This page tells you about pomalidomide and its possible side effects. There is information about
Pomalidomide (pronounced pom-a-lid-oh-mide) is a type of biological therapy drug. It is also known by its brand name, Imnovid (pronounced imm-know-vid).
Pomalidomide is a treatment for myeloma. It is for people who have already had at least 2 other treatments, including lenalidomide and bortezomib, that are no longer working.
Pomalidomide affects how the immune system works and is called an immunomodulatory agent. It works in a number of ways, including
- Stopping the myeloma cells developing
- Stopping blood vessel growth – it is a type of anti angiogenic drug
- Encouraging the immune system to kill the myeloma cells
You take pomalidomide as capsules with a glass of water. You need to swallow the capsules whole. Don’t break or chew them. You should take them at the same time every day. You can take pomalidomide with or without food.
It is very important to take capsules according to the instructions your doctor or pharmacist gives you. You should take the right dose, not more or less. And never stop taking a cancer drug without talking to your specialist first.
You take pomalidomide every day for 3 weeks and then have a break for 1 week. This is 1 cycle of treatment. You then start the next cycle. You will also need to take a steroid. You take the treatment for as long as it is controlling the myeloma.
Pomalidomide 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 contraception before you have the treatment. They will make sure that you understand the risks of taking pomalidomide.
You will need to agree to use effective contraception
- For 4 weeks before you start treatment
- During treatment
- For 4 weeks after you finish treatment
Women also need to have pregnancy tests before starting treatment and every 4 weeks while having treatment.
Pregnant women should not touch or handle pomalidomide. You must store it in a place where pregnant women or children cannot reach it.
Some people worry about taking pomalidomide but it doesn’t cause physical defects in adults.
More than 10 in every 100 people have one or more of these effects.
- An increased risk of getting an infection from a drop in white blood cells – chest infections called pneumonia are the most common type of infection. It is harder to fight infections and you can become very ill. 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. You will have blood tests regularly to see how well your bone marrow is working.
- Tiredness and breathlessness due to a drop in red blood cells (anaemia) affects more than 4 out of 10 people (46%). If your red blood cell levels get very low you may need a blood transfusion
- Bruising more easily due to a drop in platelets happens in more than 2 out of 10 people (27%). You may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia)
- Tiredness and lack of energy affects about 3 out of 10 people (30%) during and after treatment. Most people find their energy levels are back to normal within 6 months to a year
- Difficulty sleeping due to the steroids
- Constipation happens in 2 in 10 people (20%). 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 bone pain in 2 out of 10 people (20%). You may also have swollen joints
- Diarrhoea affects just over 2 in 10 people (20%) – drink plenty of fluids. Tell your doctor or nurse if diarrhoea becomes severe, or continues for more than 3 days
- Breathlessness due to changes in lung tissue affects 2 in 10 people (20%)
- Swelling of the ankles and legs due to a build up of fluid (oedema) happens to more than 1 in 10 people (13%) – this is usually mild
- Loss of appetite
- Feeling or being sick, which is usually well controlled with anti sickness medicines
- 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
- Loss of fertility – we don’t know exactly how this drug affects your ability to father a child or become pregnant after treatment. Talk to your doctor if you think you may want to have a baby in the future. Men may be able to store sperm before starting treatment
Between 1 and 10 in every 100 people have one or more of these effects.
- Blood clots occur in just under 3 in 100 people (3%). 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 or other anti clotting medicines when you start treatment
- High uric acid levels in the blood due to the breakdown of tumour cells (tumour lysis syndrome). You will have regular blood tests to check your uric acid levels. You may also have a tablet called allopurinol to take. Drinking plenty of fluids helps to flush out the excess uric acid
- Dizziness and loss of balance (vertigo) – do not operate machinery or drive if you have this
- Shaky hands (tremor) caused by nerve damage
- Blurred vision and more rarely clouding of the eye (cataract)
- Skin reaction – you may have a rash and your skin may be dry, red and itchy
- 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
- Changes in your heart rhythm and blood pressure. Your nurse or doctor will check your blood pressure and you will have heart tests (ECGs) if you need them
- Kidney changes that are mild and unlikely to cause symptoms. You will have regular blood tests to check how well your kidneys are working
- Urine infections
- Difficulty passing urine
- A higher risk of heart attack (damage to heart muscle) – let your doctor or nurse know straight away if you have sudden chest pain and breathlessness
- A stroke or mini stroke – let your nurse or doctor know straight away if you have facial weakness, arm weakness, or speech problems
- An increased risk of a second cancer some years after the treatment
You may only have a few of these side effects. A side effect may get worse through your course of treatment. Or you may have more side effects as the course goes on. This depends on
- How many times you've had a drug before
- Your general health
- How much of the drug you have (the dose)
- Other drugs you are having
Coping with side effects
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 other over the counter remedies. Some drugs can react together.
Do not breastfeed during this treatment because the drug may come through in the breast milk.
Possible long term effects
Pomalidomide is a fairly new drug in cancer treatment. This means that there is limited information available at the moment about possible longer term effects that it may cause. Tell your doctor if you notice anything that is not normal for you.
Sex for men
Pomalidomide is present in semen during treatment. All men taking pomalidomide should use condoms during sexual intercourse. This needs to be continued for 7 days after the treatment ends.
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.
We don’t 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 we don’t mention here and you think it 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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