Lenalidomide (Revlimid®)

OncoLink
Last Modified: August 22, 2011

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Pronounced: LEN-a-LID-oh-mide
Classification: Immunomodulatory Agent

About Lenalidomide

Exactly how lenalidomide works to kill cancer cells is not clear. It appears to increase the body's immune response, prevent growth of blood vessels to feed the cancer (antiangiogenesis) and decreasing the production of proteins that fuel growth of cancer cells.

How to Take Lenalidomide

Lenalidomide comes in a capsule and is should be taken with water once daily for 21 days, then 7 days off therapy before starting again. Take lenalidomide at around the same time every day, with or without food. Do not break, chew or open the capsules. If you touch a broken capsule or come into contact with the medicine inside, wash the area with soap and water.

Possible Side Effects of Lenalidomide

There are a number of things you can do to manage the side effects of Lenalidomide. 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:

Reproductive Concerns

Lenalidomide is similar to the drug thalidomide, which can cause severe life-threatening birth defects. You should not become pregnant or father a child while on this medication. Patients will need to agree to the following in order to be prescribed this medication:

  • Women must use 2 forms of effective birth control for 4 weeks prior to starting, during treatment and for 4 weeks after stopping treatment with this medication.
  • Men must use a latex condom during any sexual contact with a female, even if they have had a vasectomy or the woman is already pregnant. Men will need to do this while on treatment and for 4 weeks after stopping therapy.
  • Men should not donate sperm while on therapy or for 4 weeks after stopping therapy.
  • Women should not become pregnant or breastfeed while taking this medication.
  • Do not donate blood while on this therapy as it can be passed on to another person.
  • If you or your partner becomes pregnant while on treatment, notify your physician immediately.

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 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.

Fatigue

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.

Diarrhea

Your oncology team can recommend medications to relieve diarrhea. Also, try eating low-fiber, bland foods, such as white rice and boiled or baked chicken. Avoid raw fruits, vegetables, whole grain breads, cereals and seeds. Soluble fiber is found in some foods that absorbs fluid and can help relieve diarrhea. Foods high in soluble fiber include: applesauce, bananas (ripe), canned fruit, orange and grapefruit sections, boiled potatoes, white rice and products made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Drink 8-10 glasses on non-alcoholic, un-caffeinated fluid a day to prevent dehydration. Read Low Fiber Diet for Diarrhea for more tips.

Skin Reactions

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 the Nail and Skin Care Tip Sheet.

Lenalidomide can cause a serious skin reaction and swelling under the skin. If you develop a rash, skin reaction or swelling, notify your healthcare team right away.

Muscle or Joint Pain/Aches and Headache

Your doctor or nurse can recommend medication and other strategies to relive pain. Also view OncoLink's page on pain management.

Blood Clots

Blood clots are a rare side effect that can occur anywhere in the body. They occur most frequently in the calves or the lungs. People at risk for developing blood clots include those with a family history of blood clots, smokers, those who have an inactive lifestyle, older people, and those with other medical problems.

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 Concerns

Clinical trials found that patients who have taken this medication may be at increased risk of developing another type of cancer compared to those who did not take the drug. The FDA is investigating this. Talk to your physician about the risks and benefits of taking this medication.


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