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