pomalidomide: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
pomalidomide: clinical details
Prescribing considerations
- Initiate and monitor under a clinician experienced in multiple myeloma.
- Confirm compliance with the Pregnancy Prevention Programme and controlled prescribing and dispensing requirements.
- Assess venous and arterial thrombotic risk and the suitability of thromboprophylaxis.
- Review previous severe reactions to thalidomide or lenalidomide.
- Establish hepatitis B status and assess infection, neuropathy, cardiac, hepatic and tumour-lysis risks.
Contraindications and cautions
- Pregnancy
- Women of childbearing potential unless all Pregnancy Prevention Programme conditions are met
- Male patients unable to comply with required contraceptive measures
- Hypersensitivity to pomalidomide or product excipients
Monitoring
- Full blood count at baseline, frequently during early treatment and regularly thereafter
- Pregnancy testing according to the Pregnancy Prevention Programme
- Liver and thyroid function
- Infection, bleeding and thromboembolic symptoms
- Neurological changes suggesting neuropathy or progressive multifocal leukoencephalopathy
- Pulmonary, cardiac and tumour-lysis complications where clinically relevant
Clinical pharmacology
Pomalidomide is a cereblon-binding immunomodulatory compound with direct anti-myeloma, immune-mediated and anti-angiogenic actions. It is partly metabolised through CYP1A2 and CYP3A4/5 and is a P-glycoprotein substrate.
Formulation and product differences
- The selected products are hard gelatin capsules with manufacturer-specific colours, markings and excipient compositions.
- The selected Grindeks capsule contains Brilliant Black PN and azorubine-carmoisine; check excipients when allergy or intolerance is relevant.
- Capsules from different manufacturers may look different and should be identified from their original packaging.
pomalidomide preparations and strengths
Capsule
Route: Oral
Strengths: 1 mg, 2 mg, 3 mg, 4 mg
pomalidomide interactions
The oncology team should review all prescribed, pharmacy-bought and complementary products.
Strong CYP1A2 inhibitors, including ciprofloxacin, enoxacin and fluvoxamine
These can substantially increase pomalidomide exposure, so specialist review and treatment adjustment may be required.
Warfarin with dexamethasone
The effect on anticoagulation is uncertain, so closer monitoring may be needed.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.