Lenalidomide (Revlimid®)

Lenalidomide (Revlimid®) is a targeted therapy drug used to treat myeloma, some types of lymphoma and myelodysplastic syndromes (MDS).

What is lenalidomide (Revlimid®)?

Lenalidomide is used to treat myeloma, some types of lymphoma and myelodysplastic syndromes (MDS). It is best to read this information with our general information about the type of cancer you have. 

Lenalidomide is both a targeted therapy drug and an immunotherapy drug. It works in several different ways.

Lenalidomide can:

  • block the development of new blood vessels which cancer cells need to grow and spread (angiogenesis inhibitor)
  • kill or stop the growth of cancer cells (cancer growth inhibitor)
  • help the immune system attack and destroy cancer cells (immune system modulator)

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

More information about this treatment

This information is correct at time of publishing. But sometimes the types of cancer this treatment is used for, or treatment side effects, may change between revision dates.

You can talk to your cancer team if you want more detailed information about this treatment. Or visit the electronic Medicines Compendium (eMC) website, which has patient information leaflets (PIL) for individual drugs.

How lenalidomide is given

Lenalidomide is given orally as capsules. This means you can take it at home. You may have lenalidomide: 

During treatment you usually see a cancer doctor, a chemotherapy nurse or a specialist nurse, and a specialist pharmacist. This is who we mean when we mention doctor, nurse or pharmacist in this information.

You will have your blood checked regularly during treatment. Before or on the day of your treatment, a nurse or a person trained to take blood (phlebotomist) will take a blood sample from you. This is to check that your blood cells are at a safe level for you to have treatment. Your doctor will tell you when your blood will be checked.

Your course of treatment

You usually take lenalidomide once a day for 21 days. You then have a break of 7 days when you do not take any lenalidomide. After this, you start taking it again in the same way.

If you are taking lenalidomide with bortezomib for multiple myeloma, you usually take lenalidomide once a day for 14 days. You then have a break for 7 days when you do not take any lenalidomide.  After this, you start taking it again in the same way.

Your nurse, pharmacist or doctor will discuss your treatment plan with you.

Taking lenalidomide

Lenalidomide capsules come in different strengths. Your doctor, nurse or pharmacist will tell you how many of each to take. Always take them exactly as you are told to. This is important to make sure they work as well as possible for you. 

You should: 

  • take them at about the same time each day 
  • swallow them whole with a glass of water 
  • take them with or without food 
  • not chew or open capsules

There are some important things to remember when taking lenalidomide:

  • If you forget to take lenalidomide take it as soon as you realise. But if it is less than 12 hours until the next dose, do not take the missed dose. You should never take a double dose.
  • If you are sick just after taking a dose tell your doctor. You may need to take another dose. Do not take another dose without telling your doctor first.
  • Keep them in the original package and at room temperature, away from heat and direct sunlight.
  • Remove them carefully from the packaging. Gloves should be worn when handling the capsules and hands should be washed thoroughly afterwards.  
  • Keep them safe and out of sight and reach of children.
  • If your treatment is stopped, return any unused lenalidomide to the pharmacist.

Preventing pregnancy while taking lenalidomide

You must not becoming pregnant or make someone pregnant while taking lenalidomide. This is because it may cause severe abnormalities in developing babies. You will 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.

If you can get pregnant

If you are able to get pregnant, you will have a pregnancy test before starting treatment with lenalidomide. The pregnancy test will be repeated every 4 weeks during treatment and for 4 weeks after treatment finishes. 

You must also use an effective form of contraception, such as:

  • an implant 
  • injection 
  • 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 4 weeks before treatment
  • during treatment 
  • for 4 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.

If you can make someone pregnant

If your partner is able to get pregnant, you must use a condom during sex while taking lenalidomide and for a week after treatment finishes. This is because lenalidomide can pass into your semen and can be harmful to developing babies. 

If your partner thinks they might be pregnant during your treatment, contact your doctor or specialist nurse straight away.

About side effects

About side effects

We explain the most common side effects of this treatment here. We also include some that are less common. 

