Lenalidomide

Lenalidomide Brand Name– Revlimid

What is Lenalidomide

Lenalidomide is a structural analog of thalidomide that has immunomodulatory, antiangiogenic, and antineoplastic properties.

It is indicated for the treatment of adult patients with myelodysplastic syndrome, multiple myeloma, mantle cell lymphoma, follicular lymphoma, and marginal zone lymphoma. Use of lenalidomide for the treatment of chronic lymphocytic leukemia is not recommended outside of a clinical trial.

Lenalidomide is contraindicated in pregnancy due to a risk for birth defects or embryo-fetal death. Routine pregnancy testing is required.

All prescribers, pharmacists, and patients must be registered in the REVLIMID REMS program to prescribe, dispense, or receive lenalidomide.

Information about the drug and the program can be found at www.celgeneriskmanagement.com or by calling 1-888-423-5436.

Indications

1. amyloidosis
2. mantle cell lymphoma (MCL)
3. multiple myeloma
4. myelodysplastic syndrome (MDS)
5. non-Hodgkin’s lymphoma (NHL)

NOTE: Treatment with lenalidomide was associated with a 92% increased risk of death (hazard ratio = 1.92; 95% CI, 1.08 to 3.41) and a higher incidence of serious cardiovascular adverse reactions (e.g., atrial fibrillation, myocardial infarction, heart failure) compared with chlorambucil in a randomized clinical trial in patients with chronic lymphocytic leukemia (CLL); therefore, use of lenalidomide for the treatment of CLL is not recommended outside of a clinical trial

Side Effects

1. abdominal pain
2. abdominal pain
3. anaphylactoid reactions
4. anemia
5. anemia
6. angina
7. angioedema
8. anorexia
9. anorexia
10. aphasia
11. arthralgia
12. arthralgia
13. asthenia
14. asthenia
15. atrial fibrillation
16. azotemia
17. back pain
18. back pain
19. biliary obstruction
20. bleeding
21. blurred vision
22. bone fractures
23. bone pain
24. bone pain
25. bradycardia
26. bullous rash
27. cardiac arrest
28. cardiomyopathy
29. cataracts
30. cataracts
31. chest pain (unspecified)
32. chest pain (unspecified)
33. chills
34. cholecystitis
35. coagulopathy
36. colitis
37. confusion
38. constipation
39. constipation
40. cough
41. cough
42. dehydration
43. dehydration
44. depression
45. depression
46. diabetes mellitus
47. diabetes mellitus
48. diarrhea
49. diarrhea
50. dizziness
51. dizziness
52. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
53. dysarthria
54. dysgeusia
55. dysgeusia
56. dyspepsia
57. dyspepsia
58. dysphagia
59. dyspnea
60. dyspnea
61. dysuria
62. ecchymosis
63. edema
64. elevated hepatic enzymes
65. elevated hepatic enzymes
66. epistaxis
67. epistaxis
68. erythema
69. erythema multiforme
70. exfoliative dermatitis
71. fatigue
72. fatigue
73. fetal death
74. fever
75. fever
76. gastritis
77. gastroesophageal reflux
78. GI bleeding
79. GI obstruction
80. GI perforation
81. gout
82. gout
83. graft-versus-host disease (GVHD)
84. hallucinations
85. headache
86. headache
87. heart failure
88. hematuria
89. hemolysis
90. hemolytic anemia
91. hepatic failure
92. hepatitis
93. hepatotoxicity
94. hirsutism
95. hoarseness
96. hyperbilirubinemia
97. hyperbilirubinemia
98. hyperglycemia
99. hyperglycemia
100. hyperhidrosis
101. hyperhidrosis
102. hypernatremia
103. hypertension
104. hyperthyroidism
105. hyperuricemia
106. hyperuricemia
107. hypocalcemia
108. hypocalcemia
109. hypoesthesia
110. hypoglycemia
111. hypokalemia
112. hypokalemia
113. hypomagnesemia
114. hyponatremia
115. hyponatremia
116. hypophosphatemia
117. hypophosphatemia
118. hypotension
119. hypotension
120. hypothyroidism
121. hypoxia
122. hypoxia
123. impaired stem cell mobilization
124. impotence (erectile dysfunction)
125. infection
126. infection
127. influenza
128. influenza
129. insomnia
130. insomnia
131. interstitial lung disease
132. interstitial nephritis
133. intracranial bleeding
134. lethargy
135. leukemia
136. leukopenia
137. leukopenia
138. libido decrease
139. lymphadenopathy
140. lymphoma
141. lymphopenia
142. lymphopenia
143. maculopapular rash
144. malaise
145. melena
146. migraine
147. muscle cramps
148. muscle cramps
149. musculoskeletal pain
150. musculoskeletal pain
151. myalgia
152. myalgia
153. myocardial infarction
154. myocarditis
155. nausea
156. nausea
157. nephrotoxicity
158. neutropenia
159. neutropenia
160. new primary malignancy
161. night sweats
162. ocular hypertension
163. organ transplant rejection
164. palpitations
165. pancreatitis
166. pancytopenia
167. paresthesias
168. paresthesias
169. pelvic pain
170. pericarditis
171. peripheral edema
172. peripheral neuropathy
173. peripheral neuropathy
174. pharyngitis
175. pharyngitis
176. phlebitis
177. pleural effusion
178. pneumonitis
179. progressive multifocal leukoencephalopathy
180. pruritus
181. pruritus
182. pulmonary edema
183. pulmonary embolism
184. pulmonary hypertension
185. rash
186. rash
187. renal failure (unspecified)
188. respiratory arrest
189. rhinitis
190. rhinorrhea
191. sinus tachycardia
192. sinusitis
193. skin cancer
194. skin hyperpigmentation
195. spinal cord compression
196. Stevens-Johnson syndrome
197. stomatitis
198. stroke
199. supraventricular tachycardia (SVT)
200. syncope
201. teratogenesis
202. thrombocytopenia
203. thrombocytopenia
204. thromboembolism
205. thrombosis
206. toxic epidermal necrolysis
207. tremor
208. tumor flare
209. tumor flare
210. tumor lysis syndrome (TLS)
211. vertigo
212. visual impairment
213. vomiting
214. vomiting
215. weakness
216. weakness
217. weight loss
218. weight loss
219. wheezing
220. xerosis
221. xerostomia

