Chemotherapy Patient Resource Area

Thalidomide/Thalomid^®

Drug
Thalidomide (generic name) is manufactured as Thalomid^® (trade name) (Celgene Corp., Warren, NJ).

Action
Thalidomide interferes with the growth of rapidly dividing cells. It belongs to a class of drugs known as immunomodulating agents and is used to treat a skin condition known as erythema nodosum leprosum (leprosy). It also is used to treat several types of cancers, including kidney, ovarian, and breast cancer, and a type of brain tumor called a glioma. It is also used in combination with other drugs to treat malignant melanoma, multiple myeloma, and colorectal cancer.

What does the drug look like?
Thalidomide is supplied in 50-mg, white-colored capsules; 100-mg, tan-colored capsules; and 200-mg, blue-colored capsules.

How long will I take the drug?
The length of treatment varies and depends on your diagnosis and how well your body responds to the treatment.

How do I take the drug?
Thalidomide is taken by mouth once a day at bedtime, at least one hour after the evening meal. The dose of thalidomide is based on your body size and is determined by your doctor. Your doctor and pharmacist will tell you how many capsules to take each day. Take your daily dose of thalidomide all at once. Swallow each capsule whole; do not chew them or open them. Your dose may be adjusted during therapy, and the number of capsules you need to take may change, so follow all directions and medicine labels carefully. If you miss a dose of thalidomide, take it as soon as possible, on an empty stomach. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses. If you accidentally take too many capsules, or someone else accidentally takes your medicine, contact your doctor or the nearest emergency room immediately.

Storage
Store this medicine at room temperature. Do not store it in the bathroom, near the kitchen sink, or in other damp places, because moisture may cause this medication to break down. Keep this medicine in its original container, out of the reach of children or pets. Do not keep outdated medication that you no longer need. Ask your nurse or pharmacist how you should dispose of any medicine you do not use.

• Thalidomide causes drowsiness, dizziness, weakness, and fatigue. Taking the drug in the evening minimizes daytime drowsiness. Some people develop a tolerance to the sedative effect of the drug and are less drowsy after several weeks of treatment. If you are drowsy, do not drive a car or operate equipment, such as lawn mowers or machinery. Avoid drinking alcohol while taking thalidomide because of the additive sedative effect that alcohol will cause.
• Thalidomide may cause a drop in blood pressure (orthostatic hypotension) if you stand up quickly. You may feel dizzy and are at risk for falling. After lying down, sit upright for a few minutes before standing.
• Notify your doctor immediately if a rash develops during treatment with thalidomide. Do not take another dose of the drug until you have had the rash evaluated by your doctor and received clearance to continue the drug.
• Thalidomide may cause peripheral neuropathy (numbness, tingling, pain, or burning sensations in the feet or hands). Be sure to let your doctor know about all of the medications you are taking because other medications can contribute to this condition. Avoid wearing tight-fitting shoes and socks. Keep feet loosely covered or uncovered while in bed to avoid friction and overheating. Maintain moderate activity as tolerated, such as walking. Gently massaging affected areas may improve circulation and reduce pain. Soaking affected areas in cool water also may be helpful.
• Thalidomide may cause constipation. Drink at least 6-8 glasses of fluid per day. Increase your intake of dietary fiber by eating fresh fruits, vegetables, and whole grain breads and cereals. To help prevent constipation, a mild laxative may be recommended.
• Swelling or fluid retention in the feet, ankles, and legs may occur. Notify your doctor if this occurs. Elevate your legs as much as possible. Support hose or stockings may be helpful.
• Thalidomide may make your skin sensitive to sunlight. Wear protective clothing, avoid prolonged exposure to sunlight, and apply sunscreen to skin and lips. Do not use tanning beds or sun lamps.
• Thalidomide may cause severe birth defects or fetal death if taken by pregnant women. Special paperwork must be completed prior to starting thalidomide treatment. You will receive written information and counseling about the risk of birth defects. A consent form must be signed prior to starting thalidomide to ensure that women understand the risk and agree not to become pregnant. Men taking thalidomide must agree to use a latex condom. If the woman is of childbearing potential, she must use two methods of reliable birth control for four weeks before starting thalidomide. A pregnancy test is performed on every woman within 24 hours before she begins taking thalidomide and during treatment. Although most patients taking thalidomide are beyond childbearing age, the risk of birth defects still is discussed with all patients.

Drug and food interactions
Let your doctor know what medications you are taking. Also, if you are taking vitamins, herbs, or nutritional supplements, be sure to let your doctor know.

• Rash
• Numbness, tingling, pain, or burning sensation in the feet or hands
• Lack of bowel movements for three days
• Swelling of the feet, ankles, or legs