thalidomide at a glance
Medicine class
Immunomodulatory and immunosuppressive agent
Licensed role
Part of combination treatment for previously untreated multiple myeloma in adults aged 65 or over, or those ineligible for high-dose chemotherapy
Administration
Swallow whole with water; do not crush, chew or open
Essential safety control
Prescribed and supplied through a Pregnancy Prevention Programme for all patients
What is thalidomide used for?
The selected UK products have the same licensed indication. Specialist use outside this licence also occurs.
Licensed with melphalan and prednisone as first-line treatment for untreated multiple myeloma in adults aged 65 or over, or adults unable to receive high-dose chemotherapy.
Specialists may use thalidomide outside the licence for some manifestations of Behçet’s disease.
How does thalidomide work?
Thalidomide binds to cereblon and changes which regulatory proteins cells break down. Its anti-myeloma effects involve altered immune activity, reduced survival signals for myeloma cells and effects on blood-vessel formation and the bone-marrow environment. The same biology contributes to its severe effects on an embryo.
thalidomide preparations and strengths
Capsule
Route: Oral
Strengths: 50 mg
Tablet
Route: Oral
Strengths: 100 mg
How to take thalidomide
Follow the specialist team’s instructions and check the product label because the selected tablet and capsule formulations differ.
Swallow tablets or capsules whole with a full glass of water.
Do not crush or chew tablets, or open, crush or chew capsules.
If powder contacts skin, wash immediately with soap and water; flush mucous membranes thoroughly with water.
Pregnant people, or those who think they may be pregnant, must not handle the medicine or blister. Caregivers and healthcare professionals should use disposable gloves.
Return unused medicine to the pharmacist; never share it.
thalidomide side effects
Common or expected effects
- Sleepiness, tiredness or dizziness
- Constipation
- Numbness, tingling or altered sensation from peripheral neuropathy
- Tremor
- Swelling of the hands, feet or legs
- Reduced white cells, red cells or platelets
- Dry mouth, nausea or vomiting
- Rash or dry skin
Get urgent medical advice
- Blood clots in a vein or lung, heart attack or stroke
- Peripheral neuropathy that may become severe or irreversible
- Severe allergic or blistering skin reactions, including SJS, TEN and DRESS
- Severe infection, sepsis or reactivation of hepatitis B or shingles
- Fainting, slow heart rate or heart block
- Severe bleeding or markedly reduced blood-cell counts
- New neurological, cognitive or behavioural symptoms suggesting PML
- Liver injury, intestinal obstruction, perforation or gastrointestinal bleeding
thalidomide in pregnancy
Thalidomide must not be used during pregnancy because even limited exposure can cause miscarriage, foetal death or severe birth defects. People who could become pregnant must meet every Pregnancy Prevention Programme condition, including effective contraception and supervised pregnancy testing. Thalidomide is present in semen, so male patients must follow the required condom and sperm-donation precautions. If pregnancy occurs or is suspected during treatment, stop thalidomide and contact the specialist team urgently.
thalidomide while breastfeeding
thalidomide interactions
Clinically important additive effects can occur.
Alcohol and sedating medicines
Opioids, sleeping tablets, anxiolytics, antipsychotics, sedating antihistamines and alcohol can increase sleepiness and impairment.
Beta blockers and other heart-rate-lowering medicines
Additive slowing of the heart rate or conduction problems may occur.
Common questions about thalidomide
Answers are fully visible for fast scanning and source review.
Is thalidomide chemotherapy?
It is usually described as an immunomodulatory treatment rather than conventional cytotoxic chemotherapy, although it is combined with chemotherapy and a corticosteroid in its licensed multiple-myeloma use.
Why is thalidomide controlled so strictly?
It can cause severe birth defects and foetal death, so prescribing and dispensing are linked to a formal Pregnancy Prevention Programme and controlled-access measures.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.