Thalidomide

Uses	Multiple Myeloma and Erythema Nodosum Leprosum
Therapy	Anti-Neoplastic, Immunomodulators
Side Effects	Sleepiness, Numbness And Tingling In Hands And Feet, Constipation, Swelling Of Hands And Feet

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Molecule Description

Thalidomide is a prescription-only medicine used to treat multiple myeloma (a type of blood cancer) and erythema nodosum leprosum (ENL), a painful inflammatory complication of leprosy. It belongs to a group of medicines called immunomodulators. In multiple myeloma it is generally used in combination with other anti-cancer medicines, while in ENL it is used to control the painful skin nodules and inflammation associated with the condition. Treatment with Thalidomide must be started and supervised by a haematologist or oncologist. This molecule carries a risk of nerve damage (peripheral neuropathy), blood clots in the veins and lungs, and excessive sleepiness, so regular clinical monitoring and laboratory tests are required throughout the course of therapy. The dose and duration are decided by the treating doctor based on the condition being treated, body response and other ongoing treatments. Thalidomide causes severe birth defects and foetal death, and can only be dispensed under a strict pregnancy-prevention (risk management) programme. Patients who can become pregnant, and male patients, must follow the contraception requirements advised by their doctor. Before starting treatment, inform your doctor about all current medicines, supplements and any existing medical problems, especially nerve disorders, a history of blood clots, or liver and kidney disease.

Uses

To treat multiple myeloma (a type of blood cancer), usually in combination with other anti-cancer medicines
To treat erythema nodosum leprosum (ENL), a painful inflammatory complication of leprosy

Contraindications

When should one not use Thalidomide

Allergic reaction to this medicine or any of its ingredients
Pregnancy, planning a pregnancy, or being unable to follow the required pregnancy-prevention measures
Male patients who are unable or unwilling to follow the required contraception precautions
Breastfeeding
Severe existing nerve damage (peripheral neuropathy)

Side effects

Common side effects of this drug are:

Excessive sleepiness (somnolence)
Numbness, tingling, burning pain or weakness in the hands and feet (peripheral neuropathy)
Tiredness and weakness
Constipation
Dizziness, including dizziness on standing up
Weight gain or swelling of the hands and ankles
Tremor
Mood changes
Skin rash, dryness or itching
Decreased white blood cells and platelets
Slow heart rate or palpitations
Blurred vision
Blood clots in the leg veins or lungs (pain, swelling or redness in the leg, sudden breathlessness or chest pain)
Severe skin reactions with blistering or peeling
Severe allergic reactions
Tumour lysis syndrome (rapid breakdown of cancer cells)
Severe birth defects or foetal death if taken during pregnancy

Precautions and Warnings

Pregnancy

No. Thalidomide causes severe birth defects and may result in foetal death, even after a single dose. Patients who can become pregnant must follow the required pregnancy-prevention measures, including effective contraception and regular pregnancy testing, as advised by their doctor.

Breast Feeding

No. Breastfeeding is not recommended during treatment with Thalidomide because of the potential risk to the infant.

Driving

No. Thalidomide frequently causes sleepiness, dizziness and blurred vision, which impair alertness and coordination. Avoid driving or operating machinery if you experience these effects.

Alcohol

Alcohol should be avoided or limited while taking Thalidomide, as it can increase the sleepiness and dizziness caused by this medicine. Discuss alcohol consumption with your doctor.

Other General Warnings

Talk to your doctor if

You notice new or worsening numbness, tingling, burning pain or weakness in your hands and feet, as this may be a sign of nerve damage that can become permanent
You experience sudden swelling, pain or redness in your leg, or sudden breathlessness and chest discomfort, as these may be signs of a blood clot
You develop a skin rash, blistering or peeling of the skin
You experience dizziness, fainting spells or confusion
You have a history of blood clots, heart disease, liver or kidney disease, or an existing nerve disorder
You are due to undergo any surgical or dental procedure, as your treating team must know you are on this medicine
You are on long-term treatment, as regular blood tests and clinical check-ups are required
Never share this medicine with anyone else, and return unused or expired medicine to your doctor or pharmacist as required by the risk-management programme

Mode of Action

How Does It Work?

Thalidomide works by modifying the activity of the immune system and reducing the production of inflammatory substances in the body. It also stops the formation of new blood vessels that tumours need in order to grow, and acts on specific proteins inside myeloma cells to slow down their growth and survival. In erythema nodosum leprosum, this anti-inflammatory action helps settle the painful skin nodules, fever and swelling.

Interactions

Interactions with other medicines

Sedatives, sleeping medicines and other medicines that act on the central nervous system can add to the excessive sleepiness caused by Thalidomide
Medicines that increase the risk of blood clots, such as oral contraceptives and hormone replacement therapy, need caution when used with Thalidomide
Blood thinners and anticoagulants may need closer monitoring during treatment
Inform your doctor about all prescription medicines, over-the-counter medicines and herbal supplements you are taking before starting treatment

Interactions with food items

Thalidomide may be taken with or without food. As it commonly causes sleepiness, your doctor may advise you to take your dose at bedtime to reduce the effect of drowsiness during the day.

Dosage

Overdose

If an overdose is suspected, seek emergency medical help immediately. Symptoms of an overdose may include excessive sleepiness, dizziness and a drop in blood pressure. There is no specific antidote; management involves supportive hospital care with monitoring of vital signs. Take the medicine pack or strip with you so the treating doctor knows exactly what has been taken.

Missed a Dose

If you miss a dose and remember it within a short time of your usual dosing time, take it as soon as you remember. If it is already close to the time of your next dose, skip the missed dose and continue with your normal schedule. Never take a double dose to make up for a missed one. Do not change your dose or stop Thalidomide without consulting your doctor, as the schedule is part of a supervised treatment plan.

Frequently Asked Questions (FAQs)

Even a single dose of this medicine during pregnancy can cause severe birth defects or foetal death. Because of this, strict pregnancy-prevention measures, effective contraception and regular pregnancy testing are required for patients who can become pregnant, and contraception requirements also apply to male patients, as set out in the applicable risk-management programme. The medicine is dispensed only when these conditions are met.

Thalidomide is used to treat multiple myeloma, a type of blood cancer, usually along with other anti-cancer medicines, and to treat erythema nodosum leprosum (ENL), a painful inflammatory complication of leprosy.

This medicine commonly causes excessive sleepiness and tiredness. Taking your dose at bedtime, if your doctor advises it, helps reduce the impact of drowsiness during the day.

Yes. Nerve damage causing numbness, tingling, burning pain or weakness in the hands and feet is a common side effect and can become permanent if treatment is not stopped in time. Report any such symptoms to your doctor immediately.

Yes. Your doctor may advise regular blood tests and clinical check-ups to monitor blood counts, nerve function and signs of blood clots so that treatment remains safe.

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