This page tells you about the cancer drug lenalidomide and its possible side effects. There is information about
- What lenalidomide is
- How lenalidomide works
- How you have lenalidomide
- Preventing pregnancy while taking lenalidomide
- Tests during treatment
- About side effects
- Common side effects
Lenalidomide (pronounced len-a-lid-oh-mide) is a type of biological therapy drug. It is also known by its brand name, Revlimid.
Lenalidomide is a treatment for myeloma and blood disorders called myelodysplastic syndromes. You may also have it as part of clinical trials for other types of cancer.
For myeloma, lenalidomide may be given with a steroid called dexamethasone. Or it may be given with another chemotherapy drug called melphalan and a steroid called dexamethasone.
Researchers are still finding out exactly how lenalidomide works. It affects all sorts of cell processes, including how cells divide and grow. We know that it interferes with chemicals that cells use to signal to each other to grow. It affects how the immune system works and is called an immunomodulatory agent. It also stops tumours making their own blood vessels. To develop, all cancers need a blood supply.
You take lenalidomide as capsules with a glass of water. You need to swallow them whole. Don’t break or chew them. You should take lenalidomide at the same time every day. You can take the capsules with or without food.
You take lenalidomide every day for 3 weeks and then have a break for 1 week. This is one cycle of treatment. You then start the next cycle.
It is very important that you take the capsules according to the instructions your doctor or pharmacist gave you. You should take the right dose, not more or less. And never stop taking a cancer drug without talking to your specialist first.
If you forget to take lenalidomide at your regular time but less than 12 hours have passed take the capsule straight away. If more than 12 hours have passed do not take the capsule but just take your next capsule at the usual time the next day.
Lenalidomide can cause birth defects in children. So you must not become pregnant or father a child while taking this drug. Your doctor will talk to you about effective methods of contraception before you have the treatment. Some people worry about taking lenalidomide but it doesn’t cause physical defects in adults.
Because lenalidomide causes birth defects, your doctor will talk to you before you start treatment. They will make sure that you understand the risks of taking lenalidomide and agree to use contraception
- For 4 weeks before you start treatment
- During treatment
- For 4 weeks after you finish treatment
Women also need to have pregnancy tests every 4 weeks while having treatment and 4 weeks afterwards.
Men with a female partner who could become pregnant should use condoms during sex for the time they are having treatment and for a week after finishing treatment.
Pregnant women should not touch or handle lenalidomide. You must store it in a place where pregnant women or children cannot reach it.
You have blood tests before starting treatment and regularly during your treatment. The tests check your levels of blood cells. They also check how well your liver and kidneys are working.
We've listed the side effects associated with lenalidomide. You can use the links to find out more about each side effect. Where there is no link, please go to our cancer drug side effects section or use the search box at the top of the page.
You may have a few side effects. They may be mild or more severe. A side effect may get better or worse through your course of treatment. Or more side effects may develop as the course goes on. This depends on
- How many times you've had the drug before
- Your general health
- The amount of the drug you have (the dose)
The side effects may be different if you are having lenalidomide with other drugs.
Tell your doctor or nurse straight away if any of the side effects get severe.
More than 10 in every 100 people have one or more of the side effects listed below.
