinetic studies show that teriflunomide reaches steady‑state concentrations after about 14 days of daily dosing. The terminal half‑life of the metabolite is prolonged (approximately 2 weeks) because it undergoes extensive entero‑hepatic recirculation, a factor that underlies the need for a loading‑dose regimen and for careful monitoring of hepatic function.

Conditions Treated with Arava

Rheumatoid arthritis (RA) – RA affects around 420 000 adults in the United Kingdom (Epidemiology of Rheumatoid Arthritis, 2022). Leflunomide has demonstrated comparable efficacy to methotrexate in reducing DAS28 (Disease Activity Score) and radiographic progression, and is often used when patients have an incomplete response to first‑line csDMARDs or when methotrexate tolerance is limited.

Psoriatic arthritis (PsA) – The prevalence of PsA in UK adults is estimated at .6 % of the general population. Clinical trials (e.g., the LYNX study) have shown that leflunomide can reduce tender and swollen joint counts and improve skin scores for patients whose disease is dominated by peripheral joint involvement.

Off‑label considerations – In some European centres leflunomide is investigated for systemic lupus erythematosus, autoimmune hepatitis, and certain vasculitic syndromes. However, these uses are not approved by the Medicines and Healthcare products Regulatory Agency (MHRA) and remain experimental.

Who is Arava For?

Arava is appropriate for adult patients (≥ 18 years) who:

• Have confirmed moderate to severe RA or PsA despite the use of at least one conventional DMARD.
• Possess normal baseline liver function tests (ALT, AST) and a bilirubin < 2 × upper reference limit.
• Are not pregnant, lactating, or planning conception, as leflunomide is contraindicated in all stages of pregnancy (Category X).

Contraindications include documented hypersensitivity to leflunomide, clinically significant hepatic impairment, and active severe infections. Patients with known severe renal impairment (creatinine clearance < 30 mL/min) require dose adjustments or alternative therapy.

Risks, Side Effects, and Interactions

Common adverse events

• Diarrhoea or abdominal upset – Usually mild, resolves with continued therapy.
• Alopecia (hair loss) – Transient hair thinning reported in up to 15 % of users; typically improves after the first 2–3 months.
• Elevated blood pressure – Hypertension occurs in 5–10 % of patients; regular monitoring of systolic/diastolic pressure is advised.

Rare adverse events

• Hepatotoxicity – Elevations of ALT/AST > 3 × baseline occur in < 2 % of patients; severe liver injury is rare but can be life‑ threatening.
• Interstitial lung disease – Rare pulmonary toxicity presenting with dyspnoea and dry cough; case reports exist primarily in patients with pre‑existing lung disease.

Serious adverse events

• Severe hepatitis or hepatic failure – Requires immediate discontinuation and possible cholestyramine rescue to accelerate teriflunide elimination.
• Bone‑marrow suppression (agranulocytosis, aplastic anaemia) – Although uncommon, routine complete blood counts (CBC) are recommended at baseline and every 4–8 weeks during the first 6 months.
• Life‑threatening infections – Opportunistic infections (e.g., tuberculosis, pneumocystis) may be unmasked due to immunosuppression; screening for latent TB before initiation is standard practice.

Clinically relevant drug–drug interactions

• Warfarin and other anticoagulants – Leflunomide may potentiate INR; coagulation parameters should be checked 1 week after initiation and after any dose change.
• Statins (simvastatin, atorvastatin) – DHODH inhibition can increase plasma concentrations of certain statins; monitor for myopathy.
• Other hepatotoxic agents (e.g., methotrexate, isoniazid, ketoconazole) – Concurrent use heightens risk of liver injury; liver enzymes must be checked at least every 4 weeks.
• Live vaccines – The immunosuppressive effect of leflunomide contraindicates administration of live attenuated vaccines (e.g., yellow fever, MMR) while the drug is active.

Practical Use: Dosing, Missed Dose, Overdose

Standard adult dosing – The EMA‑recommended regimen begins with a 3‑day loading dose of 100 mg leflunomide once daily, followed by a maintenance dose of 20 mg once daily (tablet). Some clinicians start directly with 10 mg daily for patients who are frail or have borderline liver function, adjusting upward as tolerated.

Missed dose – If a dose is omitted and the scheduled intake is still more than 12 hours away, patients should simply skip the missed tablet and resume the regular daily schedule. Doubling a dose to “make up” for a missed tablet is discouraged, as it can precipitate hepatic or haematologic toxicity.

Overdose – Accidental ingestion of > 2 × the prescribed dose constitutes an overdose risk. The patient should seek emergency medical care; management focuses on gastrointestinal decontamination, supportive monitoring, and rapid elimination of teriflunide using cholestyramine (4 g × 3‑daily doses for 11 days) or charcoal haemoperfusion where available.

