Lenalidomide (Revlimid ®)
Lenalidomide (also known as Revlimid ®) is used to treat people with myeloma, which is a type of cancer that affects the plasma cells found inside bone marrow.
You'll see your doctor regularly while you have this treatment so they can monitor its effects. This information should help you discuss any queries about your treatment and its side effects with your doctor or specialist nurse.
Lenalidomide belongs to a new class of drugs called immunomodulatory drugs.
How lenalidomide works
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Lenalidomide affects the way the immune system works, although the exact way it works is not completely understood yet.
It also works by blocking the development of new blood vessels. Making blood vessels is called angiogenesis. Cancer cells need to make new blood vessels so they can grow and spread.
When lenalidomide is used
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Lenalidomide is licensed to treat people who have already had at least one other type of treatment. It's given with a steroid called dexamethasone.
Sometimes a chemotherapy drug called cyclophosphamide is given with the lenalidomide and dexamethasone. This combination of drugs or regime is called CRD.
The National Institute for Health and Clinical Excellence (NICE) gives advice on which new drugs or treatments should be available on the NHS in England and Wales. The Scottish Medicines Consortium (SMC) makes recommendations on the use of new drugs within the NHS in Scotland.
NICE has recommended lenalidomide as a possible treatment for people with myeloma who have already had at least two other treatments.
The SMC has recommended that lenalidomide should be available as a treatment for myeloma in people who have had at least one previous treatment.
If you live in Northern Ireland, you should speak to your cancer specialist about whether lenalidomide is recommended to treat your type of cancer.
What lenalidomide looks like
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Lenalidomide is available as 5mg, 10mg, 15mg and 25mg capsules.
How lenalidomide is given
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Lenalidomide is usually taken once a day. You should take the capsules at about the same time each day. They should be swallowed whole with a glass of water, with or without food. The capsules should not be chewed or opened.
Preventing pregnancy while taking lenalidomide
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You must not become pregnant or father a child while taking lenalidomide, because it may cause severe abnormalities in developing babies.
Women of childbearing age will be given a pregnancy test to check that they are not pregnant. This will usually be done within three days of starting lenalidomide, and repeated every four weeks until four weeks after treatment has finished.
Women of childbearing age must also use a highly effective form of contraception, such as an implanted or injected device, or the progesterone-only pill. The combined oral contraceptive pill is not recommended because it increases the risk of developing blood clots, which is also increased by lenalidomide and dexamethasone. Contraception must be used for four weeks before treatment, throughout treatment and for four weeks after treatment finishes.
Men taking lenalidomide must use a condom during sexual intercourse with a woman of childbearing age or with a pregnant woman. They should continue to use a condom throughout the lenalidomide treatment and for one week after treatment finishes.
Because of the potential birth defects that lenalidomide can cause, it's likely that you will have to take part in a pregnancy prevention programme. You will need to sign a consent form. Your doctor or specialist nurse will give you some written information about the risks of lenalidomide and the best ways to prevent pregnancy.
Possible side effects of lenalidomide
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Each person's reaction to a cancer drug is different. Some people have very few side effects while others may experience more. The side effects described below won't affect everyone who has lenalidomide.
We've outlined the most common side effects, but haven't included those that are rare and therefore unlikely to affect you. If you notice any effects that aren't listed here, discuss them with your doctor or nurse.
Risk of infection
Lenalidomide can reduce the number of white blood cells, which help to fight infection. White blood cells are produced by the bone marrow. If the number of your white blood cells is low, you will be more prone to infections. A low white blood cell count is called neutropenia.
The number of white blood cells will usually return to normal before your next treatment is due. You will have a blood test before having more treatment to check the number of white blood cells. Occasionally, your treatment may need to be delayed if your number of blood cells (blood count) is still low.
Contact your doctor or the hospital straight away if:
your temperature goes above 38˚C (100.4˚F)
you suddenly feel unwell, even if your temperature is normal.
Bruising and bleeding
Lenalidomide can reduce the production of platelets, which help the blood to clot. Tell your doctor if you have any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin. You can have a platelet transfusion if your platelet count is low.
Increased risk of blood clots
If you have chest pain, suddenly feel short of breath or develop a painful swelling in your leg, this could be a sign of a blood clot. If you think you may have a blood clot, tell your doctor straight away. You may be given medication to thin your blood and help prevent any clots forming while you're taking lenalidomide.
Lenalidomide can cause a rash, which may be itchy. Your doctor can prescribe treatment to help reduce this.
You may get constipated. This can usually be helped by drinking plenty of fluids, eating more fibre in your diet and doing some gentle exercise. You may need to take medicine to help (laxative). Your doctor can prescribe these or you can buy them at a pharmacy.
You may have difficulty sleeping or your sleep pattern may be affected.
Feeling tired is a common side effect especially towards the end of treatment and for some weeks after it’s over. It’s important to try to pace yourself and get as much rest as you need. Try to balance this with taking some gentle exercise, such as short walks, which will help. If tiredness is making you feel sleepy, don’t drive or operate machinery.
Feeling sick (nausea)
This is usually mild. If you do feel sick, it may begin a few hours after treatment and last for a few days. Your doctor can prescribe anti-sickness (anti-emetic) drugs to prevent, or greatly reduce, nausea and vomiting.
If the sickness isn't controlled, or if it continues, tell your doctor as; they can prescribe other anti-sickness drugs that may work better for you. Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.
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.
Additional information about lenalidomide
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Lenalidomide may affect your ability to drive. Don't drive if you have dizziness, blurred vision, excessive tiredness or if you feel sleepy. Ask your doctor for advice if you're not sure whether you are safe to drive.
Some medicines, including those that you can buy in a shop or chemist, can be harmful to take when you’re having cancer treatment. Tell your doctor about any medicines you’re taking, including over-the-counter drugs, complementary therapies and herbal drugs.
Your ability to become pregnant or father a child may be affected by lenalidomide. It's important to discuss fertility with your doctor before starting treatment.
There is a potential risk that lenalidomide may be present in breast milk, so women are advised not to breastfeed during this treatment and for a few months afterwards.
Non-cancer hospital admission
If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you are having treatment with lenalidomide. You should tell them the name of your cancer specialist so that they can ask them for advice.
It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home. During office hours you can contact the clinic or ward where you had your treatment. Your specialist nurse or doctor will tell you who to contact during the evening or at weekends.
Things to remember about lenalidomide capsules
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It's important to take your capsules as directed by your doctor.
Keep the capsules in a safe place, out of the reach of children. Pregnant women should not handle the capsules.
If you forget to take a capsule, don't take a double dose. Inform your doctor and keep to your regular dose schedule.
If you're sick just after taking the capsule, let your doctor know. You may need to take another dose. Don't take another capsule without telling your doctor, nurse or pharmacist first.
If your doctor decides to stop the treatment, return any remaining capsules to the pharmacist. Don't flush them down the toilet or throw them away.
This information has been compiled using a number of reliable sources, including:
electronic Medicines Compendium (eMC) website. (accessed September 2012).
National Institute for Health and Clinical Excellence (NICE). Lenalidomide for the treatment of multiple myeloma in people who have received at least one prior therapy (TA171). June 2009.
Scottish Medicines Consortium (SMC). 441/08 - Lenalidomide (Revlimid). May 2010.
With thanks to: Professor Gareth Morgan, Professor of Haematology; and the people affected by cancer who reviewed this edition. Reviewing information is just one of the ways you could help when you join our Cancer Voices network.