Revlimid (lenalidomide) is a brand-name oral capsule prescribed to treat multiple myeloma and certain other blood cell cancers in adults. This article covers topics such as side effects, dosage, and how Revlimid works.

Revlimid belongs to a drug class called thalidomide analogs. The medication is available in a generic version.

Read on for more information about Revlimid. You can also refer to this overview article for a comprehensive look at Revlimid and its other uses.

Revlimid has boxed warnings. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). For details, see the “Before taking Revlimid” section.

Revlimid is FDA approved to treat multiple myeloma in certain adults.

Multiple myeloma is a type of cancer that affects your blood cells. It occurs when cancerous plasma cells (a type of white blood cell) develop in your bone marrow (the spongy tissue inside your bones). The cancerous cells form tumors in your bone marrow. These tumors prevent your bone marrow from making enough healthy blood cells.

The cancerous cells can spread in your bloodstream to form tumors in other bones throughout your body.

Symptoms of multiple myeloma

Multiple myeloma can cause symptoms such as:

  • fever
  • bone pain
  • bones that fracture (break) easily
  • bruising easily
  • unusual bleeding, such as bleeding gums or nosebleeds
  • fatigue and weakness
  • shortness of breath
  • frequent infections

Who Revlimid is prescribed for

Revlimid is prescribed for adults with multiple myeloma. It may be taken by people with or without a past hematopoietic stem cell transplant (HSCT). (HSCT is a treatment for multiple myeloma in which you receive a transplant of stem cells to generate new, healthy blood cells.)

People who have not had a past HSCT will take Revlimid with dexamethasone to treat multiple myeloma.

People who have had an autologous HSCT (auto-HSCT) will take Revlimid on its own for maintenance (ongoing) treatment of multiple myeloma. (An auto-HSCT uses stem cells from your own body.)

Multiple myeloma occurs when cancerous plasma cells (a type of white blood cell) develop in your bone marrow (the spongy tissue inside your bones). The cancerous cells increase in numbers and form tumors in your bone marrow. The cancerous cells can spread in your bloodstream to form tumors in other bones throughout your body.

Revlimid works in three main ways to treat multiple myeloma.

The way Revlimid works

Revlimid directly targets the cancerous plasma cells. It stops these cells from growing and developing, causing them to die. Revlimid also stimulates certain cells in your immune system to attack and kill the cancerous cells. Revlimid also stops the growth of new blood vessels that the cancer cells need to grow and spread.

These actions help shrink multiple myeloma tumors and stop them from spreading.

How Revlimid works to treat multiple myeloma is called its mechanism of action.

Clinical trials studying Revlimid in people with and without a previous stem cell transplant found Revlimid to be an effective treatment for multiple myeloma.

Studies in people without a previous stem cell transplant compared treatment with Revlimid plus dexamethasone with treatment using melphalan, prednisone, and thalidomide (MPT). These trials found that people who took Revlimid plus dexamethasone lived longer without their multiple myeloma getting worse and longer overall than people who took MPT.

Studies in people with a previous stem cell transplant compared maintenance (ongoing) treatment with Revlimid to maintenance treatment with a placebo (a treatment containing no active drug). These studies found that people who took Revlimid lived longer without their multiple myeloma getting worse and longer overall than people who took a placebo.

For more information about how well Revlimid works to treat multiple myeloma, see the drug’s prescribing information.

The National Cancer Institute has included Revlimid in its treatment guidelines for multiple myeloma.

Keep in mind that how well and long Revlimid works for multiple myeloma will depend on many factors. Your doctor can tell you more about your potential results with Revlimid treatment.

Revlimid comes as an oral capsule. It’s available in the following strengths:

  • 2.5 milligrams (mg)
  • 5 mg
  • 10 mg
  • 15 mg
  • 20 mg
  • 25 mg

Read on for information about the recommended Revlimid dose for multiple myeloma and how to take the drug.

Dosage

For people who have not had a stem cell transplant: The usual starting dosage is 25 mg, taken once per day on days 1 to 21 of a 28-day cycle. You should not take a dose of Revlimid on days 22 through 28. During the 28-day cycle, you’ll also take dexamethasone on certain days. You should repeat the 28-day treatment cycle for as long as your doctor recommends.

How long you can take Revlimid depends on whether an auto-HSCT is a treatment option for you. If you’re not due to have an auto-HSCT and Revlimid doesn’t cause bothersome side effects, your doctor will likely recommend taking Revlimid for as long as it continues to work for you.

