Lenalidomide Eugia (Uk) (Lenalidomide)

Lenalidomide is used in hematologic malignancies that respond to immunomodulatory therapy.

• Multiple Myeloma: improves progression‑free and overall survival when combined with dexamethasone.
• Relapsed/Refractory Multiple Myeloma: restores disease control after prior therapies.
• Myelodysplastic Syndromes with del(5q): reduces transfusion dependence and cytopenias.

• Lenalidomide binds to the cereblon component of the CRL4‑CRBN E3 ubiquitin ligase complex, altering substrate specificity and leading to degradation of transcription factors Ikaros and Aiolos. This results in modulation of the immune response, inhibition of angiogenesis, and induction of apoptosis in malignant plasma cells and dysplastic progenitors.

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

Common Side Effects

• Fatigue: persistent tiredness affecting daily activities.
• Diarrhoea: loose stools that may require fluid replacement.
• Constipation: reduced bowel movements causing discomfort.
• Rash: mild skin eruptions that resolve with or without treatment.
• Nausea: feeling of sickness that may be transient.
• Peripheral neuropathy: tingling or numbness in extremities.

Serious or Rare Side Effects

• Neutropenia: dangerously low neutrophil counts increasing infection risk.
• Thrombocytopenia: low platelet levels leading to bleeding tendencies.
• Venous thromboembolism: formation of blood clots in deep veins or lungs.
• Secondary primary malignancies: emergence of new cancers unrelated to the original disease.
• Severe allergic reactions: anaphylaxis or Stevens‑Johnson syndrome.
• Hepatotoxicity: elevated liver enzymes indicating liver injury.

Before initiating therapy, clinicians should evaluate patient‑specific risk factors and monitor for toxicity.

• Monitor blood counts: perform regular CBCs to detect neutropenia or thrombocytopenia.
• Assess thromboembolic risk: consider prophylactic anticoagulation in high‑risk patients.
• Contraindicated in pregnancy: enforce strict contraception and avoid use in pregnant women.
• Adjust for renal impairment: dose may need modification based on creatinine clearance.
• Store at room temperature: keep in the original container, protect from moisture and light.

Lenalidomide can interact with several drug classes, requiring careful management.

Major Interactions (Avoid)

• Strong CYP3A4 inducers (e.g., rifampin, carbamazepine): may markedly reduce lenalidomide exposure.
• Live vaccines: increased risk of infection due to immunosuppression.

Moderate Interactions (Monitor Closely)

• Anticoagulants (warfarin, DOACs): may heighten bleeding risk when combined with thrombocytopenia.
• NSAIDs: can exacerbate platelet suppression.
• Other immunomodulatory agents (e.g., pomalidomide): additive myelosuppression.
• P‑glycoprotein inhibitors (e.g., verapamil): may increase plasma concentrations.