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Compare Methotrexate vs. Arava

Head-to-head comparisons of medication uses, side effects, warnings, and more.

Key takeaways

Methotrexate (Otrexup, Rasuvo) and leflunomide (Arava) are both used to treat rheumatoid arthritis (RA), but they have some key differences. Methotrexate is an antimetabolite that can be used for both cancer and non-cancer conditions, while leflunomide is a disease-modifying antirheumatic drug (DMARD) specifically for RA. Methotrexate is taken as an oral tablet or given as an injection once per week, whereas leflunomide is taken orally once a day. Methotrexate can cause side effects like low white blood cells and mouth sores, while leflunomide can cause stomach upset, hair loss, and high blood pressure. Methotrexate is also used to treat various cancers, unlike leflunomide, which is only for RA. Both medications can cause serious side effects, including liver damage and infections, but leflunomide can stay in your body for up to two years after stopping it, which is not the case with methotrexate.

  • Methotrexate (Trexall)
    Leflunomide (Arava)
  • Methotrexate (Trexall)
    Leflunomide (Arava)

  • Summary of Methotrexate vs. Arava

    Summary for Antimetabolite
    Prescription only

    Methotrexate (Trexall) belongs to a drug class called antimetabolites. It’s used as chemotherapy at high doses to kill cancer cells and treat different cancers, such as acute lymphoblastic leukemia (ALL). At lower doses, methotrexate (Trexall) is considered a disease-modifying antirheumatic drug (DMARD) that treats certain non-cancer conditions, such as rheumatoid arthritis (RA). This medication is a tablet that you take by mouth. For most conditions, it’s taken once a week, but for some, it’s taken more often than that. Methotrexate (Trexall) side effects include mouth sores, nausea, and stomach upset.

    Summary for Disease-modifying antirheumatic drug (DMARD)
    Prescription only

    Leflunomide (Arava) is a non-biologic, disease-modifying antirheumatic drug (DMARD). It's used to treat rheumatoid arthritis (RA) in adults. This medication is a tablet that's taken by mouth once per day. Your care team will regularly follow up with you throughout treatment because leflunomide (Arava) can potentially cause many side effects. Common side effects include stomach upset, headache, rash, hair loss, and high blood pressure. Liver damage and severe infections are some of the rarer, but more serious, side effects.

  • Indications of Methotrexate vs. Arava

    Indications for

    Cancer:

    •Acute lymphoblastic leukemia (ALL) in adults and children; given with other chemotherapy
    •Cutaneous T-cell lymphoma in adults; given by itself or with other chemotherapy
    •Advanced non-Hodgkin lymphoma in adults; given with other chemotherapy

    Non-cancer conditions:

    •Rheumatoid arthritis (RA) in adults
    •Polyarticular juvenile idiopathic arthritis (pJIA) in children
    •Severe psoriasis in adults
    Indications for
    •Rheumatoid arthritis (RA)

  • Pros and Cons of Methotrexate vs. Arava

    Pros and Const for Antimetabolite
    Pros
    •Taken by mouth, so a good option for people who don’t like needles
    •A non-steroidal option for autoimmune conditions (e.g., rheumatoid arthritis, psoriasis)
    •Doesn’t typically cause hair loss or weight gain
    Cons
    •Might cause nausea and mouth sores
    •Can raise your risk for infection
    •Requires regular office visits and lab tests to check for serious side effects
    Pros and Const for Disease-modifying antirheumatic drug (DMARD)
    Pros
    •Taken once daily by mouth
    •Works well to treat symptoms of RA
    •Available as a lower-cost generic
    Cons
    •Can cause a lot of side effects (e.g., stomach upset, infections, hair loss, liver problems, skin reactions)
    •Can stay in your body for a few years after you stop treatment
    •Can't use during pregnancy or in children

  • Common Side Effects of Methotrexate vs. Arava

    Common Side Effects for
    •Mouth sores
    •Nausea or vomiting
    •Diarrhea
    •Stomach upset
    •Dizziness
    •Tiredness
    •Chills
    •Fever
    •Infection
    •Higher liver enzyme levels in the blood
    •Low white blood cells
    •Low platelet levels
    Common Side Effects for
    •Diarrhea (27%)
    •Headache (13%)
    •Nausea (13%)
    •Rash (12%)
    •Abnormal liver labs (10%)
    •Hair thinning or hair loss (9%)
    •High blood pressure (9%)

  • Warnings of Methotrexate vs. Arava

    Common Side Effects for
    •Harm to unborn baby
    •Allergic reaction
    •Low blood cell counts
    •Damage to the digestive tract
    •Liver damage
    •Lung problems
    •Serious skin problems (including skin burns)
    •Kidney damage
    •Risk of serious side effects with dosing errors
    •Effect on folic acid levels in the body
    •Serious infections
    •Serious nervous system problems
    •Risk for new cancers
    •Tumor lysis syndrome
    •Changes to your ability to have children (infertility)
    •Higher risk for side effects if you have extra body fluid
    Common Side Effects for
    •Not safe during pregnancy
    •Liver problems
    •Serious infections
    •Low blood cell counts
    •Serious allergic reactions and skin reactions
    •Nerve pain
    •Lung problems
    •High blood pressure
    •Slow removal of leflunomide (Arava) from your body

  • Prices with our coupons for Methotrexate vs. Arava

    Learn more about Methotrexate
    Learn more about Leflunomide

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