Revlimid-Lenalidomide

Patient Education Quick Reference Guide Diablo Valley Oncology/Hematology Medical Group Phone Number: 925-677-5041

Description Your treatment is called lenalidomide (len-a-LID-oh-mide) or Revlimid® (REV-li-mid). It is commonly used to treat multiple myeloma and has also been used to treat other diseases. Lenalidomide stops the growth of and kills abnormal (myeloma) cells and allows the normal cells to work properly.

What Do I Need to Know Before Starting Treatment?

  • Be sure to tell your healthcare provider about any prescription or over-the-counter products you are taking, including dietary supplements, vitamins, herbal medicines and homeopathic remedies.
  • Avoid breastfeeding during treatment. It is not known if lenalidomide passes into breast milk.
  • Some chemotherapy drugs can cause sterility. Talk with your healthcare provider about your options if you want to have children in the future.
  • Do not get any immunizations or vaccinations while you are being treated without the approval of your healthcare provider.
  • Because lenalidomide can cause significant harm to a fetus (see “What Do I Need to Know Before Starting Lenalidomide?”), you must be registered in the RevAssist? Program to take lenalidomide. This handout is not a replacement for the requirements of the RevAssist Program.
 

What Do I Need to Know Before Starting Lenalidomide?

  • Lenalidomide can cause severe fetal harm, including life-threatening birth defects. Even one dose taken by a pregnant woman can cause severe birth defects. When taking this medication, women should not have sexual intercourse OR should use at least two forms of effective birth control for at least one month before beginning lenalidomide, during treatment and for one month after stopping treatment. In addition, women who could become pregnant (women who have not had a hysterectomy and who have had a period in the last 24 months) should have a pregnancy test 10 to 14 days before starting lenalidomide, a pregnancy test 24 hours before starting lenalidomide and have pregnancy tests regularly during treatment to make sure they are not pregnant. Men who are taking lenalidomide (even those who have had a vasectomy) should use a latex condom during any sexual contact. If you or your partner misses a period, has abnormal menstrual bleeding or becomes pregnant while taking lenalidomide, stop taking the medicine and contact your healthcare provider right away.
  • Those with kidney disease may be at greater risk of side effects from lenalidomide. Tell your healthcare provider if you have ever had kidney problems.
  • Lenalidomide can cause blood clots in the veins and, in rare cases, in the lungs. Blood clots are more common when lenalidomide is used with another drug called dexamethasone. Tell your healthcare provider right away if you have chest pain, shortness of breath or swelling in the arm or leg. Your healthcare provider may give you a medicine to help reduce the risk of blood clots.
  • You should not donate blood while you are taking lenalidomide.
  • If you are a male, you should not donate sperm while taking lenalidomide.
Your treatment can interact with other substances, including:
  • Digoxin (Lanoxin®)
Some medicines interfere with the effectiveness of birth control pills (oral contraceptives). If you are taking birth control pills and one of the following drugs, you will need to use two OTHER effective methods of birth control while taking lenalidomide:
  • Drugs used to treat HIV, such as atazanavir (Reyataz®), indinavir (Crixivan®), nelfinavir (Viracept®), ritonavir (Norvir®) or saquinavir (Invirase®)
  • Griseofulvin (Grifulvin V® or Gris-PEG®)
  • Modafinil (Provigil®)
  • Rifabutin (Mycobutin®) or rifampin (Rifadin®)
  • Penicillins
  • Phenytoin (Dilantin®), phenobarbital (Luminal®) or carbamazepine (Tegretol®)
  • St. John’s Wort
Please note this list is a summary and does not contain all possible drug interactions. Contact your healthcare provider if you are taking any medications that can interact with your treatment.

Who Should Not Take This Treatment

You should not take this treatment if you are pregnant or are at risk of becoming pregnant or if you are allergic to lenalidomide or any of its components.  

How Is the Treatment Given?

