Home Drug Guide Thalidomide

Drug Guide

Generic Name

Thalidomide

Brand Names Thalomid

Classification

Therapeutic: Immunomodulatory agent, Antineoplastic, Sedative

Pharmacological: Immunomodulator, Teratogen, Anti-inflammatory

FDA Approved Indications

  • Multiple myeloma in combination with dexamethasone
  • Erythema nodosum leprosum (Hansen's disease)

Mechanism of Action

Thalidomide modulates the immune system by inhibiting tumor necrosis factor-alpha (TNF-α), reducing inflammatory cytokines, and exerting anti-angiogenic effects, which contribute to its anti-cancer activity.

Dosage and Administration

Adult: Dosing varies based on indication; for multiple myeloma, typical starting dose is 200 mg daily, adjusted as needed.

Pediatric: Not approved for pediatric use.

Geriatric: Use with caution; adjust based on tolerability and response.

Renal Impairment: Adjust dose as needed; discontinue if severe renal impairment develops.

Hepatic Impairment: Use cautiously; no specific dosing adjustments established.

Pharmacokinetics

Absorption: Well absorbed orally.

Distribution: Widely distributed, crosses the placenta, appears in breast milk.

Metabolism: Primarily hepatic via non-enzymatic reduction.

Excretion: Renal and fecal routes.

Half Life: Approximately 6-8 hours.

Contraindications

  • Pregnancy (category X), due to teratogenicity (see warnings below)
  • Known hypersensitivity to thalidomide

Precautions

  • Use in women of childbearing potential only under strict REMS program; risk of thromboembolism; peripheral neuropathy; somnolence; drowsiness; sedation; risk of blood clots; peripheral neuropathy; teratogenicity; hematologic toxicity

Adverse Reactions - Common

  • Sleepiness, fatigue (Common)
  • Constipation (Common)
  • Peripheral neuropathy (Uncommon)
  • Sedation (Common)

Adverse Reactions - Serious

  • Thrombosis and pulmonary embolism (Uncommon)
  • Birth defects (teratogenicity) (Serious and preventable)
  • Blood dyscrasias (neutropenia, anemia, thrombocytopenia) (Serious)

Drug-Drug Interactions

  • Clozapine (increased risk of hematologic toxicity)
  • Corticosteroids (increased risk of thromboembolism)
  • Other drugs affecting blood clotting

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor neurological status for peripheral neuropathy, blood counts, and signs of thromboembolism.

Diagnoses:

  • Risk for peripheral neuropathy
  • Risk for bleeding or thrombosis
  • Risk for pregnancy-related complications

Implementation: Ensure strict adherence to pregnancy prevention program; counsel about side effects; monitor blood counts and neurological status.

Evaluation: Assess efficacy of treatment and monitor for adverse effects continuously.

Patient/Family Teaching

  • Must use effective contraception during therapy and for 4 weeks after discontinuation
  • Report signs of blood clots, neuropathy, or unusual bleeding immediately
  • Avoid alcohol and other CNS depressants unless approved by healthcare provider

Special Considerations

Black Box Warnings:

  • Embryo fetal injury and birth defects (category X) — mandatory pregnancy prevention program in place

Genetic Factors: Pharmacogenetic considerations not well established.

Lab Test Interference: May affect tests related to blood counts.

Overdose Management

Signs/Symptoms: Symptoms may include severe sedation, somnolence, peripheral neuropathy, and blood dyscrasias.

Treatment: Supportive care; monitor vital signs, blood counts, neurological status; no specific antidote.

Storage and Handling

Storage: Store at controlled room temperature (20°C to 25°C).

Stability: Stable under recommended storage conditions.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.