Pomalidomide (Oral route)
Pomalidomide is contraindicated in pregnancy. Pomalidomide is a thalidomide analogue, and thalidomide is a known human teratogen that causes severe birth defects or embryo-fetal death. In females who can become pregnant, obtain 2 negative pregnancy test before treatment initiation. It is required that females of reproductive potential use 2 forms of contraception or abstain from heterosexual sex during and for 4 weeks after stopping treatment with pomalidomide. The only way to acquire pomalidomide is through a restricted distribution program called POMALYST REMS. DVT, pulmonary embolism, myocardial infarction, and stroke have been reported in patients with multiple myeloma treated with pomalidomide. Thromboprophylaxis is recommended, and the regimen choice should be based on assessment of the underlying risk factors of the patient .
Uses of This Medicine:
Pomalidomide is used in combination with dexamethasone to treat multiple myeloma (cancer of the blood) in patients who have received at least 2 other medicines that did not work well. This medicine is used in patients with multiple myeloma that has worsened during treatment or within 60 days of the last treatment. It interferes with the growth of multiple myeloma cells, which are eventually destroyed in the body. Pomalidomide is an antineoplastic (cancer medicine).
This medicine is available only under a restricted distribution program called the Pomalyst® REMS (Risk Evaluation and Mitigation Strategy) program.
Before Using This Medicine:
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:
Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Appropriate studies have not been performed on the relationship of age to the effects of pomalidomide in the pediatric population. Safety and efficacy have not been established.
Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of pomalidomide in the elderly.
There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.
- Grapefruit Juice
Other medical problems—
The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:
- Anemia (low red blood cells) or
- Blood clots or
- Bone marrow problems or
- Deep vein thrombosis (blood clot in the leg) or
- Neutropenia (low white blood cells) or
- Pulmonary embolism (blood clot in the lung) or
- Thrombocytopenia (low platelets in the blood)—Use with caution. May make these conditions worse.
- Kidney disease or
- Liver disease—Use with caution. The effects may be increased because of slower removal of the medicine from the body.
Proper Use of This Medicine:
Take this medicine exactly as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered.
It is very important that you understand the rules of the Pomalyst® REMS program. Read the patient Medication Guide. Read and follow these instructions carefully. Ask your doctor or pharmacist if you have any questions. You might be asked to sign a form to show that you understand the information.
Swallow the capsule whole with water. Do not break, chew, or open it. If you accidentally open or handle the medicine in the capsule, wash your skin with soap and water right away.
You may take this medicine with or without food.
The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
- For oral dosage form (capsules):
- For multiple myeloma:
- Adults—At first, 4 milligrams (mg) once a day. Your doctor may adjust your dose as needed. This medicine is usually taken on days 1 to 21 of a 28-day cycle. This schedule is repeated again every 28 days.
- Children—Use and dose must be determined by your doctor.
- For multiple myeloma:
If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
If you miss a dose of this medicine and it is less than 12 hours since your regular time, take it as soon as you can and take your next dose at the normal time. If you miss a dose and it is more than 12 hours since your regular time, skip the missed dose and take your next dose at the normal time. Do not use extra medicine to make up for a missed dose.
Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.
Keep out of the reach of children.
Do not keep outdated medicine or medicine no longer needed.
Ask your healthcare professional how you should dispose of any medicine you do not use.
Return unused capsules to your doctor or pharmacist.
Precautions While Using This Medicine:
It is very important that your doctor check your progress at regular visits to see if it is working properly and to allow for a change in the dose. Blood tests may be needed to check for unwanted effects.
Using this medicine while you are pregnant can harm your unborn baby. Pregnancy tests are required before and during treatment with this medicine. Women who are sexually active must use 2 forms of effective birth control together to avoid pregnancy. You should begin using birth control 4 weeks before starting treatment with this medicine. Continue the birth control during treatment, even if the dose is stopped for a short time, and for at least 4 weeks after your last dose. Talk to your doctor about the most effective forms of birth control for you and your partner. Call your doctor right away if you think you are pregnant.
Men who are sexually active must protect their female partner from getting pregnant. Pomalidomide will appear in the semen so male patients must not donate sperm. If you are sexually active, you must use a latex or synthetic condom every time you have sex with a woman who could get pregnant even if you have had a vasectomy. Use a condom for sex during treatment with this medicine, even if the dose is stopped for a short time, and for up to 28 days after your last dose. Call your doctor right away if you think your sexual partner may be pregnant.
Do not donate blood while you are taking this medicine and for at least 1 month after your last dose.
Using this medicine may increase your risk for having blood clots, strokes, or heart attacks. Your risk for these serious problems is even greater if you have high blood pressure or high cholesterol, or if you smoke cigarettes. Contact your doctor right away if you experience chest pain, confusion, difficulty speaking, double vision, headaches, an inability to move arms, legs or facial muscle, or an inability to speak.
