Talidomida

Talidomida Uses, Dosage, Side Effects, Food Interaction and all others data.

Talidomida is a synthetic glutamic acid derivative immunomodulator with anti-inflammatory, antiangiogenetic, sedative and hypnotic activity.

In patients with erythema nodosum leprosum (ENL) the mechanism of action is not fully understood. Available data from in vitro studies and preliminary clinical trials suggest that the immunologic effects of this compound can vary substantially under different conditions, but may be related to suppression of excessive tumor necrosis factor-alpha (TNF-a) production and down-modulation of selected cell surface adhesion molecules involved in leukocyte migration. For example, administration of thalidomide has been reported to decrease circulating levels of TNF-a in patients with ENL, however, it has also been shown to increase plasma TNF-a levels in HIV-seropositive patients. As a cancer treatment, the drug may act as a VEGF inhibitor.

Talidomida is an immunomodulatory agent with a spectrum of activity that is not fully characterized. Talidomida is racemic — it contains both left and right handed isomers in equal amounts: one enantiomer is effective against morning sickness, and the other is teratogenic. The enantiomers are converted to each other in vivo. That is, if a human is given D-thalidomide or L-thalidomide, both isomers can be found in the serum. Hence, administering only one enantiomer will not prevent the teratogenic effect in humans.

Trade Name Talidomida
Availability Prescription only
Generic Thalidomide
Thalidomide Other Names Talidomida, Thalidomide, Thalidomidum
Related Drugs Revlimid, Velcade, Darzalex, Pomalyst, clofazimine, Ninlaro, Kyprolis, Thalomid
Type
Formula C13H10N2O4
Weight Average: 258.2295
Monoisotopic: 258.064056818
Protein binding

55% and 66% for the (+)R and (−)S enantiomers, respectively.

Groups Approved, Investigational, Withdrawn
Therapeutic Class Anti-Leprotic drugs, Immunosuppressant
Manufacturer
Available Country
Last Updated: September 19, 2023 at 7:00 am
Talidomida
Talidomida

Uses

Multiple Myeloma: Talidomida in combination with dexamethasone is used for the treatment of patients with newly diagnosed multiple myeloma (MM).

Erythema Nodosum Leprosum: Talidomida is used for the acute treatment of the cutaneous manifestations of moderate to severe erythema nodosum leprosum (ENL). Talidomida is not used as monotherapy for such ENL treatment in the presence of moderate to severe neuritis. Talidomida is also used as maintenance therapy for prevention and suppression of the cutaneous manifestations of ENL recurrence

Talidomida is also used to associated treatment for these conditions: Chronic Graft Versus Host Disease, Multiple Myeloma (MM), Stomatitis, Aphthous, Uremic Pruritus, Waldenström's Macroglobulinemia (WM), Advanced Systemic light chain amyloidosis, Moderate Erythema nodosum leprosum, Refractory Graft versus host disease, Severe Erythema nodosum leprosum, Treatment naive multiple myeloma

How Talidomida works

In patients with erythema nodosum leprosum (ENL) the mechanism of action is not fully understood. Available data from in vitro studies and preliminary clinical trials suggest that the immunologic effects of this compound can vary substantially under different conditions, but may be related to suppression of excessive tumor necrosis factor-alpha (TNF-a) production and down-modulation of selected cell surface adhesion molecules involved in leukocyte migration. For example, administration of thalidomide has been reported to decrease circulating levels of TNF-a in patients with ENL, however, it has also been shown to increase plasma TNF-a levels in HIV-seropositive patients. As a cancer treatment, the drug may act as a VEGF inhibitor.

Dosage

Talidomida dosage

Multiple Myeloma: Talidomida is administered in combination with dexamethasone in 28-day treatment cycles. The dose of Talidomida is 200 mg administered orally once daily with water, preferably at bedtime and at least 1 hour after the evening meal. The dose of dexamethasone is 40 mg daily administered orally on days 1-4, 9-12, and 17-20 every 28 days.

Patients who develop adverse reactions such as constipation, somnolence, or peripheral neuropathy may benefit by either temporarily discontinuing the drug or continuing at a lower dose. With the abatement of these adverse reactions, the drug may be started at a lower dose or at the previous dose based on clinical judgment. Erythema Nodosum Leprosum: For an episode of cutaneous ENL, Talidomida dosing should be initiated at 100 to 300 mg/day, administered once daily with water, preferably at bedtime and at least 1 hour after the evening meal. Patients weighing less than 50 kilograms should be started at the low end of the dose range.

In patients with a severe cutaneous ENL reaction, or in those who have previously required higher doses to control the reaction, Talidomida dosing may be initiated at higher doses up to 400 mg/day once daily at bedtime or in divided doses with water, at least 1 hour after meals.

In patients with moderate to severe neuritis associated with a severe ENL reaction, corticosteroids may be started concomitantly with Talidomida. Steroid usage can be tapered and discontinued when the neuritis has ameliorated.

Dosing with Talidomida should usually continue until signs and symptoms of active reaction have subsided, usually a period of at least 2 weeks. Patients may then be tapered off medication in 50 mg decrements every 2 to 4 weeks.

Patients who have a documented history of requiring prolonged maintenance treatment to prevent the recurrence of cutaneous ENL or who flare during tapering should be maintained on the minimum dose necessary to control the reaction. Tapering off medication should be attempted every 3 to 6 months, in decrements of 50 mg every 2 to 4 weeks.

Side Effects

Severe and irreversible peripheral neuropathy, constipation, dizziness, orthostatic hypotension, drowsiness, somnolence, bradycardia, increase of viral load in HIV-infected patients, hypersensitivity reaction.

