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Lenalidomide: Brands, Price & Uses in Bangladesh
Lenalidomide is an oral immunomodulatory antineoplastic agent (a thalidomide analog) used in the treatment of certain blood cancers.
About Lenalidomide
Indications of Lenalidomide
Lenalidomide is an oral immunomodulatory antineoplastic agent (a thalidomide analog) used in the treatment of certain blood cancers. Its established, FDA-approved indications include:
- Multiple myeloma: In combination with dexamethasone for adults with multiple myeloma; also approved as single-agent maintenance therapy following autologous hematopoietic stem cell transplantation (HSCT).
- Myelodysplastic syndromes (MDS): For transfusion-dependent anemia due to low- or intermediate-1-risk MDS associated with a deletion 5q (del5q) cytogenetic abnormality, with or without additional cytogenetic abnormalities.
- Mantle cell lymphoma (MCL): For relapsed or refractory mantle cell lymphoma that has progressed after two prior therapies, one of which included a proteasome inhibitor.
- Follicular lymphoma (FL) and marginal zone lymphoma (MZL): In combination with rituximab, for previously treated follicular lymphoma or marginal zone lymphoma (adjunct/combination-therapy use; not for use as monotherapy in this setting).
Lenalidomide must only be prescribed and monitored by a physician experienced in the use of antineoplastic/immunomodulatory therapy, under a controlled distribution and risk-management program.
Dosage & Administration of Lenalidomide
Lenalidomide dosing is individualized by indication and is administered orally once daily, preferably at the same time each day, with or without food. Capsules should be swallowed whole with water and must not be opened, broken, or chewed; women who are pregnant should avoid handling the capsules.
Dosing by Indication (Adults)
| Indication | Typical Adult Dose |
|---|---|
| Multiple myeloma (with dexamethasone) | 25 mg once daily on Days 1-21 of each repeated 28-day cycle |
| Multiple myeloma (post-transplant maintenance) | 10 mg once daily continuously (Days 1-28 of each 28-day cycle); may be increased to 15 mg daily after 3 cycles if tolerated |
| Myelodysplastic syndrome with del5q | 10 mg once daily, continued or adjusted based on blood counts and response |
| Mantle cell lymphoma | 25 mg once daily on Days 1-21 of each 28-day cycle |
| Follicular/marginal zone lymphoma (with rituximab) | 20 mg once daily on Days 1-21 of each 28-day cycle, for up to 12 cycles |
Renal Impairment Dose Adjustment
| Renal Function (CrCl) | MM/MCL Dose | FL/MZL Dose | MDS/Post-HSCT Dose |
|---|---|---|---|
| 30-60 mL/min | 10 mg daily | 10 mg daily | 5 mg daily |
| <30 mL/min (not on dialysis) | 15 mg every other day | 5 mg daily | 2.5 mg daily |
| <30 mL/min (on dialysis) | 5 mg daily (after dialysis) | 5 mg daily (after dialysis) | 2.5 mg daily (after dialysis) |
Dose may also require modification for hematologic toxicity (neutropenia, thrombocytopenia) as directed by the treating physician. Do not alter the dose or stop Lenalidomide without medical advice.
Side Effects of Lenalidomide
Common side effects of Lenalidomide vary somewhat by indication but commonly include:
- Neutropenia, thrombocytopenia, anemia, and leukopenia (may be severe; see Precautions and Warnings)
- Diarrhea, constipation, nausea
- Fatigue, weakness, insomnia
- Muscle cramps, back pain
- Peripheral edema, rash, pruritus (itching)
- Fever, cough, shortness of breath
Serious but less common effects include severe blood clots (deep vein thrombosis, pulmonary embolism), heart attack or stroke, severe skin reactions, tumor lysis syndrome, and second primary malignancies. Report any unusual bruising/bleeding, leg swelling, chest pain, shortness of breath, or severe rash to a physician immediately.
Contraindications of Lenalidomide
Lenalidomide is contraindicated in:
- Pregnancy - Lenalidomide is a thalidomide analog and can cause severe, life-threatening birth defects or fetal death; it must never be used during pregnancy (see Pregnancy and Lactation).
- Known severe hypersensitivity to Lenalidomide or any component of the formulation, including reactions such as angioedema, Stevens-Johnson syndrome, or toxic epidermal necrolysis.
Frequently Asked Questions about Lenalidomide
What is Lenalidomide used for?
Lenalidomide is used to treat certain blood cancers, including multiple myeloma (with dexamethasone or as maintenance after stem cell transplant), myelodysplastic syndrome with a specific chromosomal abnormality (del5q), mantle cell lymphoma, and, in combination with rituximab, follicular or marginal zone lymphoma.
Can Lenalidomide be used during pregnancy?
No. Lenalidomide is strictly contraindicated in pregnancy because it can cause severe birth defects or fetal death. Women of reproductive potential must use effective contraception and undergo pregnancy testing before and during treatment, under a physician-supervised risk-management program.
What are the most serious side effects of Lenalidomide?
The most serious risks of Lenalidomide include severe reductions in blood cell counts (neutropenia, thrombocytopenia), an increased risk of blood clots (deep vein thrombosis, pulmonary embolism) and cardiovascular events, and, with long-term use, an increased risk of second cancers. Regular blood monitoring is required throughout treatment.
How is Lenalidomide taken?
Lenalidomide is taken orally, usually once daily at the same time each day, with or without food. The capsule should be swallowed whole with water and never opened, crushed, or chewed. Always follow the exact schedule and dose prescribed by your specialist.
Can I stop taking Lenalidomide on my own if I feel better?
No. Do not stop, skip, or change the dose of Lenalidomide without consulting your physician, as treatment schedules are carefully designed around cycles and blood count monitoring; stopping abruptly can affect disease control and safety.
Who should not take Lenalidomide?
Lenalidomide should not be used by anyone who is pregnant or by patients with a known severe hypersensitivity reaction to Lenalidomide, such as angioedema or severe skin reactions. It should only be prescribed and monitored by a specialist experienced in its use.
Disclaimer
The information provided is accurate to the best of our knowledge, but it does not replace professional medical advice. We cannot guarantee its completeness or accuracy, and the absence of specific information about a drug should not be taken as an endorsement. We are not responsible for any consequences arising from this information, so please consult a healthcare professional for any concerns or questions.