CautionThalidomide (Celgene)
Thalidomide
Immunomodulatory / anti-angiogenic
Historical severe teratogen — restricted current use with mandatory PPP.
Oral
First-line for
- Multiple myeloma (specialist)
- Leprosy erythema nodosum leprosum
Mechanism
Cereblon binding modulates E3 ubiquitin ligase → degradation of IKZF1/IKZF3 → anti-inflammatory, anti-angiogenic, immunomodulatory.
"Thalidomide = trunk phocomelia, take PPP seriously"
- A single dose in weeks 4–8 can cause severe phocomelia
- Cardiac, renal, ocular, GI defects also documented
- Contraception 1 month before/during/after; men also require condoms
Dosing
- Myeloma
- 50–200 mg at bedtime (specialist)
Contraindications
- AbsolutePregnancy — absolute contraindication
- AbsoluteWomen/men without effective contraception per PPP
- AbsoluteExisting peripheral neuropathy
Side effects
- Peripheral neuropathy
- Sedation, constipation
- VTE (add prophylaxis)
- Bradycardia
- Rash — including SJS/TEN
Fetal & maternal notes
- • Phocomelia, amelia, cardiac, ophthalmological, renal defects — 50% risk with T1 exposure
- • PPP compliance mandatory: pregnancy testing before, during, and after treatment
Key interactions
CNS depressants
CautionAdditive sedation
Chemotherapy / dexamethasone
Avoid↑ VTE — anticoagulate
Clinical pearls
- 💡 Lenalidomide and pomalidomide carry identical teratogenic risk and PPP requirements
- 💡 Even a single accidental dose warrants urgent MFM referral
Content last reviewed: REPLACE_ME (e.g. 2026-07)
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