Drug General Information (ID: DDIYPUIH3T)
Drug Name			Trimetrexate		Drug Info		Teriflunomide		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antifungal Agents				Selective Immunosuppressants
Structure

Mechanism of Trimetrexate-Teriflunomide Interaction (Severity Level: Major)
Additive immunosuppressive effects Click to Show/Hide Mechanism Graph
Drug Name		Trimetrexate				Teriflunomide
Mechanism 1		Immunosuppressive effects				Immunosuppressive effects
Key Mechanism Factor 1
		Factor Name		Immunosuppressive effects
		Factor Description		Immunosuppression is when your immune system is not functioning as it should. The immune system is made up of cells, tissues and organs that help the body fight off infections. If the immune system is suppressed, an infection that your body was able to control may become serious or even fatal.
Mechanism Description		Additive immunosuppressive effects by the combination of Trimetrexate and Teriflunomide
Increased risk of hepatotoxicity Click to Show/Hide Mechanism Graph
Drug Name		Trimetrexate				Teriflunomide
Mechanism 2		Hepatotoxicity				Hepatotoxicity
Key Mechanism Factor 2
		Factor Name		Hepatotoxicity
		Factor Description		Combination of drugs that can induce hepatotoxicity may increase the risk of liver injury. Symptoms vary depending on the level of exposure and the total extent of liver damage, and may cause few symptoms if the damage is mild, and eventually lead to liver failure in patients with severe damage.
Mechanism Description		Increased risk of hepatotoxicity by the combination of Trimetrexate and Teriflunomide

Recommended Action
Management		Close monitoring is recommended if leflunomide or teriflunomide is used in patients who are currently receiving or have recently received other immunosuppressive and hepatotoxic agents, and vice versa. Due to the prolonged elimination half-life of leflunomide's active metabolite, an interaction may occur even when these agents are initiated after the discontinuation of treatment with leflunomide or teriflunomide. Liver enzymes, bilirubin, platelet, white blood cell count, and hemoglobin or hematocrit should be evaluated at baseline and regularly during therapy.

References
1	Product Information. Arava (leflunomide). Hoechst Marion-Roussel Inc, Kansas City, MO.