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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)

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Leflunomide

(Arava)

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Summary for Methotrexate

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.

Indications for Methotrexate

Cancer:

Non-cancer conditions:

Pros and Cons for Methotrexate

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

Common Side Effects for Methotrexate

  • 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

Warnings for Methotrexate

  • 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

Summary for Arava

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 for Arava

Pros and Cons for Arava

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 for Arava

  • Diarrhea (27%)
  • Headache (13%)
  • Nausea (13%)
  • Rash (12%)
  • Abnormal liver labs (10%)
  • Hair thinning or hair loss (9%)
  • High blood pressure (9%)

Warnings for Arava

  • 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

Price Card Drug Icon
Methotrexate72 tablets / 2.5mg
$27.81$233.76
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Price Card Drug Icon
Leflunomide30 tablets / 20mg
$20.48$103.67
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