Home Drug Guide Lenalidomide

Drug Guide

Generic Name

Lenalidomide

Brand Names Revlimid

Classification

Therapeutic: Antineoplastic, Immunomodulator

Pharmacological: Immunomodulatory agent

FDA Approved Indications

Multiple myeloma
Myelodysplastic syndromes with deletion 5q

Mechanism of Action

Lenalidomide modulates the immune system and exhibits anti-angiogenic properties, leading to tumor cell apoptosis and inhibition of cytokine production.

Dosage and Administration

Adult: Typically 25 mg daily on days 1-21 of a 28-day cycle, with dose adjustments based on response and tolerability.

Pediatric: Not established; not recommended for pediatric use.

Geriatric: Caution; dose adjustments may be necessary due to increased risk of adverse effects.

Renal Impairment: Dose adjustments required based on renal function.

Hepatic Impairment: Use with caution; no specific dosage adjustment guidelines established.

Pharmacokinetics

Absorption: Well absorbed orally.

Distribution: Widely distributed, with a volume of distribution reflecting extensive tissue uptake.

Metabolism: Metabolized minimally; primarily excreted unchanged.

Excretion: Excreted predominantly via the kidneys.

Half Life: Approximately 3 hours.

Contraindications

Pregnancy (Category X) due to high teratogenic risk.
Hypersensitivity to lenalidomide or any component of the formulation.

Precautions

Teratogenicity: strict risk management program (e.g., REMS) required.
Blood dyscrasias: monitor blood counts.
Thromboembolism: increased risk; consider prophylaxis.
Immunosuppression: increased infection risk.

Adverse Reactions - Common

Neutropenia (Very common)
Thrombocytopenia (Very common)
Anemia (Common)
Fatigue (Common)
Diarrhea (Common)

Adverse Reactions - Serious

Deep vein thrombosis (DVT)/Pulmonary embolism (Uncommon but serious)
Secondary malignancies (Rare)
Anaphylaxis (Rare)
Severe skin reactions (Rare)

Drug-Drug Interactions

DVT prophylactic agents (e.g., aspirin, warfarin, LMWH)
Other immunosuppressants

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor complete blood counts regularly, assess for signs of infection, bleeding, and thromboembolic events.

Diagnoses:

Risk for infection,
Risk for bleeding,
Risk for thromboembolism

Implementation: Administer as prescribed, provide thromboprophylaxis when indicated, counsel on pregnancy prevention, monitor for adverse effects.

Evaluation: Effectiveness indicated by hematologic response, absence of adverse effects, patient adherence.

Patient/Family Teaching

Strict adherence to contraceptive requirements due to teratogenic risk.
Report signs of infection, bleeding, or thrombosis immediately.
Inform about possible side effects and when to seek medical attention.

Special Considerations

Black Box Warnings:

Teratogenicity and embryoofetal toxicity — pregnancy must be avoided. Use of REMS program to prevent fetal exposure.
Second primary malignancies are increased — monitor patients regularly.

Genetic Factors: None specified.

Lab Test Interference: May alter blood cell counts, which require close monitoring.

Overdose Management

Signs/Symptoms: Severe cytopenias, bleeding, or adverse reactions,

Treatment: Supportive care; no specific antidote; discontinue medication and provide supportive treatments as needed.

Storage and Handling

Storage: Store at 20-25°C (68-77°F).

Stability: Stable under recommended storage conditions.