Lenalidomidă Teva (Lenalidomide)

• Lenalidomide is an immunomodulatory agent used in hematologic malignancies and related disorders.
• Multiple myeloma: improves progression‑free survival and overall response rates in adult patients.
• Multiple myeloma (maintenance therapy): prolongs remission after initial treatment or stem‑cell transplantation.
• Myelodysplastic syndromes with del(5q): reduces transfusion dependence and improves peripheral blood counts.

• Lenalidomide binds to cereblon, a component of the CRL4‑CRBN E3 ubiquitin ligase complex, altering substrate specificity and leading to degradation of transcription factors such as Ikaros and Aiolos. This results in modulation of cytokine production, inhibition of angiogenesis, and direct anti‑tumor activity by reducing proliferation of malignant plasma cells and myelodysplastic clones.

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

Common Side Effects

• Neutropenia: reduced neutrophil count increasing infection risk.
• Thrombocytopenia: low platelet levels leading to bleeding tendency.
• Fatigue: persistent tiredness affecting daily activities.
• Diarrhea or constipation: gastrointestinal disturbances.
• Rash or pruritus: mild skin irritation.
• Nausea: upset stomach, sometimes with vomiting.

Serious or Rare Side Effects

• Venous thromboembolism: deep vein thrombosis or pulmonary embolism.
• Secondary primary malignancies: emergence of new cancers.
• Severe skin reactions: Stevens‑Johnson syndrome or toxic epidermal necrolysis.
• Hepatotoxicity: significant elevation of liver enzymes.
• Severe infections: opportunistic or bacterial infections requiring hospitalization.

Before initiating therapy, clinicians should assess patient suitability and monitor for potential complications.

• Monitor blood counts: perform regular complete blood count tests to detect cytopenias.
• Assess thrombotic risk: evaluate history of clotting disorders and consider prophylactic anticoagulation.
• Evaluate renal and hepatic function: adjust therapy if impairment is present.
• Contraindicated in pregnancy: enforce effective contraception and avoid use in pregnant women.
• Store at room temperature: keep in the original packaging, protect from moisture and direct sunlight.

Lenalidomide may interact with several medicines, requiring careful management.

Major Interactions (Avoid)

• Anticoagulants (e.g., warfarin): increased risk of bleeding.
• Immunosuppressants (e.g., cyclosporine): heightened toxicity and infection risk.
• Live vaccines: reduced efficacy and potential for infection.

Moderate Interactions (Monitor Closely)

• CYP3A4 inhibitors (e.g., ketoconazole): may raise lenalidomide exposure.
• CYP3A4 inducers (e.g., rifampin): may lower drug levels.
• NSAIDs: combined use can increase renal adverse effects.
• Hormonal contraceptives: may reduce contraceptive effectiveness.
• Antiplatelet agents (e.g., aspirin): additive risk of bleeding.