Thalidomide (Thalidomid ®)
Thalidomide is a drug used to treat myeloma, which is a type of cancer that affects the plasma cells found inside bone marrow. Research is taking place to see whether it might be effective as a treatment for other cancers.
This section describes thalidomide, how it's given and some of its possible side effects.
You'll see your doctor regularly while you have this treatment so they can monitor its effects. This information should help you discuss any queries about your treatment and its side effects with your doctor or specialist nurse.
Thalidomide was originally developed to prevent morning sickness in pregnant women. Many people have heard of thalidomide. It was originally used to treat sickness during pregnancy, but its use was stopped because it was found to cause birth defects. The birth defects happened because thalidomide changes the growth and development of new blood vessels.
Thalidomide is now used as a treatment for cancer. It's mainly used to treat myeloma. It's safe for adults to take and it's only given following precautions to prevent pregnancy (see below).
The way thalidomide works in the treatment of cancer is not fully understood. Cancers need to produce a network of new blood vessels in order to grow. Without forming these new blood vessels, cancers cannot grow larger than a pinhead.
Researchers have shown that thalidomide can stop cancers from developing new blood vessels. This should reduce the cancer’s supply of oxygen and nutrients, which, it is hoped, will cause the tumour to shrink or at least to stop growing. Drugs that interfere with blood vessel growth in this way are called angiogenesis inhibitors or anti-angiogenics.
When thalidomide is used
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Thalidomide is licensed to be given with the chemotherapy drug melphalan and the steroid prednisolone, for people aged 65 or older who have untreated myeloma and who aren’t suitable for high-dose treatment with stem cell support. You may hear this combination of drugs referred to as MPT.
Thalidomide is sometimes combined with other chemotherapy drugs - for example, the chemotherapy regime CTD (cyclophosphamide, thalidomide and dexamethasone).
What thalidomide looks like
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Thalidomide is available as 50mg capsules.
How thalidomide is given
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Thalidomide capsules should be swallowed whole with plenty of water an hour after food, preferably in the late evening. Thalidomide may be given in combination with chemotherapy drugs.
Preventing pregnancy while taking thalidomide
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You must not become pregnant or father a child while taking thalidomide, because it causes severe abnormalities in developing babies.
Women of childbearing age will be given a pregnancy test to check that they are not pregnant. This will usually be done within three days of starting thalidomide, and repeated every four weeks until four weeks after treatment has finished.
Women of childbearing age must also use a highly effective form of contraception, such as an implanted or injected device, or the progesterone-only pill. The combined oral contraceptive pill is not recommended because it increases the risk of developing blood clots, which is also increased by thalidomide. Contraception must be used for four weeks before treatment, throughout treatment and for four weeks after treatment finishes.
Men taking thalidomide must use a condom during sexual intercourse with a woman of childbearing age or with a pregnant woman. They should continue to use a condom throughout the thalidomide treatment and for one week after it finishes.
Because of the potential birth defects that thalidomide can cause, it's likely that you will have to take part in a pregnancy prevention programme. You will need to sign a consent form and may have to be registered with the company that makes the drug. Your doctor or specialist nurse will give you some written information about the risks of thalidomide and the best ways to prevent pregnancy.
Women of childbearing age can only be prescribed four weeks of thalidomide at a time. This is so that a pregnancy test can be done with each new prescription. The thalidomide can only be prescribed by your hospital doctor, so you'll need to make frequent visits to the hospital. All other patients can be prescribed up to 12 weeks of thalidomide at a time.
Possible side effects of thalidomide
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Each person’s reaction to cancer treatment is different. Some people have very few side effects while others may experience more. The side effects described below won't affect everyone having this treatment.
We've outlined the most common side effects, but haven't included those that are very rare and therefore unlikely to affect you.
If you notice any effects that aren't listed below, discuss them with your doctor or specialist nurse.
Risk of blood clots
Cancer can increase your risk of developing a blood clot (thrombosis), and having thalidomide can increase this risk further. You may be given medicines to thin your blood and help prevent clots forming.
A blood clot may cause pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious, so it’s important to tell your doctor straight away if you have any of these symptoms.
Temporary reduction in blood cells
On its own, thalidomide has only a small effect on blood cell numbers. However, if it's given with chemotherapy drugs, the number of calls in your blood may fall and become low. You will have regular tests to count your blood cells.
Feeling very tired or sleepy
It’s not unusual for people to feel drowsy or sleepy when taking thalidomide. Tell your doctor if this is a problem for you. It will help to take the tablets in the evening. You may find that the drowsiness improves as you continue to take the drug. It’s important not to operate machinery or to drive if you’re feeling sleepy.