Do not receive pembrolizumab together with pomalidomide or similar medicines and dexamethasone.
Pomalidomide can temporarily lower the number of white blood cells in your blood, increasing the chance of getting an infection. It can also lower the number of platelets, which are necessary for proper blood clotting. If this occurs, there are certain precautions you can take, especially when your blood count is low, to reduce the risk of infection or bleeding:
- If you can, avoid people with infections. Check with your doctor right away if you think you are getting an infection or if you get a fever or chills, cough or hoarseness, lower back or side pain, or painful or difficult urination.
- Check with your doctor right away if you notice any unusual bleeding or bruising, black, tarry stools, blood in the urine or stools, or pinpoint red spots on your skin.
- Be careful when using a regular toothbrush, dental floss, or toothpick. Your medical doctor, dentist, or nurse may recommend other ways to clean your teeth and gums. Check with your medical doctor before having any dental work done.
- Do not touch your eyes or the inside of your nose unless you have just washed your hands and have not touched anything else in the meantime.
- Be careful not to cut yourself when you are using sharp objects such as a safety razor or fingernail or toenail cutters.
- Avoid contact sports or other situations where bruising or injury could occur.
Check with your doctor right away if you have pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, vomiting, or yellow eyes or skin. These could be symptoms of a serious liver problem.
This medicine may cause serious allergic reactions, including angioedema, which may be life-threatening and requires immediate medical attention. Check with your doctor right away if you have a rash, itching, a large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs, trouble breathing, or chest tightness while you are using this medicine.
Serious skin reactions can occur with this medicine. Check with your doctor right away if you have blistering, peeling, or loosening of the skin, red skin lesions, severe acne or a skin rash, sores or ulcers on the skin, or fever or chills with this medicine.
This medicine may cause a serious type of reaction called tumor lysis syndrome. Your doctor may give you a medicine to help prevent this. Call your doctor right away if you have a decrease or change in urine amount, joint pain, stiffness, or swelling, lower back, side, or stomach pain, a rapid weight gain, swelling of the feet or lower legs, or unusual tiredness or weakness.
This medicine may cause nerve damage. Check with your doctor right away if you have tingling, burning, numbness, or pain in your hands or feet. These could be symptoms of a nerve condition called peripheral neuropathy.
This medicine may make you dizzy or confused. Do not drive or do anything else that could be dangerous until you know how this medicine affects you.
Avoid cigarette smoking while using this medicine. The blood level may be lower than normal if you smoke.
Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.
Side Effects of This Medicine:
- More common
- Black, tarry stools
- bladder pain
- bleeding gums
- bloating or swelling of the face, arms, hands, lower legs, or feet
- blood in the urine or stools
- bloody nose
- body aches or pain
- burning, numbness, tingling, or painful sensations
- chest pain
- cloudy urine
- decreased or increased urination
- difficult, burning, or painful urination
- difficulty with breathing
- dry mouth
- ear congestion
- fast or irregular heartbeat
- feeling sad or empty
- frequent urge to urinate
- incoherent speech
- increased thirst
- lack of appetite
- loss of appetite
- loss of interest or pleasure
- loss of voice
- lower back or side pain
- metallic taste
- muscle pain or cramps
- muscle weakness
- nasal congestion
- numbness or tingling in the hands, feet, or lips
- pale skin
- pinpoint red spots on the skin
- rapid weight gain
- runny nose
- shakiness in the legs, arms, hands, or feet
- sore throat
- stomach pain
- tightness in the chest
- trembling or shaking of the hands or feet
- trouble concentrating
- trouble sleeping
- troubled breathing with exertion
- ulcers, sores, or white spots in the mouth
- unsteadiness or awkwardness
- unusual bleeding or bruising
- unusual weight gain or loss
- weakness in the arms, hands, legs, or feet
- Less common
- dizziness or lightheadedness
- pain, redness, or swelling in the arm or leg
- troubled breathing
- Incidence not known
- Blistering, peeling, or loosening of the skin
- difficulty in passing urine (dribbling)
- joint pain
- red skin lesions, often with a purple center
- red, irritated eyes
- unusual tiredness or weakness
- weakness or heaviness of the legs
- yellow eyes or skin
- More common
- Back pain
- blurred vision
- decreased appetite
- difficulty with moving
- flushed, dry skin
- fruit-like breath odor
- increased hunger
- increased sweating
- lack or loss of strength
- muscle spasms or stiffness
- night sweats
- Incidence not known
- Feeling of constant movement of self or surroundings
- sensation of spinning
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Last Updated: 6/18/2019