Lenalidomide (REVLIMID)

Myelodysplastic syndromes

Multiple myeloma

Myelodysplastic syndromes

• Oral: 10mg daily for 21 days of a 28-day cycle, or 5mg daily continuously

Multiple myeloma

• Oral: 5-25mg once daily for 21 days of a 28-day cycle
• Oral: 10mg daily continuously post autologous stem cell transplant until disease progression or unacceptable toxicity

Note: Given as monotherapy or in combination with chemotherapy or biologics

Available as 2.5mg, 5mg, 10 mg, 15 mg, 20 mg, and 25 mg capsules. Capsules contain lactose. Capsules should NOT be opened. Store at room temperature.

Immunomodulator

Take with or without food

If a dose is missed, patients should be instructed to take it as soon as they can if it is within 12 hours of the missed dose. If it is over 12 hours since the missed dose, patients should skip the missed dose and resume with the next scheduled dose.

Common: Anemia, Neutropenia, Thrombocytopenia, Fatigue, Pruritus, Rash, Constipation, Diarrhea, Arthralgia.

Less Common: Hypothyroidism, Dyspepsia, Pneumonia, Respiratory tract infection, Progressive multifocal leukoencephalopathy, Deep vein thrombosis, Pulmonary embolism.

The adverse effects listed above are not exhaustive. Please refer to the relevant product monograph for full details.

Baseline before treatment: CBC & differential, platelets, serum creatinine, bilirubin, ALT, AST, ALP, TSH

If premenopausal female: lab-based pregnancy test x 2 prior to initiation of treatment.

• Test #1 – 7-14 days prior to treatment
• Test #2 – 24 hours prior to treatment  

During treatment:

• Weekly for 1 month: CBC & differential, platelets, serum creatinine, pregnancy test (if premenopausal female). 
• Monthly after 1st month of therapy: CBC & differential, platelets, serum creatinine, bilirubin, ALT, alkaline phosphatase, pregnancy test (if premenopausal female). 
• Every 3 months after 1st month of therapy: TSH, T3, T4. 
• 4 weeks after discontinuing lenalidomide – pregnancy test (if premenopausal female). 
• Regular clinical assessments and grading of rash, diarrhea, fatigue and respiratory symptoms.

• This drug can impact or be impacted by metabolic enzymes for absorption and excretion. Many drugs can also affect or be affected by these enzymes, so please consult with pharmacy to assess for interactions.
• Current drug interaction databases should be consulted for more information.

• Avoid in pregnancy and lactation.
• Lenalidomide has demonstrated a significantly increased risk of deep vein thrombosis (DVT) and pulmonary embolism (PE), as well as risk of myocardial infarction and stroke in patients with multiple myeloma who were treated with Lenalidomide and dexamethasone therapy. Patients should be started on prophylaxis. ASA 81mg once daily can be used in patients not currently taking anticoagulants.
• Patients must be enrolled in a medication surveillance program prior to starting treatment.

BC Cancer. BC Cancer Drug Manual. Lenalidomide.  Vancouver, British Columbia: BC Cancer Agency. Available at: http://www.bccancer.bc.ca/drug-database-site/Drug%20Index/Lenalidomide_monograph.pdf.Updated March 1, 2019.  Accessed February 2, 2024.

Lexicomp. Lenalidomide Monograph. In: Lexi-Drugs. Hudson, Ohio: Lexi-Comp, Inc. Available at: https://online-lexi-com.qe2a-proxy.mun.ca/lco/action/doc/retrieve/docid/patch_f/361321?cesid=aUv4KN67SwK&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3Dlenalidomide%26t%3Dname%26acs%3Dtrue%26acq%3Dlenalidomide. Updated January 24, 2024. Accessed February 2, 2024.

Cancer Care Ontario. Lenalidomide Monograph. Drug Formulary. Toronto, Ontario: Cancer Care Ontario. Available at: https://www.cancercareontario.ca/en/drugformulary/drugs/monograph/43951. Updated May 2022. Accessed January 22, 2024.

Celgene Inc. REVLIMID® Product Monograph. Mississauga, Ontario. Updated March 20, 2018.