Thalamid-Thalidomide

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

Description Your chemotherapy treatment is called thalidomide (tha-LI-doe-mide) or Thalomid® (THAL-o-mid). Thalidomide is commonly used to treat multiple myeloma and has also been used to treat other diseases. Thalidomide is a type of drug called an immunomodulator. It slows or stops the growth of abnormal (myeloma) cells and eventually causes the cancer cells to shrink and die.

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.
  • Use an effective birth control method while you are taking this treatment. Because thalidomide can cause significant harm to a fetus (see “What Do I Need to Know Before Starting Thalidomide?”), you must be registered in the S.T.E.P.S.? Program to take thalidomide. This handout is not a replacement for the requirements of the S.T.E.P.S. Program. Tell your healthcare provider right away if you or your partner becomes pregnant.
  • Avoid breastfeeding during treatment. It is not known if thalidomide 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.
  • Chemotherapy can sometimes cause changes in the amount of electrolytes in your body, such as sodium, potassium and magnesium. Your healthcare provider will check your blood for these changes and will treat any problems that are found.
 

What Do I Need to Know Before Starting Thalidomide?

  • Thalidomide can cause some of the nerve cells in your hands and feet to stop working properly. This condition is called neuropathy (see “What Are the Possible Side Effects?”). Your risk of developing severe neuropathy is higher if you already had this condition before starting treatment. This problem usually improves slowly a few months after treatment is done, but can be permanent. Tell your healthcare provider if you develop numbness, tingling, pain or a burning sensation in your hands or feet.
  • Thalidomide 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 thalidomide, 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) must have a pregnancy test within 24 hours of starting thalidomide and have pregnancy tests regularly during treatment to make sure they are not pregnant. Men who are taking thalidomide (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 thalidomide, stop taking the medicine and contact your healthcare provider right away.
  • Thalidomide can cause blood clots in the veins and, in rare cases, in the lungs. Blood clots are more common when thalidomide is used with 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 thalidomide.
  • If you are a male, you should not donate sperm while taking thalidomide.
  • Thalidomide can cause severe drowsiness. You may not be able to drive a car or operate other machinery while taking thalidomide. This side effect may be worse if you take it with other medicines that cause drowsiness. Talk with your healthcare provider before taking any medicines that can make you drowsy.
  • Thalidomide can cause your heart to beat slower than normal. Thalidomide can also cause a side effect called orthostatic hypotension. Orthostatic hypotension is a sudden decrease in blood pressure that can cause you to feel faint or dizzy when you stand up. While being treated, sit up and stand up slowly to avoid sudden drops in your blood pressure. Tell your healthcare provider if you feel dizzy, faint, more tired than usual or short of breath, or if you are taking medicine to lower your blood pressure.
  • Tell your healthcare provider if you are HIV positive. If you are HIV positive, thalidomide can increase the amount of HIV virus in your blood. You may need to be monitored more closely during treatment.
  • Thalidomide can cause skin reactions (See “What Are the Possible Side Effects?”). In extremely rare cases, thalidomide can cause Stevens-Johnson syndrome or toxic epidermal necrolysis, two serious skin conditions. Tell your healthcare provider immediately if you have a rash that looks like pimples or blisters on the skin, in the mouth or on the genitals or if you have swelling around the eyes.
  • In rare cases, thalidomide can cause seizures. These seizures are more common in those who are at risk for seizures. Tell your healthcare provider if you have been told that you are at risk or if you have had a seizure in the past. You may need to be monitored more closely during treatment.
  • In very rare cases, thalidomide can cause an allergic reaction. Tell your healthcare provider right away if you have a fever, cold sweats, shortness of breath, chest tightness, tongue or facial swelling, a rapid heartbeat or back pain while you are being treated.
Your treatment can interact with other substances, including:
  • Drugs that cause drowsiness, such as barbiturates, alcohol, chlorpromazine and reserpine. Barbiturates include drugs such as secobarbital (Seconal®), pentobarbital (Nembutal®) and phenobarbital (Luminal®).
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 thalidomide:
  • 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 Medication You should not take thalidomide if you are pregnant or are at risk of becoming pregnant or if you are allergic to thalidomide or any of its components.  

How Is the Treatment Given?

  • You will take thalidomide by mouth once a day. Try to take it at bedtime, at least one hour after your evening meal. Eating a high fat meal may make it harder for your body to absorb the thalidomide and make it less effective. 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 the next day. Do not take two doses at the same time. It is important to take thalidomide exactly as prescribed. Do not stop the medicine or change the dose without talking with your healthcare provider. Swallow thalidomide capsules whole with water. Do not break, chew or open your capsules.
  • You may be given medicines to help prevent and control nausea and vomiting before you receive your treatment. These medicines are usually given by mouth, but may be given by injection.
  • Store thalidomide at room temperature away from children and pets. Thalidomide should be protected from light, so do not remove it from its package until just before use. If you take too much thalidomide, 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
  • Vomiting that is severe, bloody or that lasts several hours
  • Severe abdominal pain or bloody stools
  • Painful or frequent urination or blood in your urine
  • Seizures, severe headaches, confusion or blurred vision
  • Constipation that lasts more than two to three days or constipation with abdominal pain
  • Pain in the arms or legs or sudden shortness of breath
  • Dizziness or feeling lightheaded
  • Skin rash that is itchy, painful or blistering
  • Inability to eat or weight loss
  • Thoughts of suicide
 

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).

Side Effect

How to Minimize Side Effect

Possible Treatments

Constipation (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 (Common. Symptoms are generally mild to moderate but can be severe.)
  • 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.
Rash (Common with doses of 800 mg/day or higher. Less Common with doses of 600 mg/day or less. Symptoms are generally mild but can be moderate.)
  • 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.
Fluid Retention (Less Common. Symptoms are generally mild but can be moderate.)
  • 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.
Nausea/Vomiting (Less Common. Symptoms are generally mild but can be moderate.)
  • 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.
Risk of Infection (Less 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.
Anemia (Rare)
  • 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.
Risk of Bleeding (Rare)
  • 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.
  What Are the Other Possible Side Effects? The listed below are additional side effects found with this drug. It does not list all possible side effects. For more information, talk with your healthcare provider.

Common Side Effects

  • Fatigue or weakness
  • Dizziness
  Less Common Side Effects
  • Headache
  • Feeling unsteady or off balance
  • Mood changes or depression
  • Uncontrolled shaking (tremor)