Lenalidomid Ohre Pharma (Lenalidomide)

Lenalidomide is employed in the management of hematologic malignancies where it modulates the immune environment and inhibits tumor growth.

• Multiple myeloma: improves progression‑free survival and overall response rates in adult patients.
• Myelodysplastic syndromes: reduces transfusion dependence and delays transformation to acute leukemia.
• Mantle cell lymphoma: enhances response when combined with standard chemotherapy in relapsed or refractory disease.

• Lenalidomide binds to the cereblon component of the CRL4‑E3 ubiquitin ligase complex, altering substrate specificity and promoting ubiquitination and proteasomal degradation of the transcription factors Ikaros (IKZF1) and Aiolos (IKZF3). This results in reduced cytokine production, enhanced T‑cell and NK‑cell activity, and inhibition of angiogenesis, collectively providing antitumor effects in plasma‑cell and lymphoid cancers.

Lenalidomide may cause a range of adverse reactions, varying from mild to serious.

Common Side Effects

• Fatigue: persistent tiredness affecting daily activities.
• Diarrhea: loose stools that may be mild to moderate.
• Nausea: feeling of sickness often accompanied by loss of appetite.
• Rash: skin redness or itching.
• Constipation: difficulty passing stools.
• Peripheral neuropathy: tingling or numbness in extremities.

Serious or Rare Side Effects

• Thromboembolic events: deep vein thrombosis or pulmonary embolism.
• Severe neutropenia: markedly reduced neutrophil count increasing infection risk.
• Hepatotoxicity: elevated liver enzymes or liver injury.
• Secondary primary malignancies: emergence of new cancers.
• Severe cutaneous reactions: Stevens‑Johnson syndrome or toxic epidermal necrolysis.

Before initiating lenalidomide therapy, several precautions and monitoring measures should be observed.

• Pregnancy risk: contraindicated in pregnancy due to teratogenicity; ensure effective contraception.
• Thrombosis prophylaxis: assess need for anticoagulation in patients with additional risk factors.
• Hematologic monitoring: perform regular CBC to detect neutropenia or anemia.
• Renal function: adjust dosing or monitor closely in patients with impaired kidney function.
• Hepatic function: evaluate liver enzymes before and during treatment.
• Store at ambient temperature: keep below 25 °C in the original container, protect from moisture and light.

Lenalidomide can interact with other medicines, altering efficacy or safety.

Major Interactions (Avoid)

• Strong CYP3A4 inducers (e.g., rifampin): may reduce lenalidomide plasma levels.
• Anticoagulants (e.g., warfarin): increased risk of bleeding when combined with lenalidomide‑associated thrombocytopenia.
• Immunosuppressants (e.g., cyclosporine): heightened risk of severe neutropenia.

Moderate Interactions (Monitor Closely)

• P-glycoprotein substrates (e.g., digoxin): potential increase in drug exposure.
• CYP2C19 inhibitors (e.g., fluconazole): may modestly raise lenalidomide concentrations.
• NSAIDs (e.g., ibuprofen): additive risk of renal impairment and gastrointestinal bleeding.