How it is administered

Thalidomide is taken by mouth as a capsule. It is available in strengths of 50 mg, 100 mg, 150 mg, and 200 mg. The capsules should be swallowed whole with water, preferably at bedtime and at least 1 hour after the evening meal.

How it works

Thalidomide is an immunomodulatory agent, meaning it helps regulate the immune system. Its exact mechanism of action is not fully understood, but it is known to work through a protein called cereblon, which is part of a complex that helps regulate the breakdown of certain proteins in cells. Thalidomide has several effects: it reduces inflammation, suppresses the production of certain immune signals (like tumor necrosis factor-alpha), and inhibits the growth of new blood vessels (angiogenesis).

In multiple myeloma, a type of blood cancer, thalidomide helps slow the growth of cancer cells and affects the environment around the tumor, making it harder for the cancer to survive and spread. It also increases the activity of natural killer cells and certain cytokines that help the body fight cancer.

Who Should take it

Thalidomide is used in combination with dexamethasone to treat patients with newly diagnosed multiple myeloma, a cancer of the plasma cells in the bone marrow. It may also be used for other conditions as determined by your doctor, but its main use in blood cancers is for multiple myeloma.

Patients who are prescribed thalidomide should be closely monitored by their healthcare team, and the medication is only available through a special program (THALOMID REMS) due to its risks.

Who should not take it

Thalidomide should NOT be taken by women who are pregnant or who may become pregnant, as it can cause severe birth defects or death of an unborn baby, even with a single dose. Women of childbearing potential must use two reliable forms of birth control and have regular pregnancy tests before, during, and after treatment.

People who have had a severe allergic reaction to thalidomide or any of its components should not take it. Caution is also needed in people with a history of blood clots, nerve damage, or certain heart problems.

Commonly used with

Thalidomide is most commonly used with dexamethasone for treating multiple myeloma. It may also be used with other chemotherapy agents or supportive medications, depending on your treatment plan.

Because thalidomide increases the risk of blood clots, your doctor may also prescribe blood thinners or recommend other preventive measures.

Commonly tested with

In clinical studies for multiple myeloma, thalidomide has been tested in combination with dexamethasone and sometimes with other chemotherapy drugs. It is not recommended to use thalidomide with certain immune checkpoint inhibitors (like pembrolizumab) outside of clinical trials, as this combination has been associated with increased risk of death in patients with multiple myeloma.