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Leflunomide toxicity and washout — SCE Rheumatology MCQ

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HardRheumatological pharmacologyLeflunomide toxicity and washoutSCE Rheumatology

A 57-year-old woman taking leflunomide for RA develops severe diarrhoea, weight loss and hypertension. ALT is 148 IU/L and she wishes to conceive with her partner after recovery. What is the most appropriate management?

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Correct answer: C — Stop leflunomide and give cholestyramine washout

Leflunomide has a long half-life and significant hepatotoxic and teratogenic concerns; cholestyramine washout accelerates elimination. Folinic acid rescue is used for methotrexate toxicity, not leflunomide. Pregnancy planning requires documented adequate drug elimination according to guidance.

Reference: BNF; BSR csDMARD monitoring guideline 2025