- An increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. Chest infections called pneumonia are most common. You may have headaches, aching muscles, a cough, a sore throat, pain passing urine, or you may feel cold and shivery. If you have a severe infection this can be life threatening. Contact your treatment centre straight away if you have any of these effects or if your temperature goes above 38°C
- Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
- Bruising more easily due to a drop in platelets – you may have nosebleeds, or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae)
- Tiredness and lack of energy in just under 1 in 3 people (30%) during and after treatment – most people find their energy levels are back to normal within 6 months to a year
- Constipation in 1 in 4 people (25%) – drink at least 2 to 3 litres of fluid a day and eat a diet high in fibre. Your doctor or nurse can give you a laxative if you need one
- Muscle cramps and aches in 1 out of 5 people (20%)
- Swollen and painful joints
- Blood clots in just under 1 out of 5 people (20%) – if this happens you will have treatment to thin your blood, dissolve any clots, and stop more developing. If you are at higher than normal risk of developing blood clots, your doctor will give you aspirin when you start lenalidomide treatment. Let your doctor or nurse know straight away if you have sudden chest pain or leg pain
- Diarrhoea in just over 1 in 10 people (10%) – drink plenty of fluids and tell your doctor or nurse if diarrhoea becomes severe or continues for more than 3 days
- Skin reaction – you may have a rash and your skin may be dry, red and itchy
- Shaky hands (tremor) caused by nerve damage
- Numbness or tingling in fingers and toes often causes difficulty with fiddly things such as doing up buttons – it starts within a few days or weeks and usually goes within a few months of finishing treatment
- Blurred vision
- Dizziness – don't drive or operate machinery if you feel dizzy or have blurred vision
- Feeling or being sick, which is usually well controlled with anti sickness medicines
- Changes in the levels of potassium, sodium and calcium in your blood – you may not have any symptoms from this but you will have regular blood tests to check the levels
- Loss of fertility – you may not be able to become pregnant or father a child after this treatment. Talk to your doctor before starting treatment if you think you may want to have a baby in the future. Men may be able to store sperm before starting treatment
- Bone pain
- Kidney changes that are mild and unlikely to cause symptoms – they will usually go back to normal when treatment finishes. Let your nurse know if you pass less urine than usual
- Swelling of the body, including the limbs
- A high temperature and flu like symptoms
- Poor appetite and taste changes
- Chest pain spreading to the arms, neck, or jaw, due to a heart attack – let your doctor or nurse know straight away if you have this. You may also feel sweaty and breathless, or feel sick
- Higher blood sugar levels – tell your doctor or nurse if you get very thirsty or if you are passing urine more than usual
- Tummy (adominal) pain
- Mood changes
- Clouding of the eye (cataract)
- Difficulty sleeping
Between 1 and 10 in every 100 people have one or more of these.
- A sore or dry mouth
- Changes in your heart rhythm and blood pressure – your nurse or doctor will check your blood pressure and you will have ECGs if you need them
- Breathlessness due to changes in lung tissue
- A drop in the level of thyroid hormones (hypothyroidism) – you will have regular blood tests to check your hormone levels
- Liver changes – you are unlikely to notice any symptoms and your liver function will usually go back to normal when treatment ends
- Some hearing loss and ringing in the ears (tinnitus)
- Urine infections
- Darkening of skin
- An increased risk of certain blood disorders, including acute myeloid leukaemia
- Difficulty getting an erection
- Increased sweating
- Liver changes that are very mild and unlikely to cause symptoms – they will almost certainly go back to normal when treatment is finished
- Difficulty in balancing when walking
- Ringing in the ears (tinnitus)
- Weight loss
Fewer than 1 in 100 people have these.
- There is a small increase in the risk of developing a basal cell skin cancer after lenalidomide
- An allergic reaction while you have the treatment, causing fever, chills, shivering (rigors), a headache and feeling sick. A few people have a more severe reaction, with wheezing, an itchy rash and a drop in blood pressure. Your nurse will give you medicines before treatment to try to prevent a reaction
- Loss of interest in having sex (libido)
- Inflammation of the bowel causing abdominal pain, bloating or diarrhoea
- Skin sensitivity to sunlight – do not sit in the sun and do cover up or use a sun block
- Bleeding within the skull – let your doctor or nurse know straight away if you have sudden dizziness, headaches, eyesight changes or confusion
- Loss of vision
- Passing large amounts of urine with bone pain and weakness, due to a kidney disorder – let your doctor or nurse know straight away if you have this
Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.
Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies. Some drugs can react together. Lenalidomide may stop the contraceptive pill working so well.
Do not breastfeed during this treatment because the drug may come through in the breast milk.
Lenalidomide capsules contain lactose (milk sugar). If you have an intolerance to lactose, tell your doctor before taking this medicine.
You should not donate blood during treatment and for 1 week afterwards.
You should not have immunisations with live vaccines while you are having treatment or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG, yellow fever and Zostavax (shingles vaccine).
You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your treatment. It is safe to have the flu vaccine.
It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines), but not many people in the UK have these now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.
This page does not list all the very rare side effects of this treatment that are very unlikely to affect you. For further information look at the Electronic Medicines Compendium website at www.medicines.org.uk.
If you have a side effect not mentioned here that you think may be due to this treatment you can report it to the Medicines Health and Regulatory Authority (MHRA) at www.mhra.gov.uk.
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