What is pomalidomide (Imnovid®)?

Pomalidomide (Imnovid®) is a targeted therapy drug. It is used to treat myeloma. It is best to read this information with our general information about targeted therapies and myeloma. Pomalidomide is both a targeted therapy drug and an immunotherapy drug. It works in several different ways.

Pomalidomide can:

Your doctor will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.

How pomalidomide is given

You will be given pomalidomide as an outpatient. During treatment you usually see a cancer doctor, a cancer nurse or specialist nurse, and a specialist pharmacist. This is who we mean when we mention doctor, nurse or pharmacist in this information.

Your course of treatment

Pomalidomide comes in capsules, so you can take it at home. Pomalidomide is usually taken with steroids or other cancer drugs.

Pomalidomide is usually given as a course of several cycles of treatment. Each cycle is made up of days that you have treatment and days that you do not. The days that you do not have treatment are called rest days. You take pomalidomide for as long as it works well for you. Your nurse or doctor will discuss your treatment plan with you. They may give you a copy of the treatment plan to take home with you.

The nurse or pharmacist will give you the capsules to take home. Always take them exactly as explained. This is important to make sure they work as well as possible for you.

Taking pomalidomide capsules

Take the capsules at about the same time each day, with or without food. Swallow them whole with a glass of water. The capsules should not be chewed or opened. You may be given capsules of different strengths. Take all your capsules or tablets exactly as they have been explained to you.

If you forget to take pomalidomide, contact your doctor or nurse. Do not take an extra dose.

There are some important things to remember when taking your capsules:

  • Keep them in the original packaging.
  • Keep them safe and out of sight and reach of children.
  • If you are sick just after taking the capsules or tablets, contact the hospital. Do not take another dose without talking to your doctor first.
  • If your treatment is stopped, return any remaining capsules to the pharmacist.

Preventing pregnancy while taking pomalidomide

You must not get pregnant or make someone pregnant while having pomalidomide and for a while after treatment finishes. This is because pomalidomide can cause birth defects in developing babies.

You will have to take part in a pregnancy prevention programme while taking pomalidomide. Even if you do not think you are at risk of getting pregnant or making someone pregnant, you may still be included in the pregnancy prevention programme. You can talk to your doctor or specialist nurse about this.

The pregnancy prevention programme involves:

  • Being given written information about the risks of pomalidomide
  • Being given advice about contraception – you may be advised to use different contraception during your treatment
  • Having pregnancy tests (if it is possible you could become pregnant).

Your doctor or specialist nurse will ask you to sign a consent form once you have read the information.

If during your treatment, you think you might be pregnant or have made someone pregnant, contact your doctor or specialist nurse straight awa

About side effects

We explain the most common side effects of this treatment here. We also include some less common side effects. You may get some of the side effects we mention, but you are unlikely to get all of them.

If you are also having treatment with other cancer drugs, you may have some side effects that we have not listed here. Always tell your doctor, nurse or pharmacist about any side effects you have.

Your doctor can give you drugs to help control some side effects. It is important to take them exactly as your nurse or pharmacist explains. This means they will be more likely to work for you. Your nurse will give you advice about managing your side effects. After your treatment is over, most side effects start to improve.

Serious and life-threatening side effects

Some cancer treatments can cause severe side effects. Rarely, these may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.

Contact the hospital

Your nurse will give you telephone numbers for the hospital. If you feel unwell or need advice, you can call them at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.

More information

We cannot list every side effect for this treatment. There are some rare side effects that are not listed. You can visit the electronic Medicines Compendium (eMC) for more detailed information.

Common side effects of pomalidomide

Risk of infection

This treatment can reduce the number of white blood cells in your blood. These cells fight infection.

If the number of white blood cells is low, you are more likely to get an infection. A low white blood cell count is called neutropenia.

If you have an infection, it is important to treat it as soon as possible. Contact the hospital straight away on the 24-hour contact number you have if:

  • your temperature goes over 37.5°C (99.5°F)
  • you suddenly feel unwell, even with a normal temperature
  • you have symptoms of an infection.

Symptoms of an infection include:

  • feeling shivery
  • a sore throat
  • a cough
  • diarrhoea
  • needing to pass urine often.

It is important to follow any specific advice your cancer treatment team gives you.

The number of white blood cells will usually return to normal before your next treatment. You will have a blood test before having more treatment. If your white blood cell count is low, your doctor may delay your treatment for a short time.

Bruising and bleeding

This treatment 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 that you cannot explain. This includes:

  • nosebleeds
  • bleeding gums
  • tiny red or purple spots on the skin that may look like a rash.

Some people may need a drip to give them extra platelets. This is called a platelet transfusion.

Anaemia (low number of red blood cells)

This treatment 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, 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. This is called a blood transfusion.

Skin changes

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.

Rarely, pomalidomide can cause a much more serious skin condition. You may have a skin rash that causes peeling and blistering. Contact the hospital straight away if this happens.

Constipation

This treatment can cause constipation. Here are some tips that may help:

  • Drink at least 2 litres (3½ pints) of fluids each day.
  • Eat high-fibre foods, such as fruit, vegetables and wholemeal bread.
  • Do regular gentle exercise, like going for short walks.

If you have constipation, contact the hospital for advice. Your doctor can give you drugs called laxatives to help.

Diarrhoea

This treatment may cause diarrhoea. Diarrhoea means passing more stools (poo) than is usual for you, or having watery or loose stools. If you have a stoma, it will be more active than usual.

If you have diarrhoea:

  • try to drink at least 2 litres (31/2 pints) of fluids each day
  • avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods
  • contact the hospital for advice.