Toxicity

The R-configuration and the S-configuration are more toxic individually than the racemic mixture. The LD50 could not be established in mice for racemic thalidomide, whereas LD50 values for the R and S configurations are reported to be 0.4 to 0.7 g/kg and 0.5 to 1.5 g/kg, respectively.

Precaution

All females of childbearing potential must use 2 reliable forms of contraception simultaneously 4 wk before starting therapy, during and 4 wk after therapy is discontinued. Therapy to be stopped immediately if pregnancy occurs. Male: Use of barrier methods of contraception if partner is of child-bearing potential. Do not donate blood or sperm during therapy. Patient should not drive or operate machinery. Discontinue therapy if any skin rash develops. Do not resume therapy if the rash is exfoliative, purpuric, or bullous, or if Stevens-Johnson syndrome or toxic epidermal necrolysis suspected

Interaction

Talidomida enhances sedative activity of barbiturates, alcohol, chlorpromazine and reserpine. Avoid use of other drugs that have the potential to cause peripheral neuropathy. Increased risk of thromboembolic events with darbepoetin-alfa and doxorubicin.

Food Interaction

  • Avoid alcohol. Ingesting alcohol may increase the drowsiness caused by thalidomide.
  • Take after a meal. Wait at least 1 hour after eating before taking thalidomide.

[Moderate] GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents.

Use in combination may result in additive central nervous system depression and
MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol.

Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

Elimination Route

The absolute bioavailability has not yet been characterized in human subjects due to its poor aqueous solubility. In studies of both healthy volunteers and subjects with Hansen’s disease, the mean time to peak plasma concentrations (Tmax) ranged from 2.9 to 5.7 hours indicating that thalidomide is slowly absorbed from the gastrointestinal tract.

Half Life

The mean half-life of elimination ranges from approximately 5 to 7 hours following a single dose and is not altered upon multiple dosing.

Elimination Route

Talidomida itself has less than 0.7% of the dose excreted in the urine as unchanged drug.

Pregnancy & Breastfeeding use

Pregnancy Category X. Studies in animals or human beings have demonstrated foetal abnormalities or there is evidence of foetal risk based on human experience or both, and the risk of the use of the drug in pregnant women clearly outweighs any possible benefit. The drug is contraindicated in women who are or may become pregnant.

Contraindication

Pregnancy and lactation.

Innovators Monograph

You find simplified version here Talidomida

Talidomida contains Thalidomide see full prescribing information from innovator Talidomida Monograph, Talidomida MSDS, Talidomida FDA label

FAQ

What is Talidomida used for?

Talidomida is used to treat or prevent certain skin conditions related to Hansen's disease, once known as leprosy (erythema nodosum leprosum).Talidomida is also used to treat a certain type of cancer (multiple myeloma).

Is Talidomida safe to use?

There was no toxic death.Long-term use of Talidomida is safe, effective and feasible. We feel that this is one of few reports describing safety and efficacy of long-term Talidomida in relapsed and refractory MM.

What are the common side effects of Talidomida?

Talidomida may cause side effects are include:

  • drowsiness
  • confusion
  • anxiety
  • depression or mood changes
  • difficulty falling asleep or staying asleep
  • bone, muscle, joint, or back pain
  • weakness
  • headache
  • change in appetite
  • weight changes
  • nausea
  • constipation
  • dry mouth
  • dry skin
  • pale skin
  • uncontrollable shaking of a part of the body
  • swelling of the hands, feet, ankles, or lower legs
  • difficulty achieving or maintaining an erection

Is Talidomida safe during pregnancy?

Talidomida must not be taken by women who are pregnant or who could become pregnant while taking this medication. Even a single dose of Talidomida taken during pregnancy can cause severe birth defects (physical problems present in the baby at birth) or death of the unborn baby.

Is Talidomida safe during breastfeeding?

Based on its chemical properties, it is expected to pass into breast milk. The Talidomida may cause drowsiness in a breastfed infant, but the exact effects of Talidomida on the breastfed infant are unknown. The product label for Talidomida recommends people who are breastfeeding not use this medication.

Can I drink alcohol with Talidomida?

Alcohol can increase the nervous system side effects of Talidomida such as dizziness, drowsiness, and difficulty concentrating. You should avoid or limit the use of alcohol while being treated with Talidomida.

Can I drive after taking Talidomida?

Sleepiness and feeling tired. You might feel very tired or find you are falling asleep during the day. Do not drive or operate machinery.

How should Talidomida be used?

Talidomida comes as a capsule to take by mouth.Talidomida is usually taken with water once a day at bedtime and at least 1 hour after an evening meal.Take Talidomida at around the same time every day.

What happen if I forget a dose?

Take the missed dose as soon as you remember it. However, if it is less than 12 hours until your next scheduled dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

Can I overdose on Talidomida?

Talidomida is administered by a healthcare provider in a medical setting, it is unlikely that an overdose will occur.

Can Talidomida cause infertility?

Talidomida has no adverse effects on mating and fertility.

How long does Talidomida stay in the body?

Talidomida takes up to 2 days, on average, for most of the Talidomida to be gone from the body.

What are the benefits of Talidomida?

the benefits of Talidomida it helps regulate the body's germ-fighting immune system and helps control inflammation.

How long can I take Talidomida?

Talidomida usually take it every day for up to 9 cycles of treatment. Each cycle of treatment lasts 3 or 4 weeks. You usually take Talidomida on its own, for as long as it helps you and the side effects aren't too bad.

Is Talidomida a cytotoxic drug?

Talidomida does not have the side-effect profile of a conventional cytotoxic drug, it still has a broad array of adverse effects.

When is the best time to take Talidomida?

Talidomida is usually taken with water once a day at bedtime and at least 1 hour after an evening meal.Take thalidomide at around the same time every day.

*** Taking medicines without doctor's advice can cause long-term problems.
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