American Board of Internal Medicine (ABIM) Certification Practice Exam

How should liver toxicity be managed in a patient taking leflunomide?

1. Switch to a different medication

2. Increase the dosage

3. Administer with alcohol

4. Reduce the dose or discontinue use

The correct answer is: Reduce the dose or discontinue use

The management of liver toxicity in a patient taking leflunomide should involve reducing the dose or discontinuing its use. Leflunomide is an immunosuppressive medication commonly used for treating rheumatoid arthritis, but it is known to potentially cause hepatotoxicity. When elevated liver enzymes or signs of liver damage are observed, the first step is to assess the severity of the toxicity. If the liver enzymes are only mildly elevated, dose reduction might suffice. However, if there is significant liver damage or if enzyme levels continue to rise despite dose modification, discontinuation of the medication is warranted. This approach helps to prevent further damage and allows the liver to recover. Switching to a different medication is not the initial strategy in managing liver toxicity because the direct cause of the toxicity needs to be addressed first. Increasing the dosage is contraindicated as it may exacerbate liver damage. Administering leflunomide with alcohol can further increase the risk of liver toxicity and is not recommended. Therefore, in cases of suspected liver toxicity due to leflunomide, the prudent approach is to either reduce the dosage or discontinue the medication altogether to ensure patient safety and recovery of hepatic function.