Feeling sick

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.

Tummy pain

You may feel pain or discomfort in your tummy (abdomen). Or you may have indigestion. Your doctor can give you drugs to help improve these symptoms. If the symptoms do not improve or get worse, tell your doctor. 

Feeling tired

Feeling tired is a common side effect. It is often worse towards the end of treatment and for some weeks after it has finished. Try to pace yourself and plan your day so you have time to rest. Gentle exercise, like short walks, can give you more energy. If you feel sleepy, do not drive or operate machinery.

Bone and muscle pain

Some people have painful bones. You may also have muscle spasms. Tell your doctor if you notice this. They can give you painkillers.

Numb or tingling hands or feet (peripheral neuropathy)

This treatment affects the nerves, which can cause numb, tingling or painful hands or feet. You may find it hard to fasten buttons or do other fiddly tasks.

Tell your doctor if you have these symptoms. They sometimes need to lower the dose of the drug. 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.

Build-up of fluid

Your ankles, legs or hands may swell because of fluid building up. Tell your doctor or nurse if this happens, as there are medicines that can help. If the swelling is uncomfortable, they may prescribe support stockings. The swelling gets better after your treatment ends.

Dizziness

This treatment can cause you to feel dizzy and confused or unsteady. Tell your doctor or nurse straight away if you notice this. If you feel like this, do not drive or operate machinery.

Effects on the kidneys and passing urine

Pomalidomide may cause changes in the way that your kidneys work. Your doctor will take regular blood samples to check your kidneys are working properly.

If you are finding it difficult to pass urine, contact your doctor straight away. Also tell your doctor if you are going to the toilet more or less often or there is blood in your urine.

Effects on the lungs

This treatment can cause changes to the lungs. Tell your doctor if you develop:

  • a cough
  • wheezing
  • a fever (high temperature)
  • breathlessness.

You should also tell them if any existing breathing problems get worse. You may have tests to check your lungs.

Less common side effects

Allergic reaction

Some people may have an allergic reaction to this treatment. Signs include:

  • a skin rash
  • itching
  • wheezing
  • difficulty breathing
  • breathlessness.

Let your nurse or doctor know straight away if you have any of these symptoms. Do not take your next dose until you have spoken to them. 

Heart problems

Sometimes pomalidomide can affect the heart. You may notice your heart feels like it is beating too fast or that it is irregular. Let your doctor know if this happens.

Less commonly pomalidomide may cause more serious effects on the heart. Contact a doctor straight away if you:

  • have pain or tightness in your chest
  • feel breathless or dizzy
  • feel your heart is beating too fast or too slowly or is irregular.
Other conditions can cause these symptoms, but it is important to get them checked by a 

Blood clot risk

This treatment can increase the risk of a blood clot. Symptoms of a blood clot include:

  • pain, redness or swelling in a leg or arm
  • breathlessness
  • chest pain.

If you have any of these symptoms, contact a doctor straight away.

A blood clot is serious, but can be treated with drugs that thin the blood. Your doctor or nurse can give you more information.

A blood clot can increase the risk of having a stroke. Signs of a stroke include:

  • weakness or numbness in one side of your body
  • slurred speech or drooping of your face, mouth or eye
If you, or someone you know, notices you have any of these symptoms, get medical advice straight away.

Tumour lysis syndrome (TLS)

Rarely this treatment may cause the cancer cells to break down very quickly in some people. This releases uric acid (a waste product) into the blood. The kidneys usually get rid of uric acid, but may not be able cope with large amounts. This can cause chemical imbalances in the blood that affect the kidneys and the heart. This is called tumour lysis syndrome (TLS).

Your doctor may give you drugs to reduce the risk of TLS. They may also ask you to drink more fluids on the day of your treatment. Your doctor or nurse will explain more about this.

Effects on the liver

Rarely, pomalidomide may cause changes in the way your liver works. This is more risk of a in the first six months of taking pomalidomide. Your doctor will take regular blood samples to check how well your liver is working during that period. 

Hepatitis B reactivation

If you have had Hepatitis B (a liver infection) in the past, pomalidomide can make it active again. Your doctor or nurse will talk to you about this and test you for Hepatitis B.

Other information

Other medicines

Some medicines can affect how this treatment works or be harmful when you are having it. Always tell your cancer doctor about any drugs you are taking or planning to take, such as:

  • medicines you have been prescribed
  • medicines you buy in a shop or chemist
  • vitamins, herbal drugs and complementary therapies.

Tell other doctors, pharmacists or dentists who prescribe or give you medicines that you are having this cancer treatment.

You can visit the electronic Medicines Compendium (eMC) for more detailed information about your treatment.

Breastfeeding

Women are advised not to breastfeed while having this treatment. This is because the drugs could be passed to the baby through breast milk.

Fertility

Some cancer drugs can affect whether you can get pregnant or make someone pregnant. If you are worried about this, it is important to talk with your doctor before you start treatment.

Medical and dental treatment

If you need medical treatment for any reason other than cancer, always tell the doctors and nurses that you are having cancer treatment. Give them the contact details for your cancer doctor so they can ask for advice.

If you think you need dental treatment, talk to your cancer doctor or nurse. Always tell your dentist you are having cancer treatment.

Vaccinations

Your doctor or nurse may talk to you about vaccinations. These help reduce your risk of getting infections.

Doctors usually recommend that you have a flu jab, which is an inactivated vaccination. People with weak immune systems can have this type of vaccination.

If your immune system is weak, you need to avoid live vaccinations such as shingles. Your cancer doctor or GP can tell you more about live vaccinations.

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