Thalidomide

How it works

It has immunomodulatory, anti-angiogenic, and anti-inflammatory actions, modulating cytokine production and the tumour microenvironment to inhibit myeloma cell growth.

Prescribing in practice

• It is a potent human teratogen, so pregnancy must be excluded and prevented through the mandatory Pregnancy Prevention Programme, with strict contraception requirements for those of childbearing potential and relevant precautions for male patients.
• It markedly increases venous thromboembolism risk, particularly with dexamethasone, so thromboprophylaxis should be considered for all patients.
• Peripheral neuropathy, sedation, and constipation are common; assess neurological symptoms regularly and counsel on falls and driving.

Monitoring

Monitor for peripheral neuropathy, thromboembolism, and full blood count, with pregnancy testing as required by the prevention programme.

Counselling the patient

• This medicine causes severe birth defects; reliable contraception and adherence to the pregnancy prevention requirements are essential.
• Report numbness, tingling, or weakness in the hands or feet promptly.
• Do not share this medicine or donate blood while taking it, and report leg swelling, chest pain, or breathlessness urgently.

Evidence & guidelines

Thalidomide is licensed for multiple myeloma and its use is supported by established randomised trial evidence; MHRA mandates the Pregnancy Prevention Programme.