You may get some of the side effects we mention, but you are unlikely to get all of them. And you may have some side effects, including rarer ones, that we have not listed here. 

Other cancer treatments may cause different side effects. If you are also having other cancer treatment, you may have other side effects.

Always tell your doctor, nurse or pharmacist about any side effects you have. They can give you: 

  • drugs to help control some side effects 
  • advice about managing side effects. 

It is important to take any drugs exactly as explained. This means they will be more likely to work for you.

Serious and life-threatening side effects

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

Contact the hospital

Your doctor, nurse or pharmacist will give you 24-hour contact numbers for the hospital. If you feel unwell or need advice, you can call at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.

Possible side effects

Risk of infection

This treatment can reduce the number of white blood cells in your blood. These cells fight infection. If your white blood cell count is low, you may be more likely to get an infection. A low white blood cell count is called neutropenia.

An infection can be very serious when the number of white blood cells is low. It is important to get any infection treated as soon as possible. If you have any of the following symptoms, contact the hospital straight away on the 24-hour number:

  • a temperature above 37.5°C 
  • a temperature below 36°C 
  • you feel unwell, even with a normal temperature
  • you have symptoms of an infection.

Symptoms of an infection include:

  • feeling shivery and shaking
  • a sore throat
  • a cough 
  • breathlessness
  • diarrhoea
  • needing to pass urine (pee) often, or discomfort when you pass urine.

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

Your white blood cell count 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, until your cell count increases.

You may be given a drug called G-CSF. This encourages the body to make more white blood cells. You have it as a small injection under the skin.

Bruising and bleeding

This treatment can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot.

If the number of platelets is low, you may bruise or bleed easily. You may have:

  • nosebleeds
  • bleeding gums
  • heavy periods
  • blood in your urine (pee) or stools (poo)
  • tiny red, brown or purple spots that may look like a rash – these spots can be harder to see if you have black or brown skin. 

If you have any unexplained bruising or bleeding, contact the hospital straight away on the 24-hour number. You may need a drip to give you 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. Red blood cells carry oxygen around the body. If the number of red blood cells is low, this is called anaemia. You may feel:

  • very low in energy
  • breathless 
  • dizzy and light-headed. 

If you have these symptoms, contact the hospital straight away on the 24-hour number. You may need treatment for anaemia. 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 red, dry or itchy. Tell your doctor or nurse if you have any of these symptoms. They can prescribe creams and drugs to help. 

Rarely, a much more serious skin condition can develop. You may have a skin rash which then blisters, and your skin can peel. You may also feel unwell with flu-like symptoms such as a high temperature and joint pain. If you have any of these symptoms, contact your doctor or hospital immediately.

Diarrhoea

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

If you are passing loose stools 3 or more times a day and this is not normal for you, contact the hospital as soon as possible on the 24-hour number. Follow the advice they give you about:

  • taking anti-diarrhoea medicines 
  • drinking enough fluids to keep you hydrated and to replace lost salts and minerals
  • any changes to your diet that might help. 

They might also ask you for a specimen of your stool to check for infection.

Sore mouth and throat

This treatment may cause a sore mouth and throat. You may also get mouth ulcers. This can make you more likely to get a mouth or throat infection. Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.

Contact the hospital straight away on the 24-hour number, if:

  • your mouth or throat is sore, or affecting how much fluid you can drink or food you can eat 
  • your mouth, tongue, throat or lips have any blisters, ulcers or white patches. 

They can give you advice, and mouthwash or medicines to help with the pain or to treat any infection. Follow their advice and make sure you:

  • drink plenty of fluids
  • avoid alcohol and tobacco
  • avoid food or drinks that irritate your mouth and throat.

Constipation

This treatment can cause constipation. Constipation means that you are not able to pass stools (poo) as often as you normally do. It can become difficult or painful. 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 on the 24-hour number for advice. They can give you drugs called laxatives to help. 

If you have not been able to pass stools for over 2 days and are being sick, contact the 24-hour number straight away. 

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.

Changes to your taste

You may get a bitter or metal taste in your mouth. Sucking sugar-free sweets may help with this. Some foods may taste different or have no taste. Try different foods to find out what tastes best to you. Your nurse can give you more advice.

