Managing Gastro Issues Caused by Lenalidomide

Many multiple myeloma patients know all too well the discomfort of gastrointestinal side effects caused by lenalidomide Revlimid, Bristol Myers Squibb.) 

If you are struggling with persistent diarrhea, you are not alone. Recent research from Memorial Sloan Kettering Cancer Center explored the effectiveness of Colesevelam, a type of drug known as a bile acid sequestrant,  in managing this challenging side effect. In this article, we delve into the study's findings and what they could mean for your treatment journey.

How Prevalent or Severe is Diarrhea in Myeloma Patients Taking Lenalidomide?

Diarrhea affects approximately 20-40% of patients undergoing lenalidomide, with the severity ranging from grade 1 (mild) to grade 3 (severe). 

Many of these patients experience serious gastrointestinal challenges that significantly disrupt their quality of life. Commonly reported symptoms include discomfort with leaving their home due to fear of an unexpected bowel movement, a decrease in participation in social events, and physical discomfort throughout their body. 

Some will struggle with the inability to carry on daily activities, feelings of nausea, dehydration, and recurrent infections. It can also be challenging to constantly worry about managing the social and physical impact on your well-being because of these symptoms. 

Understanding Diarrhea and How Colesevelam Could Be a Solution

Recent research to help alleviate symptoms has directed us to antidiarrheals (i.e. bile acid binders) such as Colesevelam. 

Picture bile acids as water flowing through your kitchen sink. Sometimes, excess bile acids can overwhelm your digestive system, a condition called bile acid malabsorption. This overload of bile acids can lead to diarrhea, similar to water overflowing past the sink.

Colesevelam binds to excess bile acids in your intestines, acting like a drain strainer placed over your sink catching excess food particles and preventing a drain clog. With the strainer in place, the sink can handle the water flow without overflowing. Similarly, by reducing the amount of free bile acids, Colesevelam prevents diarrhea and allows your digestive system to function smoothly.

MSKCC Research Explores the Topic Further 

Dr. Malin Hultcrantz and her team are dedicated to improving the quality of life for multiple myeloma patients, including managing gastrointestinal side effects like lenalidomide-induced diarrhea.

In a study involving 25 multiple myeloma patients experiencing this side effect, Dr. Hultcrantz's team prescribed a daily dose of 1250 mg of colesevelam (two 625 mg tablets) for 12 weeks.

The results were promising: 22 out of 25 patients saw an improvement within two weeks. Of these, 17 reported that their diarrhea had completely resolved, while the other 5 noted a reduction in severity by one grade.

Though a small study size sample, these findings suggest that colesevelam can be a practical and effective solution for managing diarrhea. This would enable myeloma patients on lenalidomide to continue their treatment with minimal disruption to their quality of life.

Side Effects of Colesevelam 

Bile acid binders are not without their side effects. While many were manageable, those taking it or similar medications should watch out for constipation, acid reflux, and gas. Talk to your treating physician about other possible side effects if taking the drug. 

Conclusion

Managing symptoms surrounding your treatment can be stressful, but it is crucial to optimize your quality of life. Bile acid binders such as Colesevelam offer a promising solution to gastrointestinal side effects, such as diarrhea, that may impact your life in unwanted ways. 

If you are experiencing diarrhea or other gastro issues while on Revlimid, discuss the possibility of using Colesevelam or another medication with your healthcare provider. Together, you can determine the best strategy to manage your symptoms and maintain your treatment regimen effectively.

If you are looking for crowd-sourced solutions to your side effects, including diarrhea or other gastro issues, check out our Side Effects Solutions tool curated just for you. While this is not meant to replace consulting with your doctor or provide medical advice, you can learn what has worked (or what hasn’t) from other people in managing difficult myeloma-related side effects. 

Side Effect Solutions Tool

Sources: 

• Colesevelam for lenalidomide associated diarrhea in patients with multiple myeloma - PubMed