You may get constipated. This can usually be helped by drinking plenty of fluids, eating more fibre in your diet and doing some gentle exercise. You may need to take medicine to help (laxative). Your doctor can prescribe these or you can buy them at a pharmacy.
Numbness or tingling in hands and feet
This is due to the effect of thalidomide on the nerve endings and is known as peripheral neuropathy. You may also notice that you have difficulty with tasks like doing up buttons. If you notice any of these side effects, tell your doctor straight away. You will usually be advised to stop taking the thalidomide or the dose may be reduced. This is necessary to prevent the symptoms from getting worse. These symptoms may be permanent, or they may improve slowly with time.
Some people find that thalidomide causes headaches. Let your doctor or nurse know. They can give you painkillers to relieve this.
Dizziness on standing
You may feel dizzy for a few moments if you stand up quickly. This is caused by a temporary fall in blood pressure. Moving slowly from lying to sitting and then sitting to standing may help. Tell your doctor if you've ever had any blood pressure problems and about any medicines you're taking.
Thalidomide can cause a rash, and dry, itchy skin. Your doctor can prescribe medicine to help. Occasionally, thalidomide can cause a more serious skin rash with blistering. Let your doctor know straight away if this happens.
You may find that your ankles swell, particularly if you've been standing still or sitting down for a time. Putting your feet up when sitting helps reduce the problem. Talk to your doctor about medicines that may help. If the swelling is uncomfortable, your doctor may be able to prescribe support stockings to keep it under control.
Feeling sick (nausea) and being sick (vomiting)
This is usually mild. Your doctor can prescribe anti-sickness (anti-emetic) drugs to prevent, or greatly reduce, nausea and vomiting.
If the sickness isn't controlled, or if it continues tell your doctor as; they can prescribe other anti-sickness drugs that may work better for you. Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.
Loss of appetite
Some people lose their appetite while they’re having thalidomide. This can be mild and may only last a few days. If it doesn’t improve you can ask to see a dietitian or specialist nurse at your hospital. They can give you advice on improving your appetite and keeping to a healthy weight.
It's important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they're not mentioned above.
Additional information about thalidomide
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Thalidomide may affect your ability to drive. Don't drive if you have dizziness, blurred vision, excessive tiredness or if you feel sleepy. Ask your doctor for advice if you are not sure whether you're safe to drive.
Some medicines, including those that you can buy in a shop or chemist, can be harmful to take when you are having cancer treatment. Tell your doctor about any medicines you’ are taking, including over-the-counter drugs, complementary therapies and herbal drugs.
There is a potential risk that thalidomide may be present in breast milk, so women are advised not to breastfeed during this treatment and for a few months afterwards.
Non-cancer hospital admission
If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you are having treatment with thalidomide. You should tell them the name of your cancer specialist so that they can ask them for advice.
It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home. During office hours you can contact the clinic or ward where you had your treatment. Your specialist nurse or doctor will tell you who to contact during the evening or at weekends.
Things to remember about thalidomide capsules
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It's important to take your capsules as directed by your doctor, nurse or pharmacist.
Keep the capsules in the container they were dispensed in.
Keep them in a safe place, out of the reach of children. Pregnant women should not handle the capsules.
Thalidomide can interact with alcohol. It is advisable not to drink alcohol while taking thalidomide.
If you forget to take a capsule, don't take a double dose. Tell your doctor and keep to your regular dose schedule.
If you're sick just after taking the capsule, contact your doctor for advice.
When planning overseas travel, check whether the country you're visiting has any special requirements regarding thalidomide. For example, Australia requires you to provide a letter from your doctor explaining why you are taking the drug.
If your doctor decides to stop the treatment, return any remaining capsules to the pharmacist. Don't flush them down the toilet or throw them away.
This information has been compiled using a number of reliable sources, including:
Bortezomib and thalidomide for the first-line treatment of multiple myeloma (TA228). July 2011. National Institute for Health and Clinical Excellence (NICE).
British National Formulary. 2012. 63rd edition. British Medical Association and Royal Pharmaceutical Society of Great Britain.
electronic Medicines Compendium (eMC) website. (accessed September 2012).
Scottish Medicines Consortium (SMC). 525/08 - Thalidomide (Pharmion). January 2009.
With thanks to: Professor Gareth Morgan, Professor of Haematology; and the people affected by cancer who reviewed this edition. Reviewing information is just one of the ways you could help when you join our Cancer Voices network.