Loss of appetite

This treatment can affect your appetite. Don’t worry if you do not eat much for 1 or 2 days. But if your appetite does not come back after a few days, or if you are losing weight, tell your doctor, nurse or pharmacist. They can give you advice. They may give you food or drink supplements. Or they may suggest changes to your diet or eating habits to help.

Tummy pain

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 does not improve or gets worse.

Feeling tired

Feeling tired is a common side effect of this treatment. It is often worse towards the end of treatment and for some weeks after it ends. Try to pace yourself and plan your day so you have time to rest. Gentle exercise, like short walks, can help you feel less tired. 

If you feel sleepy, do not drive or use machinery.

Mood changes and sleep problems

You may have mood swings, feeling happy one minute and sad the next. Some people while taking this treatment can become low in mood or depressed. You may also have difficulty sleeping or your sleep pattern may be affected. Talk to your doctor or specialist nurse if you notice this.

Muscle and joint pain

This treatment can cause sore or weak muscles. Your joints may also be stiff, sore or swollen (arthritis). If you already have problems with joint pain, this may become worse. Contact the hospital on the 24-hour number if you have any of these symptoms during treatment or after it ends:

  • new or worsening aches or pains
  • new or worsening stiffness in a joint
  • swollen joints.

You may need steroids or other treatments, such as 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.

Effects on the heart

This treatment can affect how the heart works. You may have tests to check how well your heart is working. These may be done before, during and after treatment.

If the treatment is causing heart problems, your doctor may change the type of treatment you are having.

Contact the hospital straight away on the 24-hour number if you have any of these symptoms during or after treatment:

  • breathlessness
  • dizziness
  • changes to your heartbeat
  • swollen feet and ankles.

Other conditions can cause these symptoms, but it is important to get them checked by a doctor. 

Always call 999 if you have:

  • chest pain, pressure, heaviness, tightness or squeezing across the chest
  • difficulty breathing.

Changes in blood pressure

This treatment may cause low or high blood pressure. Tell your doctor or nurse if you have ever had any problems with your blood pressure. Your nurse will check your blood pressure regularly during treatment. Let them know if you feel dizzy or have any headaches.

Build-up of fluid

This treatment may cause your ankles and legs to swell. This is due to 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 give you support stockings to wear. The swelling gets better after your treatment ends.

Eye problems

Tell your doctor or nurse if you have blurry vision during treatment, or if your eyesight changes.

Raised blood sugar levels

This treatment may raise your blood sugar levels and increase the risk of diabetes. 

You will have regular blood tests to check this. 

Signs of raised blood sugar include:

  • feeling thirsty
  • needing to pass urine (pee) more often than usual
  • feeling more tired than usual.

Contact the hospital on the 24-hour number if you have these symptoms during treatment or after it ends.

If you already have diabetes, your blood sugar levels may be higher than usual. You may need advice and support from your GP or diabetes team about managing this.

Hearing problems

Lenalidomide can affect your hearing or cause ringing in the ears (tinnitus). Tell your doctor or nurse if you notice any hearing changes.

Effects on the kidneys and liver

This treatment can affect how your kidneys or liver work. This is usually mild and goes back to normal after treatment. You will have blood tests to check how well your kidneys and liver are working.

Contact your doctor straight away if you:

  • find it difficult to pass urine (pee)
  • are passing urine more, or less, often
  • have dark urine or blood in your urine
  • develop yellow skin or eyes
  • have unexplained bleeding or bruising.

Difficulty getting an erection

You may have difficulty getting or keeping an erection while on this treatment.

Less common side effects

Tumour lysis syndrome (TLS)

Some people are at risk of developing a condition called tumour lysis syndrome (TLS) during this treatment. When treatment makes large numbers of cancer cells die and break down quickly, they release lots of waste products into the blood. This can affect how well the kidneys work. It may also cause problems with the heart rhythm.

TLS can be prevented. You will have regular blood tests to check for TLS. If you are at risk of TLS, you may have:

  • extra fluids through a drip
  • medicines such as rasburicase through a drip, or allopurinol as tablets.

