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Pomalidomide (Pomalyst®)

Last Modified: November 14, 2013

Pomalidomide is a type of "immunomodulatory agent", meaning it works by affecting the immune system. The exact way it works to fight cancer is unknown. It appears to work in several ways, including inhibiting the formation of blood vessels, which tumors use to get nutrients needed to survive and grow. This is known as anti-angiogenesis. It also interferes with chemicals necessary for the growth of tumors and can cause cell death.

How to take pomalidomide

Pomalidomide is given in a capsule form. Swallow the capsule whole with water – do not break, crush or chew this medication. Take this medication without food and at least 2 hours before or 2 hours after a meal. Store this medication at room temperature.

If you miss a dose and it has been less than 12 hours since your regular dose time, take it as soon as you remember. If it has been more than 12 hours, skip the dose. Do not take 2 doses at once to make up for a missed dose. Do not smoke tobacco while taking this medication, as this can reduce the effectiveness of the medication. Be sure your healthcare provider is aware of all the medications and supplements you are taking, as this medication can interact with some other medications.

Pomalyst REMS Program

In order to receive pomalidomide, patients will need to participate in a program called REMS (Risk Evaluation and Mitigation Strategy). This program educates healthcare professionals and patients about the dangers of pomalidomide exposure to a fetus. This exposure can cause serious birth defects and patients taking the medication will need to use two reliable forms of birth control. This includes men taking pomalidomide because it is present in sperm. The REMS program limits who can prescribe and dispense the medication. Patients will also need to complete a survey and safety agreement before starting the drug and every month they are taking it. Important safety reminders:

  • Women should not become pregnant for 4 weeks before therapy, during therapy or for 4 weeks after therapy is stopped.
  • Women must agree to use 2 forms of reliable birth control during this time.
  • Men should not father a child for 4 weeks before therapy, during therapy or for 4 weeks after therapy is stopped.
  • Men must use a condom for any sexual contact during this time, even if they have had a vasectomy.
  • Any pregnancy (in women taking the medication OR partners of men who take the medication) should be reported to your oncology team right away.
  • Do not donate blood or sperm during therapy and for at least 1 month after stopping therapy.

Possible Side effects of pomalidomide

There are a number of things you can do to manage the side effects of pomalidomide. Talk to your doctor or nurse about these recommendations. They can help you decide what will work best for you. These are some of the most common side effects:

Low White Blood Cell Count (Leukopenia or Neutropenia)

White blood cells (WBC) are important for fighting infection. While receiving treatment, your WBC count can drop, putting you at a higher risk of getting an infection. You should let your doctor or nurse know right away if you have a fever (temperature greater than 100.4 F), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn't heal.

Tips to preventing infection:

  • Washing hands, both yours and your visitors, is the best way to prevent the spread of infection.
  • Avoid large crowds and people who are sick (i.e.: those who have a cold, fever or cough or live with someone with these symptoms).
  • When working in your yard, wear protective clothing including long pants and gloves.
  • Do not handle pet waste.
  • Keep all cuts or scratches clean.
  • Shower or bath daily and perform frequent mouth care.
  • Do not cut cuticles or ingrown nails. You may wear nail polish, but not fake nails.
  • Ask your doctor or nurse before scheduling dental appointments or procedures.
  • Ask your doctor or nurse before you, or someone you live with, has any vaccinations.

For more suggestions, read the Neutropenia Tip Sheet.

Low Red Blood Cell Count (Anemia)

Your red blood cells are responsible for carrying oxygen to the tissues in your body. When the red cell count is low, you may feel tired or weak. You should let your doctor or nurse know if you experience any shortness of breath, difficulty breathing or pain in your chest. If the count gets too low, you may receive a blood transfusion. Read the anemia tip sheet for more information.

Low Platelet Count (Thrombocytopenia)

Platelets help your blood clot, so when the count is low you are at a higher risk of bleeding. Let your doctor or nurse know if you have any excess bruising or bleeding, including nosebleeds, bleeding gums or blood in your urine or stool. If your platelet count becomes too low, you may receive a transfusion of platelets.

  • Do not use a razor to shave (an electric razor is fine).
  • Avoid contact sports and activities that can result in injury or bleeding.
  • Do not take aspirin (salicylic acid), non-steroidal, anti-inflammatory medications (NSAIDs) such as Motrin®, Aleve®, Advil®, etc. as these can all increase the risk of bleeding. Unless your healthcare team tells you otherwise, you may take acetaminophen (Tylenol).
  • Do not floss or use toothpicks and use a soft-bristle toothbrush to brush your teeth.

Read the thrombocytopenia tip sheet for more information.


While on cancer treatment you may need to adjust your schedule to manage fatigue. Plan times to rest during the day and conserve energy for more important activities. Exercise can help combat fatigue; a simple daily walk with a friend can help. Talk to your healthcare team and see OncoLink's section on fatigue for helpful tips on dealing with this side effect.

Peripheral Neuropathy (Numbness or Tingling in the Hands and/or Feet)

Peripheral neuropathy is a toxicity that affects the nerves. It causes a numbness or tingling feeling in the hands and feet, often in the pattern of a stocking or glove. This can get progressively worse with additional doses of the drug. In some people, the symptoms slowly resolve after the drug is stopped, but for some it never goes away completely. You should let your healthcare provider know if you experience numbness or tingling in the hands and feet, as they may need to change the doses of your medication. See OncoLink's section on peripheral neuropathy for tips on dealing with this side effect.

Blood Clots

Blood clots are a side effect of this medication and of cancer itself. They occur most frequently in the legs/calves or the lungs. Your healthcare provider may prescribe a blood thinner to reduce the risk of blood clots. Signs of a blood clot in the leg may include any of the following: leg pain, warmth, swelling of one leg more than the other. Signs of a blood clot in the lung could include: fever, shortness of breath that comes on you very quickly, racing heart, chest pain (that tends to be worse when you take a deep breath).

If you have any of these signs or symptoms of blood clots, you will need to be seen immediately so that you can be treated. Blood thinners can be given. Call your doctor or nurse.

Secondary Malignancies

There is a slight risk of developing leukemia or other type of cancer due to treatment with this medication.

Dizziness & Confusion

In clinical trials of this medication, some patients experienced dizziness and confusion. Do not operate a vehicle or machinery until you know how this medication affects you. Do not combine this medication with other medications that can cause dizziness and confusion. Do not drink alcohol while taking this medication.


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Don't Assume You Understand
by Bob Riter
July 29, 2015

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