Imnovid (Pomalidomide)

Imnovid is an immunomodulatory agent used in the management of multiple myeloma, particularly in patients with disease that has progressed after prior treatments.

• Relapsed/refractory multiple myeloma: Provides a therapeutic option after failure of lenalidomide and bortezomib.
• Multiple myeloma after prior therapies: Improves disease control when combined with dexamethasone.
• Multiple myeloma in combination regimens: Enhances anti‑myeloma activity as part of multi‑drug protocols.

• Pomalidomide binds to the cereblon component of the CRL4 E3 ubiquitin ligase complex, directing the degradation of transcription factors Ikaros and Aiolos. This leads to anti‑angiogenic, immunomodulatory, and pro‑apoptotic effects, while also inhibiting TNF‑α production and modulating cytokine release, collectively contributing to its antineoplastic activity.

Adverse reactions to pomalidomide may vary in frequency and severity.

Common Side Effects

• Neutropenia: reduced neutrophil count increasing infection risk.
• Anemia: decreased red blood cell levels causing fatigue.
• Fatigue: general feeling of tiredness.
• Constipation: difficulty passing stools.
• Diarrhoea: loose, frequent stools.
• Rash: skin irritation or redness.

Serious or Rare Side Effects

• Thromboembolic events: blood clots in veins or arteries.
• Severe infections: opportunistic or bacterial infections requiring hospitalization.
• Stevens‑Johnson syndrome: severe skin reaction.
• Tumour lysis syndrome: rapid tumour cell breakdown.
• Second primary malignancies: emergence of new cancers.

When prescribing pomalidomide, clinicians should observe several safety measures.

• Monitor blood counts: perform regular CBC to detect neutropenia or anemia.
• Assess thromboembolic risk: evaluate patient history and consider prophylactic anticoagulation.
• Avoid pregnancy: enforce strict contraception for both patient and partner.
• Use caution in renal impairment: adjust therapy based on renal function.
• Store at room temperature: keep in the original pack, protect from moisture.

Pomalidomide may interact with other medicines, requiring attention to avoid reduced efficacy or increased toxicity.

Major Interactions (Avoid)

• Strong CYP3A4 inducers (e.g., rifampin): may lower pomalidomide plasma levels.
• Anticoagulants (e.g., warfarin): increased risk of bleeding.
• Thalidomide or other IMiDs: additive teratogenic risk.

Moderate Interactions (Monitor Closely)

• CYP3A4 inhibitors (e.g., ketoconazole): may raise pomalidomide exposure.
• CYP1A2 inhibitors (e.g., fluvoxamine): potential increase in drug levels.
• NSAIDs: may exacerbate neutropenia or gastrointestinal side effects.