Thalimide

Indications

Thalidomide is a specialist medicine used mainly to treat multiple myeloma (a cancer of plasma cells in the bone marrow), usually together with other medicines such as Dexamethasone and Melphalan. It is also used to treat erythema nodosum leprosum (ENL), a painful inflammatory complication of leprosy. Because it causes severe birth defects, it is supplied only under a strict pregnancy prevention programme.

How It Works

Thalidomide is an immunomodulatory drug. It changes how the immune system works, lowers the production of inflammatory chemicals such as tumour necrosis factor (TNF), and blocks the growth of new blood vessels that tumours need. Together these effects slow myeloma cell growth and reduce the inflammation of ENL.

Dosage and Administration

Take exactly as prescribed by a specialist doctor; the dose and schedule depend on the condition, other treatment, age and side effects. Capsules are usually taken once daily at bedtime, as they cause drowsiness, swallowed whole with water and not opened or crushed. Only the patient should handle the capsules; carers and pregnant women should avoid touching them, or wear gloves. Return unused capsules to the pharmacy.

Interactions

Sedatives, alcohol, antihistamines, opioids and some antidepressants add to drowsiness. Medicines that slow the heart (such as Beta blockers and Digoxin) may increase the risk of a slow heartbeat. Medicines that cause nerve damage (such as Vincristine or Bortezomib) increase the risk of neuropathy. Hormonal contraceptives and Erythropoietin add to the risk of blood clots.

Contraindications

Do not use in pregnancy, in women who could become pregnant unless all pregnancy prevention conditions are met, in men who cannot follow the contraception requirements, or if you are allergic to Thalidomide.

Side Effects

Common side effects include drowsiness, constipation, dizziness, tingling, numbness or pain in the hands and feet (peripheral neuropathy), tremor, swelling, skin rash, low blood counts, and blood clots in the legs or lungs. It can also slow the heart rate.

Get urgent medical help if you have chest pain, sudden breathlessness, pain or swelling in one leg, a severe skin rash with blistering or peeling, fever or signs of infection, fainting or a very slow heartbeat, or sudden weakness or trouble speaking.

Pregnancy and Lactation

Thalidomide causes severe, life-threatening birth defects even after a single dose. It must never be taken during pregnancy. Women who could become pregnant must use effective contraception from 4 weeks before, during, and for 4 weeks after treatment, with regular pregnancy tests. Men must use condoms during treatment and for at least 7 days after, and must not donate sperm. Do not breastfeed during treatment. Do not donate blood during treatment and for 7 days after.

Precautions and Warnings

A blood-thinning medicine is often given to prevent clots. Blood counts and nerve symptoms are checked regularly; tell your doctor early about tingling or numbness. Avoid driving or using machines if drowsy or dizzy. Stand up slowly to avoid dizziness. Tell your doctor about heart, liver or kidney problems, or a history of blood clots.

Overdose

Overdose may cause severe drowsiness, coma, and a slow heart rate. Seek emergency medical help immediately.

Therapeutic Class

Immunomodulatory agent (antineoplastic).

Storage

Store below 30°C in the original pack, in a dry place away from light, and well out of the reach of children and anyone who could become pregnant.