  • You will take lenalidomide by mouth once a day. Try to take lenalidomide at around the same time every day. You can take lenalidomide with or without food. If you miss a dose and you remember the same day, take it as soon as you remember. If you miss your dose for a whole day, skip it and continue with the dose for the next day. Do not take two doses at the same time. It is important to take lenalidomide exactly as prescribed. Do not stop the medicine or change the dose without talking with your healthcare provider. Swallow lenalidomide capsules whole with water. Do not break, chew or open your capsules.
  • Store lenalidomide at room temperature away from children and pets. If you take too much lenalidomide, contact your healthcare provider, local poison control center or emergency room right away.
  • Do not share your medication with others. Sharing this medication with anyone else could be harmful.

When Should I Call My Healthcare Provider?

Call your healthcare provider right away if you have any of the following symptoms:
  • Shaking chills or fever of 100.5 degrees F or higher
  • Unusual bleeding, easy bruising or pinpoint red spots on your skin
  • Vomiting that is severe or that lasts several hours
  • Painful or frequent urination or blood in your urine
  • Diarrhea that causes an additional four bowel movements a day, diarrhea that lasts more than one day, diarrhea at night or diarrhea with fever, cramps or bloody stools
  • Irregular or rapid heart beat, chest pain or chest tightness
  • Dizziness or feeling lightheaded
  • Inability to eat or weight loss
  • Pain in the arms or legs or sudden shortness of breath
 

What Are the Possible Side Effects?

All drugs can cause side effects, but every person reacts differently to each drug. The following chart lists the possible side effects that can occur with your treatment, how to recognize and minimize symptoms and possible treatments. The side effects are grouped by how often the side effect occurs: Common (occurs in more than 25 percent of patients), Less Common (occurs in 5 to 25 percent of patients) or Rare (occurs in less than 5 percent of patients). Some of these side effects occur more commonly when used in combination with a drug called dexamethasone.

Side Effect

How to Minimize Side Effect

Possible Treatments

Risk of Infection (Common)
  • Fever and chills
  • Painful urination
  • Sore throat and cough
  • Nasal congestion
  • Swelling or redness of the skin at the site of a wound
  • Wash your hands often.
  • Brush and floss your teeth daily.
  • Clean cuts right away with warm water, soap and antiseptic.
  • When your white blood cell count is low, stay away from crowds and people with colds or other illnesses.
  • You may be given medicine to increase your white blood cell count.
  • You may be given an antibiotic to treat or prevent infection.
  • Your healthcare provider may decrease your dose or delay further treatment.
Risk of Bleeding (Common)
  • Unusual bleeding or easy bruising
  • Black or tar-like stools
  • Blood in your urine
  • Pinpoint red spots on your skin
  • Bleeding gums or nosebleeds
  • Avoid aspirin and aspirin-like drugs, such as ibuprofen.
  • Use caution with sharp objects, such as razors and nail cutters.
  • Avoid activities that can cause cuts, bumps and bruises.
  • You may be given medicine to increase your platelet count.
  • Your healthcare provider may decrease your dose or delay further treatment.
Anemia (Less Common)
  • Fatigue or weakness
  • Dizziness
  • Pale skin
  • Feeling out of breath
  • Feeling cold
  • Plan rest periods throughout the day.
  • Organize daily activities so that you conserve your energy.
  • Try to eat a well balanced diet and drink plenty of fluids.
  • Stand up slowly to avoid getting dizzy.
  • You may be given medicine to increase your red blood cell count.
  • Your healthcare provider may decrease your dose or delay further treatment.
Diarrhea (Less Common. Symptoms are generally mild, but can be moderate.)
  • Loose or watery stools several times a day
  • Abdominal cramping, gas and bloating
 
  • Eat small, frequent meals and bland foods—such as bananas, rice, applesauce and toast.
  • Avoid caffeine; alcohol; raw fruits and vegetables; raw eggs; undercooked meats; spicy, fatty and greasy foods; milk and dairy products; foods that cause gas, such as beans and other legumes; high fiber and high-fat foods; foods left un-refrigerated for more than two hours (one hour for egg dishes and cream or mayonnaise-based foods); bulk laxatives; and stool softeners.
  • Drink eight to ten glasses of clear liquids every day.
  • Your healthcare provider may prescribe medicine to help treat diarrhea.
Constipation (Less Common. Symptoms are generally mild, but can be moderate.)
  • No bowel movement for one to two days
  • Small, hard, dry stools
  • Bloating, gas, cramps and pain
  • Drink plenty of fluids to help loosen your bowels.
  • Drink warm or hot liquids if you do not have mouth sores.
  • Your healthcare provider may suggest eating foods that are high in fiber, such as bran, vegetables, whole wheat breads and fruit.
  • Try prunes or prune juice, which act like laxatives.
  • Exercise can help loosen bowels.
  • Your healthcare provider may recommend a stool softener.
Neuropathy (Less Common. Symptoms are generally mild, but can be moderate.)
  • Numbness or tingling feeling in the hands or feet
  • Muscle cramps
  • Loss of balance
  • Difficulty buttoning buttons or picking up objects
  • Decreased awareness of heat or cold in fingertips and toes
  • Difficulty hearing
 
