CV: edema, chest pain, DEEP VEIN THROMBOSIS, MI, palpitations.
Derm: pruritus, rash, DRUG REACTION WITH EOSINOPHILIA AND SYSTEMIC SYMPTOMS (DRESS), dry skin, STEVENS-JOHNSON SYNDROME (SJS), sweating, TOXIC EPIDERMAL NECROLYSIS (TEN).
Endo: hyperthyroidism, hypothyroidism.
F and E: hypokalemia, hypomagnesemia.
GI: abdominal pain, constipation, diarrhea, nausea, vomiting, abnormal taste, anorexia, dry mouth, HEPATOTOXICITY.
Hemat: neutropenia, thrombocytopenia.
MS: arthralgia, myalgia.
Neuro: dizziness, fatigue, headache, depression, insomnia, STROKE.
Resp: cough, pharyngitis, PULMONARY EMBOLISM.
Misc: fever, tumor flare reaction, chills, HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS AND ANGIOEDEMA), MALIGNANCY, tumor lysis syndrome.
Myelodysplastic Syndromes
- PO (Adults): 10 mg once daily.
Renal Impairment
- PO (Adults): CCr 30–60 mL/min: 5 mg once daily; CCr <30 mL/min (not on dialysis): 2.5 mg once daily; CCr <30 mL/min (requiring dialysis): 2.5 mg once daily (give after dialysis on dialysis days).
Multiple Myeloma
- PO (Adults): 25 mg once daily on days 1–21 of repeated 28-day cycles (with dexamethasone); if patients not eligible for auto-HSCT, continue treatment until disease progression or unacceptable toxicity; for patients eligible for auto-HSCT, hematopoietic stem cell mobilization should take place within 4 cycles.
Renal Impairment
- PO (Adults): CCr 30–60 mL/min: 10 mg once daily; if patient tolerates initial dose, may ↑ to 15 mg once daily after 2 cycles; CCr <30 mL/min (not on dialysis): 15 mg every 48 hr; CCr <30 mL/min (requiring dialysis): 5 mg once daily (give after dialysis on dialysis days).
Maintenance Therapy for Multiple Myeloma Following Autologous Hematopoietic Stem Cell Transplantation
- PO (Adults): After adequate hematologic recovery (ANC ≥ 1000/mcL and/or platelet counts ≥75,000/mcL), initiate therapy with 10 mg once daily continuously on Days 1–28 of repeated 28–day cycles); after 3 cycles, dose may be ↑ to 15 mg once daily, if tolerated; continue treatment until disease progression or unacceptable toxicity.
Renal Impairment
- PO (Adults): CCr 30–60 mL/min: 5 mg once daily; CCr <30 mL/min (not on dialysis): 2.5 mg once daily; CCr <30 mL/min (requiring dialysis): 2.5 mg once daily (give after dialysis on dialysis days).
Mantle Cell Lymphoma
- PO (Adults): 25 mg once daily on days 1–21 of repeated 28–day cycles; continue treatment until disease relapse or unacceptable toxicity develops.
Renal Impairment
- PO (Adults): CCr 30–60 mL/min: 10 mg once daily; CCr <30 mL/min (not on dialysis): 15 mg every 48 hr; CCr <30 mL/min (requiring dialysis): 5 mg once daily (give after dialysis on dialysis days).
Follicular Lymphoma or Marginal Zone Lymphoma
- PO (Adults): 20 mg once daily on days 1–21 of repeated 28–day cycles for up to 12 cycles (with rituximab).
Renal Impairment
- PO (Adults): CCr 30–60 mL/min: 10 mg once daily; if patient tolerates initial dose, may ↑ to 15 mg once daily after 2 cycles; CCr <30 mL/min (not on dialysis): 5 mg once daily; CCr <30 mL/min (requiring dialysis): 5 mg once daily (give after dialysis on dialysis days).
Therapeutic Classification: antineoplastics
Pharmacologic Classification: immunomodulatory agents
Absorption: Well absorbed following oral administration. Levels are higher in patients with multiple myeloma.
Distribution: Crosses the placenta.
Metabolism/Excretion: 66% excreted unchanged in urine, some renal excretion involves active secretion.
Half-life: 3 hr.
(↓ need for transfusions)