Monitoring Parameters

• CBC with differential
• LFTs
• pregnancy testing
• serum creatinine/BUN
• serum electrolytes
• serum uric acid
• thyroid function tests (TFTs)

Contraindications

• angioedema
• bleeding
• blood donation
• breast-feeding
• contraception requirements
• dysfunctional uterine bleeding
• geriatric
• hepatic disease
• hepatitis
• hepatotoxicity
• hyperlipidemia
• hypertension
• hyperthyroidism
• hypothyroidism
• infection
• intrauterine fetal death
• lactase deficiency
• male-mediated teratogenicity
• menstrual irregularity
• neutropenia
• new primary malignancy
• peripheral blood stem cell (PBSC) mobilization
• pregnancy
• pregnancy testing
• renal disease
• renal failure
• renal impairment
• reproductive risk
• serious rash
• sperm donation
• thalidomide hypersensitivity
• thrombocytopenia
• thromboembolism
• tobacco smoking
• treatment outside of a clinical trial
• tumor lysis syndrome (TLS)
• vaccination

Interactions

• Bacillus Calmette-Guerin Vaccine, BCG
• Clozapine
• Darbepoetin Alfa
• Denosumab
• Digoxin
• Epoetin Alfa
• Estrogens
• Influenza Virus Vaccine
• Intranasal Influenza Vaccine
• Live Vaccines
• Measles Virus; Mumps Virus; Rubella Virus; Varicella Virus Vaccine, Live
• Measles/Mumps/Rubella Vaccines, MMR
• Rotavirus Vaccine
• Rubella Virus Vaccine Live
• Smallpox and Monkeypox Vaccine, Live, Nonreplicating
• Smallpox Vaccine, Vaccinia Vaccine
• Typhoid Vaccine
• Varicella-Zoster Virus Vaccine, Live
• Warfarin
• Yellow Fever Vaccine, Live