Thalidomide (Thalidomid ®)
Thalidomide is a targeted therapy, mainly used to treat myeloma. It may be used to treat other cancers as part of a clinical trial.
When thalidomide is used
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Thalidomide is usually taken with other chemotherapy drugs and steroids as treatment for myeloma. The combination of drugs you have will be decided by your doctor. The combination of drugs will depend on:
the stage of the myeloma and how it is affecting you
what treatments you have had before
your general health
if high-dose chemotherapy and a stem cell transplant are part of your treatment plan.
Each combination of drugs includes a steroid, either dexamethasone or prednisolone. Occasionally you may have thalidomide on its own or just with a steroid, usually dexamethasone.
Thalidomide may be given with:
melphalan (Alkeran ®) and prednisolone as first treatment for myeloma if high-dose chemotherapy and stem cell transplant are not suitable. This combination is known as MPT
cyclophosphamide and dexamethasone as a first treatment before high-dose chemotherapy and a stem cell transplant. This combination is known as CTD
bortezomib (Velcade ®) and dexamethasone as a first treatment before high-dose chemotherapy and a stem cell transplant. This combination is known as VTD
dexamethasone, cisplatin, doxorubicin (Adriamycin), cyclophosphamide and etoposide, if myeloma comes back after treatment. This combination is called DT PACE.
Thalidomide was originally developed to treat morning sickness in pregnant women. Its use was stopped because it was found to cause birth defects. Thalidomide is now used as a treatment for cancer but it must not be taken in pregnancy. A pregnancy prevention programme must be followed during treatment.
Thalidomide kills or stops the growth of myeloma cells. It also blocks 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. Thalidomide also affects the way the immune system responds to myeloma cells, although exactly how it works isn’t completely clear yet.
You usually take thalidomide once a day. Thalidomide can make you feel sleepy so it is best to take it at bedtime or in the evening. The capsules should be swallowed whole with plenty of water. The capsules should not be chewed or opened.
Always take your tablets as directed by your doctor, nurse or pharmacist. This is important to make sure they work as well as possible for you.
If you forget to take your thalidomide and less than 12 hours have passed you should take the dose as soon as you realise.
If there’s less than 12 hours until the next dose, don’t take the missed dose. Just take your usual dose at the usual time the next day. You should never take a double dose.
There are some important things to remember when taking your tablets:
Pregnant women should not touch thalidomide tablets as they can harm the developing baby.
If you are sick just after taking the tablets, 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 in a safe place, out of the reach of children.
If your doctor decides to stop the treatment, return any remaining tablets to the pharmacist. Do not flush them down the toilet or throw them away.
Thalidomide can make you feel sleepy. Because of this you should not drink alcohol while taking thalidomide.
If you plan to travel abroad, check whether the country you're visiting has any special rules about thalidomide.
Preventing pregnancy while taking thalidomide
You will take part in a pregnancy prevention programme while taking thalidomide. Your doctor will give you information about not becoming pregnant or fathering a child during and after treatment with thalidomide. This is because thalidomide can cause birth defects in developing babies. Both men and woman taking thalidomide can pass this risk on to an unborn child.
Your doctor or specialist nurse will give you some written information about the risks of thalidomide and the best ways to prevent pregnancy. They will ask you to sign a consent form once you have read the information.
Women of childbearing age will have a pregnancy test before starting treatment with thalidomide. This will be repeated every four weeks during treatment and four weeks after treatment finishes. Contraception must start four weeks before starting treatment with thalidomide.
Your doctor will talk to men and women taking thalidomide about effective contraception to use during treatment. You must use contraception before treatment, during treatment and for four weeks after treatment finishes. If you think you or your partner may be pregnant at any time during your treatment, contact your doctor or specialist nurse straightaway.
Men must also use a condom during sex with a woman of childbearing age, or with a pregnant woman, while taking thalidomide and for a week after treatment finishes. This is to reduce exposing a partner to thalidomide which can be present in semen.
Possible side effects of thalidomide
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Each person’s reaction to cancer treatment is different. Some people have very few side effects, while others may experience more. We explain the most common side effects here. But we don’t include those that are very rare and therefore unlikely to affect you.
You may get some of the side effects we mention but you are very unlikely to get all of them. If you are having other drugs as well, you may have some side effects that we don’t list here.
Always tell your doctor, pharmacist or specialist nurse about any side effects you have.
