Would you pursue cholestyramine washout in a patient on leflunomide for RA who is experiencing worsening necrotic dental infection secondary to pseudomonas?   

I would pursue a BRIEF washout of leflunomide... a single day of cholestyramine, which will reduce blood levels 50%. This was used in the phase 3 trials with good results, e.g., a decrease in blood levels and rapid resolution of related adverse events. There is not a need for the 5 days of washout, ...