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Drugs reference index «thalidomide»

thalidomide

Generic Name: thalidomide (tha LID o mide)Brand Names: Thalomid

What is thalidomide?

Thalidomide affects the immune system. It helps promote immune responses to prevent inflammation in the body.

Thalidomide is used to treat and prevent the debilitating and disfiguring skin sores caused by erythema nodosum leprosum (ENL), an inflammatory complication of leprosy. It is also used together with another medicine called dexamethasone to treat multiple myeloma (bone marrow cancer).

Thalidomide may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about thalidomide?

Thalidomide can cause severe, life-threatening birth defects or death of a baby if the mother or the father is taking this medication at the time of conception or during pregnancy. Even one dose of thalidomide can cause major birth defects of the baby's arms and legs, bones, ears, eyes, face, and heart. Never use thalidomide if you are pregnant.

For Women: You will be required to use two reliable forms of birth control beginning 4 weeks before you start taking thalidomide and ending 4 weeks after you stop taking it. Any woman who has not had a hysterectomy or has not been in menopause for at least 24 months in a row must agree in writing to use birth control before, during, and after taking thalidomide. Even women with fertility problems are required to use birth control while taking this medication. You must also have a negative pregnancy test within 24 hours before you start thalidomide treatment. While you are taking thalidomide, you will need to have a pregnancy test weekly during the first month of treatment, and then every 4 weeks thereafter.

Stop using thalidomide and call your doctor at once if you quit using birth control, if your period is late, or if you think you might be pregnant.

For Men: You must not cause a woman to become pregnant while you are taking thalidomide because the medicine may affect your sperm and cause birth defects in the baby. You must agree in writing to always use latex condoms when having sex with a woman who is able to get pregnant, even if you have had a vasectomy. Avoid ejaculating without a condom because thalidomide can be passed in your sperm.

Thalidomide is available only under a special program called "System for Thalidomide Education and Prescribing Safety" (S.T.E.P.S.). You must be registered in the program and sign documents stating that you understand the dangers of this medication and that you agree to use birth control as required by the program. For patients between 12 and 18 years, a parent or legal guardian must read and sign all written requirements for the S.T.E.P.S. program.

Do not donate blood or sperm while you are using thalidomide. Avoid exposing another person to your blood or semen through casual or sexual contact.

What should I discuss with my healthcare provider before taking thalidomide?

If you have any of these conditions, you may not be able to take thalidomide, or you may need a dosage adjustment or special tests during treatment:

  • liver disease;
  • kidney disease;
  • a history of stroke or blood clots;

  • heart disease;

  • HIV or AIDS;

  • epilepsy or seizures;

  • a weak immune system; or

  • nerve problems, such as numbness or tingling in your hands or feet.

Thalidomide can cause severe, life-threatening birth defects or death of a baby if the mother or the father is taking this medication at the time of conception or during pregnancy. Even one dose of thalidomide can cause major birth defects of the baby's arms and legs, bones, ears, eyes, face, and heart. Never use thalidomide if you are pregnant. It is not known if thalidomide passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

For Women: You will be required to use two reliable forms of birth control beginning 4 weeks before you start taking thalidomide and ending 4 weeks after you stop taking it. Any woman who has not had a hysterectomy or has not been in menopause for at least 24 months in a row must agree in writing to use birth control before, during, and after taking thalidomide. Even women with fertility problems are required to use birth control while taking this medication. You must also have a negative pregnancy test within 24 hours before you start thalidomide treatment. While you are taking thalidomide, you will need to have a pregnancy test weekly during the first month of treatment, and then every 4 weeks thereafter.

The birth control method you use must be proven highly effective: hormonal birth control (pills, implants, or injections), an intrauterine device (IUD), a tubal ligation, or a sexual partner's vasectomy. The extra form of birth control you use must be a barrier method such as a latex condom, a diaphragm, or a cervical cap.

Stop using thalidomide and call your doctor at once if you quit using birth control, if your period is late, or if you think you might be pregnant.

For Men: You must not cause a woman to become pregnant while you are taking thalidomide because the medicine may affect your sperm and cause birth defects in the baby. You must agree in writing to always use latex condoms when having sex with a woman who is able to get pregnant, even if you have had a vasectomy. Avoid ejaculating without a condom because thalidomide can be passed in your sperm.

Thalidomide is available only under a special program called "System for Thalidomide Education and Prescribing Safety" (S.T.E.P.S.). You must be registered in the program and sign documents stating that you understand the dangers of this medication and that you agree to use birth control as required by the program. For patients between 12 and 18 years, a parent or legal guardian must read and sign all written requirements for the S.T.E.P.S. program. Do not give this medicine to a child younger than 12 years old.

How should I take thalidomide?

While you are using thalidomide, you will be required to be listed on a patient registry and participate in occasional telephone surveys. You will be limited to a 28-day supply of thalidomide each time your prescription is refilled. You may continue getting refills only if you participate fully in the S.T.E.P.S. program and commit to all agreements.

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Your doctor may occasionally change your dose to make sure you get the best results from this medication.

Take this medicine with a full glass of water.

Swallow the capsule whole, without breaking it open.

Thalidomide is usually taken at bedtime. Take the medicine on an empty stomach, at least 1 hour after eating a meal.

To be sure this medication is helping your condition, your doctor will need to check your progress on a regular basis. Do not miss any scheduled appointments.

You must not donate blood or sperm while you are using thalidomide. Avoid exposing another person to your blood or semen through casual or sexual contact.

