Lenalidomide (Revlimid ®)
Lenalidomide is used to treat people with myeloma and myelodysplastic syndromes (MDS). It may be used to treat other cancers in clinical trials.
Lenalidomide (Revlimid ®) is used to treat people with myeloma. This is a type of cancer that affects the plasma cells inside bone marrow. It may also be used to treat people with myelodysplastic syndromes (MDS), a group of conditions that affect the bone marrow. Lenalidomide may be used to treat other types of cancer in research trials.
How lenalidomide works
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Lenalidomide affects the way the immune system works, although it’s not clear exactly how it works yet. It also blocks the development of new blood vessels. Making blood vessels is called angiogenesis. This stops the cancer cells from being able to grow and spread.
When lenalidomide is given
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You are usually given lenalidomide after you have already had two previous treatments for myeloma. Sometimes it may be given after just one treatment. You have lenalidomide with a steroid drug called dexamethasone and sometimes also with a chemotherapy drug.
Myelodysplastic syndromes (MDS)
Some people with MDS have an abnormality in the cells in the bone marrow (where blood cells are made) that means the body cannot make enough healthy blood cells. If you have this and need regular blood transfusions, your doctor may recommend lenalidomide after other treatments have been tried.
You usually take lenalidomide once a day for three weeks. When you have finished taking these tablets, you have no treatment for a week. The three weeks and the break is called a cycle of treatment. After this you start your second cycle of treatment.
Take the tablets at about the same time each day. Swallow them whole with a glass of water. The tablets should not be chewed or opened.
Always take your tablets exactly as your nurse or pharmacist has explained. This is important to make sure they work as well as possible for you.
There are some important things to remember when taking your tablets:
If you forget to take a tablet, take it as soon as you realise. However, if it is less than 12 hours until the next dose, don’t take the missed tablet. You should never take a double dose.
If you are sick just after taking a tablet, tell your doctor as you may need to take another dose. Don't take another dose without telling your doctor first.
Keep the tablets in the original packaging and store them at room temperature away from heat and direct sunlight.
Pregnant women should not take lenalidomide tablets as they may harm the developing baby.
Keep the tablets in a safe place, out of the reach of children.
If your doctor decides to stop the treatment, return any remaining tablets to the pharmacy. Do not flush them down the toilet or throw them away.
Preventing pregnancy while taking lenalidomide
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You must not become pregnant or father a child while taking lenalidomide. This is because it may cause severe abnormalities in developing babies. You will have to take part in a pregnancy prevention programme during treatment. Your doctor or specialist nurse will give you information about the risks of lenalidomide and pregnancy. They will ask you to sign a consent form once you have read the information.
For women taking lenalidomide
You will have a pregnancy test before you start treatment if you are of childbearing age and have not had an operation to stop you getting pregnant (sterilisation). The pregnancy test will be repeated every four weeks during treatment and for four weeks after treatment finishes. You must also use a very effective form of contraception, such as an implant or injection or the progesterone-only pill. The combined oral contraceptive pill is not recommended because it increases your risk of developing blood clots. You must use contraception for four weeks before treatment, during treatment and for four weeks after treatment finishes. If you think you may be pregnant at any time during your treatment, contact your doctor or specialist nurse straight away.
For men taking lenalidomide
You must use a condom during sex with a woman of childbearing age or a pregnant woman while taking lenalidomide and for a week after it finishes. This is because lenalidomide passes into semen. If your partner thinks they might be pregnant during your treatment, contact your doctor or specialist nurse straight away.
Possible side effects of lenalidomide
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Lenalidomide can cause different side effects. Some are more common, but you are very unlikely to get all of them. We’ve explained the most common ones here.
If you are taking other drugs as well as lenalidomide, you may have some side effects that aren't listed here. Always tell your doctor or nurse about any side effects you have.
Your doctor can prescribe drugs to help control some side effects. It’s very important to take them exactly as your nurse or pharmacist has explained so that they are more likely to work well for you. Your nurse will give you advice about managing your side effects. After your treatment is over, the side effects will start to improve.
Risk of infection
Lenalidomide can reduce the number of white blood cells in your body. These cells help to fight infection. If the number of your white blood cells is low, you are more likely to get infections. A low white blood cell count is called neutropenia.
Contact your doctor or the hospital straight away if:
your temperature goes over 37.5°C (99.5°F) or over 38°C (100.4°F), depending on the advice given by your hospital team
you suddenly feel unwell, even with a normal temperature
you have symptoms of an infection – this can include feeling shaky, a sore throat, a cough, diarrhoea or needing to pass urine a lot.
The number of white blood cells will usually return to normal before your next cycle of treatment is due. You will have a blood test before starting the next cycle. If the number of blood cells (blood count) is still low, your treatment may need to be delayed.
Your nurse will give you telephone numbers for the hospital that you can call at any time if you feel unwell or need advice. Save these numbers in your phone or keep them somewhere safe.
Bruising and bleeding
Lenalidomide can reduce the number of platelets in your blood. Platelets are cells which help the blood to clot. Tell your doctor if you have any bruising or bleeding that you can’t explain. This includes nose bleeds, bleeding gums, blood spots or rashes on the skin. If your platelet count is very low, you may need a drip to give you extra platelets (platelet transfusion).
Anaemia (low number of red blood cells)
Lenalidomide can reduce the number of red blood cells in your blood. These cells carry oxygen around the body. If the number of red blood cells is low (anaemia), you may be tired and breathless. Tell your doctor or nurse if you feel like this. If you are very anaemic, you may need a drip to give you extra red blood cells (blood transfusion).
