Pomalidomide (Imnovid®)

Pomalidomide is a targeted therapy drug used to treat myeloma.

It is best to read this information with our general information about targeted therapies and the type of cancer you have.

Pomalidomide is given as capsules. You usually have it as an outpatient. Your cancer doctor, nurse or pharmacist will tell you how often you will have it.

Like all targeted therapy drugs, pomalidomide can cause side effects. Some of the side effects can be serious, so it is important to read the detailed information below.

Your healthcare team can give you advice on how to manage any side effects. Tell your doctor or nurse straight away if you:

  • have a temperature
  • feel unwell
  • have severe side effects, including any we do not mention here.

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

If you need medical attention for any reason other than cancer, always tell the healthcare staff that you are having this treatment.

What is pomalidomide?

Pomalidomide is a targeted therapy drug used to treat myeloma.

It is best to read this information with our general information about targeted therapies and myeloma.

During treatment, you will see a cancer doctor or nurse. This is who we mean when we mention a doctor or nurse in this information.

How targeted therapies work

This animation shows how targeted therapies work and what effect they have on the body.

About our cancer information videos

How targeted therapies work

This animation shows how targeted therapies work and what effect they have on the body.

About our cancer information videos


How pomalidomide works

Pomalidomide kills or stops the growth of myeloma cells. It blocks the development of new blood vessels. Cancer cells need to make new blood vessels so they can grow and spread. Making blood vessels is called angiogenesis. Pomalidomide also helps the immune system attack and destroy the myeloma cells.


When pomalidomide is used

Pomalidomide is used to treat multiple myeloma if other treatments, including lenalidomide and bortezomib have stopped working. You have pomalidomide with a steroid drug called dexamethasone.

Pomalidomide may only be available in some situations. Your cancer doctor can tell you whether it is suitable for you. Some people may be given it as part of a clinical trial.


Taking pomalidomide

You have pomalidomide as capsules that you can take at home. The capsules come in 4 strengths: 1mg, 2mg, 3mg and 4mg. Your doctor, nurse or pharmacist will tell you how many of each tablet to take. Always take pomalidomide exactly as explained. This is to make sure they work as well as possible for you.

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 usually take pomalidomide once a day for 3 weeks. Then you will have no pomalidomide for one week. The 3 weeks and the break is called a cycle of treatment. After this, you start your second cycle of treatment.

You usually take pomalidomide with a steroid called dexamethasone. You take dexamethasone on the first day of each week of the cycle, including the week you do not take the pomalidomide.

Take dexamethasone after a meal or with milk as it can irritate your stomach. Dexamethasone can cause sleep problems. Try taking it in the morning so you sleep better at night.

You have pomalidomide as a course of several cycles of treatment for as long as it works well for you.

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

  • If you forget to take pomalidomide, contact your doctor or nurse. Do not take an extra dose.
  • Keep them in the original package at room temperature, away from heat and direct sunlight.
  • Keep this medicine safe and out of the reach of children.
  • Wash your hands after touching the capsules.
  • If your treatment is stopped, return any remaining capsules to the pharmacist.


Preventing pregnancy while taking pomalidomide

You must not become pregnant or father a child while taking pomalidomide. It may cause severe abnormalities in developing babies. You must take part in a pregnancy prevention programme during treatment.

Your doctor or specialist nurse will give you information about the risks of pomalidomide and pregnancy. They will ask you to sign a consent form once you have read the information.

For women taking pomalidomide

If you are of child-bearing age, you must have a pregnancy test before you start treatment. 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 or injection or the progesterone-only pill. The combined oral contraceptive pill is not recommended because it increases the risk of developing blood clots. You must use contraception for 4 weeks before treatment, during treatment and 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.

For men taking pomalidomide

You must use a condom during sex while taking pomalidomide and for 7 days after stopping it. This is to protect your partner from pomalidomide which can pass into your semen. 