This medication comes with patient instructions for safe and effective use. Follow these directions carefully. Never give thalidomide to another person, even if he or she has the same disorder for which you are being treated.

Store thalidomide at room temperature away from moisture and heat. Keep each capsule in its blister pack until you are ready to take it.

Do not allow another person to handle your medicine without wearing disposable gloves. Caregivers should avoid handling broken capsules or inhaling the powder from a damaged capsule.

See also: Thalidomide dosage in more detail

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for the next dose, skip the missed dose and take only the next regularly scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. An overdose of thalidomide is not expected to produce life-threatening symptoms.

What should I avoid while taking thalidomide?

Thalidomide can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. Avoid drinking alcohol, which can increase some of the side effects of thalidomide.

Thalidomide side effects

Stop using this medicine and get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have any of these serious side effects:
  • chest pain, sudden shortness of breath, coughing up blood;

  • pain or swelling in your arm, thigh, or calf;

  • fever, chills, body aches, flu symptoms, easy bruising or bleeding;

  • slow heartbeats, shallow breathing;

  • feeling like you might pass out;

  • a red, blistering, peeling skin rash;

  • a red, raised skin rash (especially if you also have fever, fast heart rate, and dizziness or fainting);

  • numbness, burning, pain, or tingly feeling; or

  • seizure (convulsions).

Less serious side effects may include:

  • feeling drowsy or sleepy;

  • anxiety, confusion, tremors or shaking;

  • bone pain, muscle weakness;

  • sleep problems (insomnia); or

  • nausea, constipation, loss of appetite.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Thalidomide Dosing Information

Usual Adult Dose for Leprosy -- Erythema Nodosum Leprosum:

For use in the acute treatment of the cutaneous manifestations of moderate to severe erythema nodosum leprosum (ENL). (Not indicated as monotherapy for such ENL treatment in the presence of moderate to severe neuritis.) Thalidomide may also be used as maintenance therapy for prevention and suppression of the cutaneous manifestations of ENL recurrence.For an episode of cutaneous ENL:Initial dose: 100 to 300 mg administered once daily with water, preferably at bedtime and at least 1 hour after the evening meal. Patients weighing less than 50 kilograms should be started at the low end of the dose range. For patients with a severe cutaneous ENL reaction, or in those who have previously required higher doses to control the reaction: Initial dose: up to 400 mg/day once daily at bedtime or in divided doses with water, at least 1 hour after meals. In patients with moderate to severe neuritis associated with a severe ENL reaction, corticosteroids may be started concomitantly with thalidomide. Steroid usage can be tapered and discontinued when the neuritis has ameliorated. Dosing with thalidomide should usually continue until signs and symptoms of active reaction have subsided, usually a period of at least 2 weeks. Patients may then be tapered off medication in 50 mg decrements every 2 to 4 weeks. Patients who have a documented history of requiring prolonged maintenance treatment to prevent the recurrence of cutaneous ENL or who flare during tapering, should be maintained on the minimum dose necessary to control the reaction. Tapering off medication should be attempted every 3 to 6 months, in decrements of 50 mg every 2 to 4 weeks.

Usual Adult Dose for Multiple Myeloma:

For the treatment of patients with newly diagnosed multiple myeloma:Initial dose: 200 mg orally once daily with water, preferably at bedtime, and at least one hour after the evening mealThalidomide is administered in combination with dexamethasone in 28 day treatment cycles. The dose of dexamethasone is 40 mg daily administered orally on days 1 through 4, 9 through 12, and 17 through 20, every 28 days.Patients who develop side effects such as constipation, oversedation, or peripheral neuropathy may benefit by either temporarily discontinuing the drug or continuing at a lower dose. With the decrease of these side effects, the drug may be started at a lower dose or at the previous dose based on clinical judgment.

What other drugs will affect thalidomide?

Cold or allergy medicine, sedatives, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression or anxiety can add to sleepiness caused by thalidomide. Tell your doctor if you regularly use any of these medicines. If you use hormonal birth control (pills, implants, injections) to prevent pregnancy: There are certain drugs that can make hormonal birth control less effective in your body. Below is a list of some of these drugs. This list may not include all drugs with the potential to affect hormonal birth control.
  • HIV medicines such as tipranavir (Aptivus), indinavir (Crixivan), saquinavir (Invirase), lopinavir/ritonavir (Kaletra), fosamprenavir (Lexiva), ritonavir (Norvir), atazanavir (Reyataz), or nelfinavir (Viracept);

  • griseofulvin (Gris-PEG, Grifulvin V, Grisactin, or Fulvicin);

  • rifampin (Rimactane, Rifadin);

  • rifabutin (Mycobutin);

  • phenytoin (Dilantin); or

  • carbamazepine (Tegretol).

If you rely on hormonal contraception as one of the two forms of birth control during your treatment with thalidomide, tell your doctor about all other medicines you use. You may also need to replace your hormonal birth control method with another effective form of contraception. Not having sexual intercourse (abstinence) is the most effective method of preventing pregnancy.

There may be other drugs not listed that can affect thalidomide. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

  • Your pharmacist has more information about thalidomide written for health professionals that you may read.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.
Copyright 1996-2006 Cerner Multum, Inc. Version: 5.01. Revision Date: 12/02/2009 10:21:44 AM.
  • thalidomide Advanced Consumer (Micromedex) - Includes Dosage Information
  • Thalidomide Professional Patient Advice (Wolters Kluwer)
  • Thalidomide MedFacts Consumer Leaflet (Wolters Kluwer)
  • Thalomid Prescribing Information (FDA)
  • Thalomid Consumer Overview

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