All About Thalomid (Thalidomide)

[Music] celludamide it is sold under the trade name salomid in the united states it's an oral drug um and it was approved by the fca for use in multiple myeloma patients in about 2006 and it was approved in combination with dexamethasone now we have more potent image so thalidomide is not used a lot in the united states in front line setting patients who have relapsed and refractory disease they do receive thalidomide uh sometimes uh it is used in combination um especially in my practice it i use it in combination with melphalan and pernicion um this combination which is called mpt is active in relapse refractory patients um salidomide can be used in combination with deratsumama bautism and dexamethasone and the dose is uh 200 milligrams every day and the dose is modified based on patients tolerance and side effect profile this is an immunomodulating drug it modulates immune system um it is uh it has effects on angiogenesis so it's an anti-angiogenesis agent and it decreases the production of cytokines which are the substances that tumor needs in order to maintain the blood supply and to get the important substances that it needs for its growth so it decreases the production of those cytokines one of those cytokines is hf and it also enhances the ability of immune system to recognize the malignant cells and it also has direct anti-myeloma effects and causes the killing of myeloma cells in terms of side effect profile the most common side effect that we see with thalidomide is fatigue some patients can have diarrhea it can also cause malgias and joint pain and it can also cause peripheral neuropathy so this is a side effect that needs to be monitored and treated and if the patient is getting quality of life affected because of this side effect then those modification of cellulite is needed peripheral neuropathy can be treated with certain medications like gabapentin and again if the quality of life is affected then we may need to decrease the dose of thydomide again this drug is also harmful to unborn fetus so it is distributed through ram's program provider patient and pharmacy have to participate in this program and make sure that if the patient is in fertile age group they are using adequate contraception and thalidomide also increases the risk of having blood clots especially when used in combination with dexamethasone patient has to be on adequate profile access for that prophylaxis could be anti-platelet agents like aspirin or in some patients who are high risk of developing blood clots we use anticoagulant coagulation like eliquids and lubinox to prevent blood clots it can also increase the risk of having other malignancies so patients need to be monitored closely and patients should always get age-appropriate cancer screening this drug increases the risk of having other malignancies so it's important that your doctor monitor you for that and get periodic blood work for the monitoring of any other hematological malignancy and you should always get age-appropriate cancer screening other second malignancies include hematological malignancies there is increased risk of developing leukemias and mds as well as solid tumors like colon cancer and breast cancer i have patients in my clinic who got all of these the percentage is small but this is still something that we need to look for and be careful about that's a very good question i um emit linoledamide or pomalidomide can make you feel fatigued and tired so i always tell my patients take it at night before you go to bed if you are taking steroids with image you can take steroids during the day time early morning because steroids can interfere with sleep one of the most common side effects of image is rash and itching so this is a side effect that can scare the patients rash appears as reddish spots it can start from your body or it can start on your arms or legs and it can spread there can be itching associated with rash sometimes patients have a rash as bad as full skin involvement so um it has something to do with the immunomodulating action of image in my patients i never give up on image because of rash if the patient has mild rash which means that you have some spots on your arms and your body then i add antihistamine drugs like citrusine during the daytime or benadryl at night and able to control the rash if the rash is swear which means that it involves most of your body and is itching a lot then i hold emit a drug for a week or so until the rash improves and adds citrusine or benadryl at night as well as steroids like short course of renaissance once the rash improves i'd re-challenge with the same drug i rechallenge within alidamite or pomalidamite and tell the patient that when you restart your immune molecule drug add citrizine or banana drill with it and take it together for a few weeks and then see what happens some patients develop rash again and i go to the same cycle again but eventually patients develop tolerance and are able to take the drug without [Music] rash