Thalidomide (Rheumatology / Dermatology)

How it works

It modulates immune function by suppressing tumour necrosis factor-alpha production and altering cytokine balance, and additionally has anti-angiogenic properties.

Prescribing in practice

• Potent human teratogen causing severe limb and organ malformations; prescribing in those of childbearing potential requires strict adherence to a Pregnancy Prevention Programme with reliable contraception and documented negative pregnancy testing before and during treatment.
• Causes a dose-dependent, potentially irreversible peripheral neuropathy, so treatment must be stopped or reviewed promptly if sensory symptoms emerge.
• Markedly increases venous thromboembolism risk, particularly when combined with corticosteroids, so thromboprophylaxis should be considered.

Monitoring

Monitor with regular pregnancy testing in those at risk, periodic neurological assessment for neuropathy, and vigilance for thromboembolic and sedative effects.

Counselling the patient

• Never share your tablets and never become pregnant or father a child while taking this medicine.
• Report any numbness, tingling, or burning in the hands or feet straight away.
• It commonly causes drowsiness, so avoid driving until you know how it affects you.

Evidence & guidelines

Use is supported by trial and long-standing clinical experience in erythema nodosum leprosum and refractory dermatological disease, reflected in MHRA-mandated risk-minimisation requirements.