Thalidomide is a type of targeted cancer drug (biological therapy). It is also known as Thalidomide Celgene. You might have it as a treatment for myeloma.
You might have thalidomide on its own or with other cancer drugs.
How thalidomide works
Thalidomide works in different ways. It:
- stops cancer cells developing
- stops cancers making their own blood vessels, that they need to be able to grow
- stimulates some of the immune system cells to attack myeloma cells
How you have thalidomide
You have thalidomide as capsules, that you take every day, with a glass of water. You should take it before going to bed, as thalidomide can make you sleepy.
The normal dose is 2 or 4 capsules once a day.
You can take the capsules with or without food.
Taking your capsules
You should take the right dose, not more or less.
Talk to your specialist or advice line before you stop taking a cancer drug.
If you forget to take thalidomide at your regular time and less than 12 hours have passed, take the 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.
When you have thalidomide
You usually take thalidomide every day. Your doctor will tell you how many capsules to take each day and how long for.
If you have thalidomide with other cancer drugs, you usually take it every day for up to 9 cycles of treatment. Each cycle of treatment lasts 3 or 4 weeks.
You usually take thalidomide on its own, for as long as it helps you and the side effects aren't too bad.
You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.
We haven't listed all the side effects. It is very unlikely that you will have all of these side effects, but you might have some of them at the same time.
How often and how severe the side effects are can vary from person to person. They also depend on what other treatment you are having. For example, your side effects could be worse if you are also having other drugs or radiotherapy.
When to contact your team
Your doctor or nurse will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:
- you have severe side effects
- your side effects aren’t getting any better
- your side effects are getting worse
Early treatment can help manage side effects better.
Common side effects
Each of these effects happens in more than 1 in 10 people (10%). You might have one or more of them. They include:
Increased risk of infection
Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.
Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection.
Breathlessness and looking pale
You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.
Bruising, bleeding gums or nose bleeds
This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. 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).
Sleepiness and feeling tired
You might feel very tired or find you are falling asleep during the day. Do not drive or operate machinery. Let your doctor know straight away.
Numbness or tingling in hands or fingers
Numbness or tingling in fingers or toes is often temporary and can improve after you finish treatment. Tell your doctor if you're finding it difficult to walk or complete fiddly tasks such as doing up buttons.
Shaky hands (tremor)
You may develop shaky hands (tremor) with this treatment.
Don’t drive or operate machinery if you have this.
Constipation is easier to sort out if you treat it early. Drink plenty of fluids and eat as much fresh fruit and vegetables as you can. Try to take gentle exercise, such as walking. Tell your doctor or nurse if you are constipated for more than 3 days. They can prescribe a laxative.
Swelling of hands and feet
Swelling of hands and feet is due to fluid build up. This is called oedema. Let your doctor or nurse know if you have any swelling.
Occasional side effects
Each of these effects happens in more than 1 in 100 people (1%). You might have one or more of them. They include:
- skin rash and dry skin
- mood changes, including depression
- dry mouth
- weak, faint or unsteady
- blurred vision
- changes in your heart including a slow heart rate or heart failure
- feeling or being sick
- pain in your chest or difficulty breathing due to blood clots in the arteries around your lungs
- fits (convulsions)
- hearing problems, such as hearing loss
- changes in levels of minerals in your blood
- increased risk of certain blood disorders
- chest infections
- kidney disease
Rare side effects
Each of these effects happens in fewer than 1 in 100 people (1%). You might have one or more of them. They include:
- blockage of the bowel
- a severe skin reaction that may start as tender red patches which leads to peeling or blistering of the skin. You might also feel feverish and your eyes may be more sensitive to light. This is serious and could be life threatening
Coping with side effects
We have more information about side effects and tips on how to cope with them.
What else do I need to know
Other medicines, foods and drink
Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.
Pregnancy and contraception
This treatment might harm a baby developing in the womb. It is important not to become pregnant or father a child while you're having treatment and for a few months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.
You may not be able to become pregnant or father a child after treatment with this drug. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.
Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.
Don’t breastfeed during this treatment because the drug may come through into your breast milk.
Treatment for other conditions
Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.
Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.
In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and the shingles vaccine (Zostavax).
- have other vaccines, but they might not give you as much protection as usual
- have the flu vaccine (as an injection)
Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine.
If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray. This is for 2 weeks following their vaccination.
Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.
You should not donate blood during treatment and for 1 week afterwards.
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.
More information about this treatment
For further information about this treatment go to the electronic Medicines Compendium (eMC) website.
You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.