  • Try to avoid the cold or extreme heat.
  • Wear mittens or gloves, socks and scarves.
  • If your fingers are numb, be careful with sharp objects.
  • Beware of hot coffee mugs, pots and pans and dishwater—you may not feel the heat until you are burned.
  • If you feel unsteady, be careful on stairs and in the shower.
  • Your healthcare provider may decrease your dose or delay further treatment.
Nausea/Vomiting (Less Common. Usually occurs when used with dexamethasone.)
  • Feeling queasy or sick to your stomach
 
  • Eat small, frequent meals and bland foods—such as bananas, rice, applesauce and toast.
  • Eat food cold or at room temperature so the smell of food will not bother you.
  • Avoid fried, spicy or fatty foods.
  • Eat and drink slowly.
  • Drink plenty of liquids during the day, but to avoid bloating, drink small amounts of liquid during meals.
  • You will be given medicine to help reduce nausea and vomiting.
Fluid Retention (Less Common. Usually occurs when used with dexamethasone.)
  • Swelling around the eyes, lower legs, ankles, feet or abdominal area
  • Slight weight gain
 
  • Check your weight regularly.
  • Try to avoid eating salty foods, as this can cause fluid retention.
  • You may be given a diuretic (water pill) to reduce the amount of fluid in your body.
  • Your healthcare provider may decrease your dose or delay further treatment.
Anorexia or Appetite Loss (Less Common. Usually occurs when used with dexamethasone.)
  • Not having an appetite
  • Feeling too nauseated to eat
  • Metallic or medicinal taste
  • Change in taste causing dislike for certain foods
  • Try eating six to eight small meals or snacks each day instead of three larger meals.
  • Vary your diet and try new foods and recipes.
  • Take a walk before meals, when possible. This may make you feel hungrier.
  • Eat with friends or family. When eating alone, listen to the radio or watch TV.
  • Cook dinners ahead of time and freeze them in small portions so that cooking smells are minimized.
  • Let others help with food, but ask that foods be prepared in small portions that can be frozen. And don’t hesitate to let them know which foods to avoid.
  • Add mild spices to change flavor.
  • It might be helpful to have a program, such as Meals on Wheels, deliver food to you.
Rash (Less Common. Usually occurs when used with dexamethasone)
  • Usually mild and short-lived
  • Generally appears on the arms and trunk (occasionally on the face)
  • May be itchy
  • May appear as a flat, discolored area on the skin or as a small raised bump
 
  • Avoid prolonged exposure to heat.
  • Use creams or moisturizers regularly. Try wearing cotton gloves on your hands.
  • Avoid using perfume, cologne or aftershave since these products can be irritating to the skin
  • Your healthcare provider may prescribe creams (mild steroids, antihistamines or antibiotics) to help treat the rash.
  • The rash may improve on its own without any treatment.
 

What Are the Other Possible Side Effects?

The chart below lists additional side effects found with the individual drugs in this treatment. Most of these side effects occur when lenalidomide is used in combination with a drug called dexamethasone. It does not list all possible side effects. For more information, talk with your healthcare provider.  

Common Side Effects

  • Muscle cramps
  • Difficulty sleeping
  Less Common Side Effects
  • Fatigue or weakness
  • Blurred vision
  • Indigestion
  • Increased blood sugar or decreased potassium
  • Joint or back pain
  • Headache or dizziness
  • Problems with taste
  • Tremor
  • Cough, shortness of breath or pneumonia
 

Rare Side Effects

  • Heart rhythm changes
  • Depression
  • Confusion