Last Modified: July 7, 2014
Classification: Immunomodulatory Agent
Thalidomide is a type of "immunomodulatory agent", meaning it works by affecting the immune system. The mechanism of action is not clear. It may work in a few ways: by inhibiting blood vessel formation (called anti-angiogenesis), enhancing how the immune system functions against the cancer cells or by decreasing growth factor production (one way tumors are “fed”).
How to Take Thalidomide
Thalidomide is given in a capsule form. Capsules should be swallowed whole with water - do not break or chew the capsules. Thalidomide is best taken before bedtime because it can cause sedation or sleepiness.
If you miss a dose and it is less than 12 hours since the dose was due, take it as soon as you remember. If it has been more than 12 hours, skip the dose. DO NOT take two doses to make up for a missed dose.
Thalidomide REMS Program
In order to receive thalidomide, 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 thalidomide 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 thalidomide 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 any breaks in treatment, 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 any breaks in treatment, 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.
- Do not donate blood while taking thalidomide, during breaks from treatment or for at least 4 weeks after stopping the medication.
Possible Side Effects of Thalidomide
There are a number of things you can do to manage the side effects of Thalidomide. 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:
When thalidomide was first introduced in the 1950's, it was used to treat insomnia, because drowsiness is the most common side effect in treating cancer patients. This can include fatigue, weakness, sleepiness, confusion and mood changes. It is best to take the medication at bedtime to reduce the tiredness during the day.
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°), 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.
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.
There are several things you can do to prevent or relieve constipation. Include fiber in your diet (fruits and vegetables), drink 8-10 glasses of non-alcoholic fluids a day and keep active. Your doctor or nurse can also recommend medications to relieve constipation. A stool softener once or twice a day may prevent constipation.
These include dryness, itching, and rash. You should use a moisturizer on your skin and lips, but avoid moisturizers with perfumes or scents. Your doctor or nurse can recommend medication if itching is bothersome. If your skin does crack or bleed, be sure to keep the area clean to avoid infection. For more suggestions, read theNail and Skin Care Tip Sheet.
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 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.
Other reported side effects
- Some people may experience dizziness when standing up from a sitting position and swelling. Sit for a minute before getting up from a lying position.
- Some people may develop a slow heartbeat (bradycardia). If you have dizziness, fainting or shortness of breath, notify your healthcare provider.
- Serious skin reactions can occur. If you develop a skin rash or peeling of your skin, notify your healthcare provider right away.
- Seizures have been reported while taking this medication. Notify your oncology provider if you have a seizure.