Drinking at least 2 litres (3½ pints) of fluid a day will also help.

Progressive multifocal leukoencephalopathy (PML)

Very rarely, this treatment may cause the following symptoms: 

  • blurred, loss of or double vision
  • difficulty speaking
  • weakness in an arm or a leg 
  • change in the way you walk or problems with your balance
  • persistent numbness
  • decreased sensation or loss of sensation, memory loss or confusion. 

These may all be symptoms of a serious and potentially fatal brain condition known as progressive multifocal leukoencephalopathy (PML). If you had these symptoms prior to treatment with lenalidomide, tell your doctor or nurse immediately about any change in these symptoms.

Other information

Blood clot risk

Cancer and some cancer treatments can increase the risk of a blood clot. Contact the hospital straight away on the 24-hour number if you have any of these symptoms during or after treatment:

  • throbbing pain or swelling in a leg or arm
  • reddening of the skin in the area – if you have black or brown skin, this can be harder to notice, but the skin might become darker
  • suddenly feeling breathless or coughing.

Always call 999 if you have:

  • chest pain
  • difficulty breathing.

A blood clot is serious, but it can be treated with drugs called anticoagulants. These thin the blood. Your doctor, nurse or pharmacist can give you more information about preventing and treating blood clots.

Hepatitis B and shingles

Some viral infections can become active again while you are taking this treatment. These may need treatment with anti-viral drugs. This includes hepatitis B (a liver infection) and herpes zoster (shingles). Your doctor or nurse will talk to you about this. Before you start treatment you will have a blood test to check if you have had hepatitis B.

Second cancer

This treatment can increase the risk of developing a second cancer years later. This is rare. The benefits of treatment usually far outweigh this risk. Your doctor can talk to you about this.

Driving

Lenalidomide may affect your ability to drive. Do not drive if you have blurred vision, or if you feel dizzy, very tired or sleepy. Talk to your doctor if you are not sure whether it is safe for you to drive.

Other medicines

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

Vaccinations

Doctors usually recommend that people with cancer have vaccinations for flu and for coronavirus (covid). These help reduce your risk of serious illness from these infections. Most people can have these vaccines, including people with weak immune systems. 

If your immune system is weak, you should not have live vaccinations. This is because they can make you unwell. Live vaccines, such as the yellow fever vaccine, contain a very weak version of the illness they will protect you against. It is important to ask your doctor, nurse or pharmacist for advice about having vaccinations. They can explain what vaccines are right for you and when it is best to have them.

Contraception

Your doctor, nurse or pharmacist will advise you not to get pregnant or make someone pregnant while having this treatment and for some time afterwards. The drugs may harm a developing baby. It is important to use contraception to prevent pregnancy. Follow their advice about:

  • what types of contraception to use 
  • how long after treatment you should continue to use contraception. 

Breastfeeding

You are advised not to breastfeed while having this treatment, or for some time after treatment ends. This is because the drugs could be passed to the baby through breast milk. 

Your doctor, nurse or pharmacist can give you more information.

Lactose

This treatment contains lactose. If you have an intolerance to some sugars, talk to your doctor before you start this treatment.

Donating blood

You must not give blood during this treatment, or for 1 week after.

Medical and dental treatment

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

If you have appointments with a dentist, always tell them you are having cancer treatment. Talk to your cancer team before you have any dental treatment.

About our information

  • Reviewers

    This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert health professionals and people living with cancer.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.

The language we use

We want everyone affected by cancer to feel our information is written for them.

We want our information to be as clear as possible. To do this, we try to:

  • use plain English
  • explain medical words
  • use short sentences
  • use illustrations to explain text
  • structure the information clearly
  • make sure important points are clear.

We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected.

You can read more about how we produce our information here.

Date reviewed

Reviewed: 01 July 2022
|
Next review: 01 February 2025
Trusted Information Creator - Patient Information Forum
Trusted Information Creator - Patient Information Forum

Our cancer information meets the PIF TICK quality mark.

This means it is easy to use, up-to-date and based on the latest evidence. Learn more about how we produce our information.