Your skin may become dry and itchy. You may also notice a rash or redness. Tell your doctor or nurse if you have any of these symptoms. They can prescribe creams and drugs to help.
You may get constipated while taking lenalidomide. Drinking plenty of fluids, eating more fibre and doing some gentle exercise can help. You may need to take medicine (laxatives) to help. Your doctor can prescribe these or you can buy them at a pharmacy.
You may have frequent or loose bowel movements. This can usually be easily controlled by taking anti-diarrhoea drugs. Your doctor can prescribe these for you. You should tell your doctor if your diarrhoea is severe or if it continues. It's important to drink plenty of fluids if you have diarrhoea, around 2 litres (4 pints) per day.
Feeling sick (nausea)
This is usually mild. Your doctor can prescribe anti-sickness (anti-emetic) drugs to help prevent or control sickness. If you still feel sick, tell your doctor as they can prescribe different anti-sickness drugs that may work better for you.
Loss of appetite
During treatment your appetite may change and you might lose weight. Try to eat small meals regularly. If your appetite doesn’t improve after a few days, let your doctor or nurse know. They can arrange for you to see a dietitian who can give you advice. You may be given food supplements or meal replacement drinks to try. Your doctor can prescribe some of these and you can buy them from a pharmacy.
You may get pain or discomfort in your tummy (abdomen), or have indigestion or wind. Your doctor can prescribe drugs to help improve these symptoms. Tell them if the pain doesn’t improve or gets worse.
Feeling tired is a common side effect. It’s often worse towards the end of treatment and for some weeks after it’s over. Try to pace yourself and get as much rest as you need. It helps to balance this with some gentle exercise, such as short walks. If you feel sleepy, don’t drive or operate machinery.
Some people have pains in their joints or muscles. You may also have muscle spasms or cramps. Tell your doctor if you have any discomfort as they can prescribe painkillers.
Numb or tingling hands or feet
Lenalidomide can affect your nerves and you may notice numbness or tingling in your hands or feet. This is called peripheral neuropathy. You may also find it hard to do up buttons or to do other fiddly tasks.
Tell your doctor if you have these symptoms. They may need to lower the dose of lenalidomide that you’re taking. The symptoms usually improve slowly after treatment finishes, but for some people they may never go away. Talk to your doctor if you are worried about this.
Increased risk of blood clots
Cancer increases the chances of a blood clot (thrombosis), and lenalidomide can add to this risk. A clot can cause symptoms such as pain or redness and swelling in a leg, breathlessness and chest pain. Contact your doctor straight away if you have any of these symptoms. A blood clot is serious but can be treated with drugs that thin the blood. You may be given these drugs while you are taking lenalidomide to help stop any clots from forming. Your doctor or nurse can give you more information.
Sometimes lenalidomide can change how your heart works. You may feel like your heart is beating too fast or too slow. If you notice any changes in your heart beat or have any pain in your chest, tell your doctor immediately.
Build up of fluid
Your ankles and legs may swell because of fluid building up. Tell your doctor or nurse if fluid builds up as there are medicines that may help. If the swelling is uncomfortable, they may prescribe support stockings. The swelling gets better after your treatment ends.
If you notice that your vision is blurry during treatment, or if your eyesight changes, tell your doctor or nurse.
You may experience mood swings, feeling up one minute and down the next. Some people taking lenalidomide can become low in mood or depressed. Tell your doctor if you notice any mood changes.
You may have difficulty sleeping or your sleep pattern may be affected. Talk to your doctor or specialist nurse if you notice this.
Changes in how the kidneys work
Treatment with lenalidomide may cause changes in the way that your kidneys work, although this usually returns to normal when the treatment finishes. Your doctor will take regular blood samples to check your kidneys are working properly.
If you notice you are finding it difficult to pass urine or going to the toilet more or less often, or if there is blood in your urine, contact your doctor straight away.
Dry or sore mouth
Your mouth may become dry, sore or red. This can make you more likely to get an infection in your mouth. Gently clean your teeth and/or dentures in the morning, at night and after meals. Use a soft-bristled or children’s toothbrush. Your nurse might ask you to rinse your mouth regularly or use mouthwashes. It’s important to follow any advice you are given and to drink plenty of fluids.
Tell your nurse or doctor if you have any problems with your mouth. They can prescribe medicines to prevent or treat mouth infections and reduce any soreness.
Effects on lungs
Sometimes people feel more breathless or develop an infection while taking lenalidomide. Let your doctor know if you notice this.
It's important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they're not mentioned above.
Lenalidomide may affect your ability to drive. Don't drive if you have blurred vision, or if you feel dizzy, very tired or sleepy. Talk to your doctor for advice if you're not sure whether it’s safe for you to drive.
Some medicines can be harmful to take when you’re taking lenalidomide. Tell your doctor about any medicines you’re taking, including ones you can buy for yourself in a shop or pharmacy, complementary therapies and herbal drugs.
Doctors don’t yet know how lenalidomide may affect fertility in men and women. If you are worried about this, talk to your doctor before starting your treatment.
Women are advised not to breastfeed during treatment and for a few months afterwards. This is in case there is any of the drug in their breast milk.
Medical or dental treatment
If you need to go to hospital for any reason not related to the cancer, always tell the doctors and nurses that you are taking lenalidomide. Tell them the name of your cancer doctor so that they can ask them for advice.
Always tell your dentist you are taking lenalidomide.
This page has been compiled using information from a number of reliable sources, including the electronic Medicines Compendium (eMC; medicines.org.uk). If you’d like further information on the sources we use, please feel free to contact us.
This information was reviewed by a medical professional.
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