Female partners who could become pregnant should also use contraception to prevent a pregnancy. If your partner thinks they might be pregnant while you are having this treatment, contact your doctor or specialist nurse straight away.


Possible 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.

You may have some side effects that we haven’t 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

Allergic reaction

Some people may have an allergic reaction to pomalidomide. 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 infection

Pomalidomide can reduce the number of white blood cells, which help to fight infection. If the number of your white blood cells is low, you are more likely to get an infection. 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)
  • 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.

You will have regular blood tests to check the number of white blood cells. These will be more frequent during the first one or two cycles of treatment. If your number of blood cells (blood count) is still low, your treatment may need to be delayed.

Bruising and bleeding

Pomalidomide 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 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)

Pomalidomide 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 (blood transfusion).

Increased risk of blood clots

Cancer increases the chances of a blood clot (thrombosis) and pomalidomide can add to this. While you are taking pomalidomide, you may be given drugs to thin your blood and help prevent clots forming.

A clot can cause symptoms including:

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

If you have any of these symptoms, contact your doctor straight away. A blood clot is serious, but it can be treated with drugs that thin the blood. Your doctor or nurse can give you more information.

Skin changes

Your skin may become dry and itchy. You may also notice a rash. Tell your doctor or nurse if you have any of these symptoms. They can give you creams and drugs to help. Occasionally, pomalidomide can cause a more serious skin rash. If this happens, let your doctor know straight away.

Constipation

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

  • Drink at least two litres (three and a half 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

If you have diarrhoea, its can usually be easily controlled with anti-diarrhoea medicines. Your doctor can give you these. If the diarrhoea is severe or continues, tell your doctor. Try to drink around 2 litres (3 and a half pints) of fluids every day.

Feeling sick

This is usually mild. Your doctor can give you anti-sickness (anti-emetic) drugs to help prevent or control sickness. If you still feel sick, tell your doctor. They can give you other anti-sickness drugs that may work better for you.

Loss of appetite

This treatment can affect your appetite. Don’t worry if you don’t eat much for a day or two. But if your appetite does not come back after a few days, tell your nurse or dietitian. They will give you advice. They may give you food or drink supplements.

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 don’t improve or get worse, tell your doctor.

Feeling tired

Feeling tired is a common side effect. 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.

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)

You may find it hard to fasten buttons or do other fiddly tasks. 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.

Heart problems

Sometimes pomalidomide can affect the heart. You may feel like your heart is beating too fast or too slow. If you notice any changes, or have chest pain or tightness, contact your doctor straight away.

Build up of fluid

Parts of the body, including your arms and legs, may swell because of fluid building up. Tell your doctor or nurse if this happens. The swelling gets better after your treatment ends.

Effects on the nervous system

Pomalidomide can affect the nervous system. You may feel confused, dizzy or unsteady. Tell your doctor or nurse straight away if you notice this. If you feel like this, don't 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 notice you are finding it difficult to pass urine, contact your doctor straight away. Also let your doctor know if you are going to the toilet more or less often or there is blood in your urine.


Less common side effects

Tumour lysis syndrome (TLS)

Pomalidomide 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 this 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.

Effects on the lungs

Sometimes people feel more breathless or develop an infection while taking pomalidomide. Rarely, pomalidomide can cause a condition in which the lungs become inflamed. This can be very serious. If you suddenly become breathless or your breathing gets worse, contact the hospital straight away.

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

Driving

If you feel dizzy, very tired or sleepy, don't drive. Talk to your doctor for advice if you are not sure whether you are safe to drive.

Other medicines

It can be harmful to take some medicines when you are taking pomalidomide. Tell your doctor about any medicines you are taking, including vitamins, herbal drugs and complementary therapies.

Fertility

Doctors don’t yet know how pomalidomide may affect your fertility. If you are worried about this, talk to your doctor before your treatment starts.

Breastfeeding

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

Medical or dental treatment

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

If you need dental treatment, always tell your dentist you are having pomalidomide.