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Immunomodulatory Drug (IMiD) Pregnancy: X (teratogen — absolute contraindication)

Lenalidomide

Brand names: Revlimid

Adult dose

Dose: 25 mg once daily on days 1–21 of 28-day cycle (myeloma); 10 mg once daily (MDS with del(5q))
Route: oral
Frequency: once daily
Max: 25 mg/day
Strict REMS programme (RevAssist/Celgene REMS) — teratogen; VTE prophylaxis mandatory (aspirin minimum; LMWH if high-risk)

Paediatric dose

Route:
Not licensed in children

Dose adjustments

Renal

Reduce dose: 10 mg/day if eGFR 30–60 ml/min; 15 mg every other day if eGFR <30 ml/min (not on dialysis); 5 mg/day (dialysis)

Hepatic

No formal guidance — use with caution

Clinical pearls

  • Thalidomide analogue but more potent — works through cereblon binding and IKZF1/3 degradation
  • REMS programme: pregnancy test monthly; two contraceptive methods; prescriber and pharmacist registration
  • MRC Myeloma XI trial: lenalidomide maintenance prolongs PFS after stem cell transplant

Contraindications

  • Pregnancy (teratogen — absolute)
  • Women of childbearing potential not on effective contraception
  • Breastfeeding
  • Inability to comply with REMS programme

Side effects

  • Neutropenia
  • Thrombocytopenia
  • DVT/PE (VTE prophylaxis mandatory)
  • Teratogenicity
  • Second primary malignancy risk
  • Peripheral neuropathy

Interactions

  • Erythropoietins (increased thrombotic risk)
  • Corticosteroids (with dexamethasone: VTE risk)
  • Digoxin (increased Cmax)

Monitoring

  • FBC weekly × 8 weeks, then monthly
  • Pregnancy test monthly (female)
  • DVT symptoms
  • Renal function quarterly

Reference: BNFc; BNF 86; NICE TA171/TA587; MRC Myeloma XI. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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