Practical precautions –

• Food – Leflunomide can be taken with or without food; a high‑fat meal may modestly increase absorption but does not change the overall exposure significantly.
• Alcohol – Excessive alcohol should be avoided as it adds extra hepatic burden.
• Comorbidities – Patients with cardiovascular disease require close blood‑pressure monitoring; those with renal insufficiency need dose reductions to 10 mg daily and more frequent laboratory review.

Buying Arava from Our Online Pharmacy

Arava can be purchased directly from our online pharmacy in the UK. Our service provides:

• Affordable pricing – The generic tablet is offered at near‑manufacturer cost, delivering savings of up to 70 % compared with brand‑name equivalents.
• Verified quality – Every batch is sourced from licensed international manufacturers that hold EMA and MHRA certificates of compliance, ensuring pharmaceutical purity and potency.
• Guaranteed delivery – Orders are dispatched discreetly via a 7‑day express courier for the UK mainland or a standard airmail service (approximately 3 weeks) for overseas territories.
• Pharmacy‑broker model – We partner with overseas licensed pharmacies and certified suppliers, allowing a private, privacy‑preserving channel for patients who encounter limited access through NHS or private prescriptions.

Our online pharmacy therefore presents a safe, cost‑effective route for adults who need leflunomide for approved rheumatic conditions but lack ready availability through conventional channels.

FAQ

• Is Arava supplied in tablet form only?
  Yes, Arava is marketed solely as film‑coated tablets. No liquid, sub‑lingual, or injectable formulations are available for this active ingredient.

• Can the medication be stored at temperatures above 30 °C?
  Stability data indicate that leflunomide tablets should be kept below 25 °C. Prolonged exposure to higher temperatures may degrade the active compound, reducing efficacy.

• How long is the shelf‑life of a typical Arava package?
  The manufacturer assigns a storage‑life of 36 months from the date of manufacture, provided the tablets remain in the original blister pack and are stored in dry conditions.

• Is grapefruit juice known to interact with leflunomide?
  Grapefruit juice can inhibit CYP3A4, modestly increasing teriflunide plasma levels. While the effect is not clinically significant for most patients, it is advisable to avoid large amounts of grapefruit juice to minimise unpredictable exposure.

• What are the recommended laboratory tests before starting Arava?
  Baseline assessment should include liver function tests (ALT, AST, bilirubin), full blood count, renal function (serum creatinine, eGFR), and blood pressure measurement. Screening for latent tuberculosis (IGRA or chest X‑ray) is also recommended.

• Can Arava be taken while travelling abroad?
  Yes, provided the patient carries a copy of the MHRA‑approved label and complies with the destination country’s personal import regulations. The medication must remain in its original packaging and be stored at room temperature.

• Is there a difference between the European and Asian formulations of leflunomide?
  The core active ingredient and dosage strengths are identical worldwide; however, some Asian markets include additional excipients such as mannitol to adjust tablet hardness. All formulations meet EMA bio‑equivalence standards.

• Do live vaccines need to be avoided while on Arava?
  Because leflunomide suppresses cellular immunity, administration of live attenuated vaccines (e.g., yellow fever, oral polio) is contraindicated during active treatment. Inactivated vaccines remain safe.

• What is the impact of Arava on pregnancy testing?
  Leflunomide is classified as pregnancy‑category X. The drug can cause fetal malformations and should be stopped immediately if pregnancy is suspected. Effective contraception is mandatory throughout treatment and for at least 2 years after cessation, unless a cholestyramine accelerated elimination protocol is employed.

• Does the UK NHS provide generic leflunomide through its own pharmacies?
  Currently the NHS supplies leflunomide only as the branded product Ariane (the UK‑licensed brand). Generic options such as Arava are not stocked directly by NHS pharmacies, which is why our online pharmacy offers a legitimate, cost‑saving alternative for patients with a valid prescription.

Glossary

Disease‑Modifying Antirheumatic Drug (DMARD)

A class of medications that slow disease progression in rheumatoid and related arthritides by targeting immune pathways rather than merely relieving pain.

Dihydroorotate Dehydrogenase (DHODH)

An enzyme in the mitochondrial inner membrane that catalyses the final step of de novo pyrimidine synthesis; inhibition halts the proliferation of activated lymphocytes.

Teriflunomide (A771726)

The active metabolite of leflunomide responsible for its immunosuppressive action; it has a long terminal half‑life due to entero‑hepatic recirculation.

Cholestyramine rescue

A therapeutic protocol using a bile‑acid sequestrant to bind teriflunide in the intestinal tract, hastening its elimination and reducing plasma concentrations after overdose or before conception.

⚠️ Disclaimer

The information provided about Arava is for general knowledge only. It does not replace professional medical consultation. All treatment decisions should be made under the supervision of a qualified healthcare provider. We assume all readers are responsible adults capable of making informed decisions about their health. Our online pharmacy offers access to Arava for individuals who may have limited availability through traditional pharmacies, prescription‑based insurance schemes, or who are seeking affordable generic alternatives. Always consult your doctor before starting, changing, or discontinuing any medication.