Drug interactions
Leflunomide + Tisagenlecleucel
Severity: Major
Leflunomide and Tisagenlecleucel: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Leflunomide is an immunosuppressant that can impair T-cell proliferation, which may reduce the expansion and persistence of CAR-T cells and therefore their efficacy. It also adds to the infection risk already present after CAR-T therapy and lymphodepletion.
What this interaction means in plain words
Leflunomide and Tisagenlecleucel can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Leflunomide belongs to Musculoskeletal; Tisagenlecleucel belongs to Oncology.
Why it happens
Leflunomide's active metabolite inhibits dihydroorotate dehydrogenase, suppressing lymphocyte proliferation and potentially blunting CAR-T cell expansion while adding to immunosuppression.
What to do
Avoid leflunomide around leukapheresis and CAR-T infusion unless clearly needed, and consider a washout (cholestyramine) given its long half-life. If it must be continued, monitor closely for infection and for response to CAR-T therapy.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Leflunomide
- Bcg vaccine live + Leflunomide Contraindicated
- Influenza virus vaccine quadrivalent intranasal + Leflunomide Contraindicated
- Leflunomide + Measles mumps and rubella vaccine live Contraindicated
- Leflunomide + Measles mumps rubella and varicella vaccine live Contraindicated
- Leflunomide + Measles vaccine Contraindicated
- Leflunomide + Smallpox vaccine live Contraindicated
Other interactions of Tisagenlecleucel
Frequently asked questions
Can I take Leflunomide with Tisagenlecleucel?
MediHelp rates the interaction as major. Leflunomide and Tisagenlecleucel can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Leflunomide is an immunosuppressant that can impair T-cell proliferation, which may reduce the expansion and persistence of CAR-T cells and therefore their efficacy. It also adds to the infection risk already present after CAR-T therapy and lymphodepletion.
How serious is the interaction between Leflunomide and Tisagenlecleucel?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid leflunomide around leukapheresis and CAR-T infusion unless clearly needed, and consider a washout (cholestyramine) given its long half-life. If it must be continued, monitor closely for infection and for response to CAR-T therapy.
What other medicines interact with Leflunomide?
MediHelp also lists interactions of Leflunomide with, for example, Bcg vaccine live, Influenza virus vaccine quadrivalent intranasal, Measles mumps and rubella vaccine live. The full list is on the Leflunomide page.
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