This page tells you about the biological therapy drug thalidomide and its possible side effects. There is information about
Thalidomide is pronounced as tha-lid-oh-mide. It is also called Thalidomide Celgene. Thalidomide is a treatment for myeloma. You may have it on its own or with the chemotherapy drug melphalan, and steroids, such as dexamethasone or prednisone. You may also have thalidomide as part of a clinical trial for other cancers.
Thalidomide is a type of cancer growth blocker. Researchers are still looking at how thalidomide 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 tell each other to grow. It also stimulates some of the the immune system cells to attack the myeloma cells. Thalidomide stops tumours making their own blood vessels that they need in order to grow.
You take thalidomide each day as capsules with a glass of water, before going to bed. You usually start on a low dose and your doctor then increases the dose unless you get bad side effects. For myeloma you may take this treatment for up to a year and 5 months.
You can take thalidomide with or without food. It is very important that you take 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 thalidomide at your regular time and less than 12 hours have passed, take your capsules straight away. If more than 12 hours have passed do not take the capsules. Take your next capsules at the usual time the next day.
Thalidomide can cause birth defects in children. So you must not become pregnant or father a child if you are taking this drug. Your doctor will talk to you about effective methods of contraception before you have the treatment.
Some people worry about taking thalidomide but it does not cause physical defects in adults.
Because thalidomide causes birth defects, your doctor will talk to you before you start treatment. They will make sure that you understand the risks of taking thalidomide 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. You must not donate semen during treatment or for 1 week afterwards.
Pregnant women should not touch or handle thalidomide. 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 the levels of blood cells, minerals and other chemicals. They also check how well your liver and kidneys are working.
We've listed the side effects associated with thalidomide. 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 thalidomide 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. 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)
- Drowsiness (feeling tired and sleepy) – this affects up to 8 in 10 people taking thalidomide (80%) so it is best to take the drug at bedtime and avoid drinking alcohol while having this treatment
- Nerve damage can cause numbness or tingling in the fingers and toes and difficulty doing small things, like doing up buttons – this affects more than 1 in 10 people (10%). Tell your doctor or nurse if you have it. Your doctor may need to reduce the dose you take
- Shaky hands (tremor) caused by nerve damage
- Dizziness occurs in around 2 out of 10 people (20%)
- Constipation happens in most people – 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
- Blood clots occur in around 2 out of 10 people (20%) – if this happens you will have treatment to thin your blood, dissolve any clots and stop any more developing. If you are at higher than normal risk of developing blood clots, your doctor will give you aspirin to prevent clots when you start thalidomide treatment. Let your doctor or nurse know straight away if you have a sudden pain in your chest or breathing problems, or if you have sudden pain or swelling in your lower leg
- 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
Swelling of your hands or feet due to fluid build up (known as peripheral oedema)
Between 1 and 10 in every 100 people have one or more of these.
- Confusion – let your doctor or nurse know straight away if you have this
- Skin changes – about 2 out of 10 people (20%) have a rash. Your skin may also be dry and itchy
- Mood changes – you may feel sad and depressed
- A sore or dry mouth
- Feeling, weak, faint or unsteady
- Blurred vision
- Changes in your heart which are usually temporary but for a small number of people may be permanent – your doctor will check your heart before and after your treatment. Let your doctor or nurse know straight away if you have sudden chest pain spreading to your arms, neck or jaw, or you feel sweaty or breathless
- Feeling sick is usually well controlled with anti sickness medicines
- Sinusitis (inflammation of the sinuses) – you may have a runny nose and a sore throat. This affects 1 in 20 people (5%) taking thalidomide
- Pain may occur in your bones, muscles, stomach and you may have headaches – mild painkillers usually control it
- Low blood pressure – you may find that your blood pressure drops when you stand up quickly and you may feel dizzy
- Loss of appetite
- Changes to your blood chemistry – the levels of calcium, sodium and potassium may be lower or higher than normal
- Slow heart beat
- An increased risk of certain blood disorders (acute myeloid leukaemia and myelodysplastic syndromes) – this affects 2 to 4 out of 100 people (2 to 4%)
- Sudden difficulty in seeing or speaking, which can be a sign of a stroke. Let your doctor or nurse know straight away if you have this
- Changes in lung tissue may cause a cough or breathlessness
Fewer than 1 in 100 people have these effects.
- A serious reaction called Stevens Johnson syndrome, which is a painful inflammation of the eyes, eyelids and skin – tell your doctor or nurse straight away if you have this
- Low levels of thyroid hormones leading to weight gain, tiredness and a lack of energy
- Blockage of the bowel – let your doctor or nurse know straight away if you have sudden, sharp tummy pain
- Low sex drive and men may have difficulty getting an erection
- Liver changes that are very mild and unlikely to cause symptoms – the liver will almost certainly go back to normal when treatment is finished
- High uric acid levels in the blood due to the breakdown of tumour cells (tumour lysis syndrome) – you may have a tablet called allopurinol to take. Drinking plenty of fluids helps to flush out the excess uric acid
- An allergic reaction – let your nurse know if you have any skin rashes, itching, swelling of the eyes, mouth or face, or difficulty breathing
- Loss of hearing
- Seizures (fits)
- Kidney changes that are mild and unlikely to cause symptoms – they will almost certainly go back to normal when treatment is finished
- Worsening of Parkinson’s disease symptoms, such as shaking (tremor) depression or confusion
- Pain in the upper abdomen or back for a few days, which may be severe – it is caused by inflammation of the pancreas and you may also feel sick, have a high temperature and a faster heart rate
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.
Don't breastfeed during this treatment because the drug may come through in the breast milk.
You must not donate blood during treatment and for a week afterwards.
Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies. Some drugs can react together.
Driving or operating machinery
Don't drive or operate machinery or tools if you have side effects such as dizziness, tiredness, sleepiness or blurred vision.
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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