Some people may have an allergic reaction to thalidomide. Signs may include a skin rash, itching, wheezing, difficulty breathing and breathlessness. Let your nurse or doctor know straight away if you have any of these symptoms. Don’t take any more doses until you have spoken to them.
Risk of blood clots
Thalidomide can increase the chances of a blood clot (thrombosis). You may be given medication to thin your blood and help prevent any clots forming during your treatment.
A blood clot may cause pain, 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 your doctor can treat it with drugs that dissolve the clot and prevent any more. Your doctor or nurse can give you more information.
Effect on blood cells
Thalidomide can reduce the number of blood cells in your blood. This is more likely if it's given with chemotherapy. You will have regular blood tests to check the number of blood cells in your blood.
Risk of infection (neutropenia)
Thalidomide can have an effect on the number of white cells in your blood. This is more likely if it's given with chemotherapy. 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.
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
Bruising and bleeding
Thalidomide can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. Tell your doctor if you have any bruising or bleeding you can’t explain. This includes nosebleeds, bleeding gums, blood spots or rashes on the skin.
Anaemia (low number of red blood cells)
Thalidomide can reduce the number of red blood cells in your blood. If the number of red blood cells is low, you may be tired and breathless. Tell your doctor or nurse if you feel like this.
Feeling tired or sleepy
Thalidomide can make you feel tired and sleepy. Taking your tablets in the evening or at bedtime can help with this. You may find that it improves as you continue to take the drug. Tell your doctor if this continues to be a problem for you. 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. Don’t drive or operate machinery if you’re feeling sleepy.
Numbness or tingling in hands and feet
Thalidomide can affect the nerves; you may notice numbness or tingling in your hands or feet. This is known as peripheral neuropathy. You may also notice find it hard to fasten buttons or do other fiddly tasks.
Tell your doctor straightaway if you have these symptoms. They sometimes need to lower the dose of the drug. The symptoms usually improve slowly after treatment finishes but in some people they may never go away. Talk to your doctor if you are worried about 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.
Dizziness on standing
You may feel dizzy for a few moments if you stand up quickly. This is caused by a temporary fall in blood pressure. Moving slowly from lying to sitting and then sitting to standing may help. Tell your doctor if you've ever had any blood pressure problems and about any medicines you're taking.
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.
Occasionally, thalidomide can cause a more serious skin rash with blistering. Let your doctor know straight away if this happens.
Build up of fluid
Your ankles, legs or hands may swell because of fluid building up. This is called peripheral oedema. Tell your doctor or nurse this happens as they can give you advice or medicines that can help. If the swelling is uncomfortable, they may prescribe support stockings to help. The swelling gets better after your treatment ends.
You may notice your vision is blurry during treatment. Tell your doctor or nurse if you notice this. Don’t drive if your vision is affected.
Feeling sick (nausea) and being sick (vomiting)
This is usually mild. 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.
Loss of appetite
Some people lose their appetite while they’re having thalidomide. This can be mild and may only last a few days. If it doesn’t improve you can ask to see a dietitian or specialist nurse at your hospital. They can give you advice on improving your appetite and keeping to a healthy weight.
Sometimes thalidomide can change how your heart works. The heart may feel as if it’s beating too slowly. If you notice any changes in your heart beat or have any pain in your chest, tell your doctor immediately.
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.
Effects on lungs
Sometimes people feel more breathless or develop an infection while taking thalidomide. Let your doctor know if you feel short of breath or have a cough.
Some people taking thalidomide can become low in mood or anxious. Tell your doctor if you notice any mood changes.
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.
Other information about thalidomide
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Don't drive if you have dizziness or blurred vision, or if you feel tired or sleepy. Talk to your doctor if you are not sure whether you're safe to drive.
Some medicines, including those that you can buy in a shop or chemist, can be harmful to take when you are taking thalidomide. Tell your doctor about any medicines you are taking, including those you can buy for yourself, complementary therapies and herbal drugs. You should avoid drinking alcohol while you are taking thalidomide.
Doctors don’t yet know how thalidomide may affect fertility in men and women. If you are worried about this, talk to your doctor before your treatment starts.
There is a potential risk that thalidomide may be present in breast milk, so women are advised not to breastfeed during this treatment and for a few months afterwards.
Medical and dental treatment
If you need to go into hospital for a reason not related to the myeloma, tell the doctors and nurses looking after you that you are having treatment with thalidomide. You should tell them the name of your cancer specialist so that they can ask them for advice.
Always tell your dentist you are taking thalidomide.
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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