Thalidomide

CLINICAL USE

Untreated multiple myeloma in patients >65 or who are ineligible for high dose chemotherapy, in combination with either melphalan and prednisone, or cyclophosphamide and dexamethasone (Unlicensed indications): Erythema nodusum leprosum Lupus erythematosus, aphthous ulceration, stomatitis, graft-versus-host disease, AIDS-associated waste syndrome, rheumatoid arthritis and other acute inflammatory conditions

DOSE IN NORMAL RENAL FUNCTION

200 mg daily Unlicensed dose: 50–800 mg daily

PHARMACOKINETICS

Molecular weight : 258.2

%Protein binding : 55–66

%Excreted unchanged in urine : <0.7

Volume of distribution (L/kg) : 166 litres

half-life – normal/ESRD (hrs) : 5–7/Unchanged

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function

10 to 20 : Dose as in normal renal function

<10 : Dose as in normal renal function

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD : Unlikely to be dialysed. Dose as in normal renal function

HD : Unlikely to be dialysed. Dose as in normal renal function

HDF/high flux : Not dialysed. Dose as in normal renal function

CAV/VVHD : Unknown dialysability. Dose as in normal renal function

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs Thalidomide enhances the effects of barbiturates, alcohol, chlorpromazine and reserpine Use with caution with other drugs that can cause peripheral neuropathy

ADMINISTRATION

Reconstition

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Route

Oral

Rate of Administration

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Comments

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OTHER INFORMATION

Major route of elimination is non-renal (i.e. by spontaneous non-enzymatic hydrolytic cleavage) therefore normal doses may be given in renal failure Has been used to treat uraemic pruritus in haemodialysis patients unresponsive to other therapy. (Silva SR. Thalidomide for the treatment of uraemic pruritus: a crossover randomised double-blind trial. Nephron. 1994; 67(3): 270–3.) Can cause unexplained hyperkalaemia. Use of thalidomide in patients with myeloma and renal failure may be associated with unexplained hyperkalaemia.

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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