If you’re due to have an auto-HSCT, you’ll typically take Revlimid for up to four cycles before your transplant.

For people who have had a stem cell transplant: The usual starting dosage is 10 mg, taken once every day for as long as your doctor recommends. If Revlimid doesn’t cause bothersome side effects, your doctor will likely recommend taking it for as long as it continues to work for you.

Note: In addition to treating multiple myeloma, Revlimid has other uses. Keep in mind that the drug’s dosage may differ with these other uses. To learn more, talk with your doctor.

How to take

You should swallow Revlimid capsules whole with a drink of water. Don’t open, split, suck, or chew the capsules. You can take Revlimid with or without food.

How often to take

You should take Revlimid once per day, at the same time each day. Taking Revlimid at the same time each day keeps a steady level of the drug in your body, which helps it work more effectively.

The use of Revlimid for multiple myeloma* may cause side effects that are mild or serious. The following lists include some of the main side effects people taking Revlimid have reported. For information about other potential side effects of the drug, talk with your doctor or pharmacist. You can also see this side effect article about Revlimid or refer to Revlimid’s prescribing information.

Note: After the Food and Drug Administration (FDA) approves a medication, it tracks and reviews side effects of the drug. If you develop a side effect while taking Revlimid and would like to inform the FDA, visit MedWatch.

* Revlimid is also approved to treat other conditions. It’s important to note that side effects from Revlimid may differ depending on the condition it’s being used to treat.

Mild side effects

Mild side effects that people taking Revlimid for multiple myeloma have reported include:

These side effects of Revlimid may be temporary, lasting a few days to weeks. But if they last longer than this, bother you, or become severe, it’s important to talk with your doctor or pharmacist.

Serious side effects

Serious side effects that people taking Revlimid for multiple myeloma have reported include:

Call your doctor right away if you develop serious side effects while using Revlimid. If the side effects seem life threatening or you think you’re having a medical emergency, call 911 or your local emergency number immediately.

* Revlimid has a boxed warning for this side effect. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). To learn more, see the “Before taking Revlimid” section.

Allergic reaction

For some people, Revlimid can cause an allergic reaction.

In general, symptoms of allergic reaction can be mild or serious.

Ways to manage

For mild allergic reaction symptoms, such as a mild rash, call your doctor right away. They may recommend treatments to help manage your symptoms. They’ll also let you know whether you should keep taking the medication.

For severe allergic reaction symptoms, such as swelling or trouble breathing, call 911 or your local emergency number right away. These symptoms require immediate medical care because they can become life threatening. If you’ve had a serious allergic reaction to Revlimid, your doctor may recommend taking a different medication instead.

Before you take Revlimid, there’s some important information to keep in mind. The drug may not be a safe option if you have certain medical conditions or other factors that affect your health. Read on for more information.

Boxed warnings

This drug has boxed warnings about the risk of blood cell problems, dangerous blood clots, and fetal harm if used during pregnancy. These are the most serious warnings from the Food and Drug Administration (FDA).

Risk of blood cell problems: Revlimid can cause severe neutropenia (low levels of white blood cells), which can raise your risk of infection. It can also cause severe thrombocytopenia (low levels of platelets), which can raise your risk of bruising and bleeding.

Tell your doctor right away if you develop a fever or other signs of infection while taking Revlimid. Also tell your doctor if you have any unusual bruising or bleeding.

Your doctor will order frequent blood tests to check your blood cells while you are taking Revlimid. If needed, your doctor may reduce your Revlimid dosage or pause your treatment until your blood cells recover. Your doctor may prescribe medications or transfusions to help increase your blood cell levels.

Risk of dangerous blood clots: Revlimid can increase your risk of blood clots that can cause deep vein thrombosis (DVT), pulmonary embolism (PE), heart attack, and stroke. The risk may be higher if you take Revlimid with dexamethasone for multiple myeloma.

Certain factors can increase your risk of dangerous blood clots with Revlimid. These include smoking, obesity, high blood pressure, high cholesterol, and past blood clots. Taking certain other medications, including birth control that contains estrogen, can also increase your risk. If you have any of these risk factors, talk with your doctor before taking Revlimid.

Your doctor will likely prescribe blood thinner medication to help prevent blood clots while you are taking Revlimid.

If you have symptoms of DVT while taking Revlimid, see your doctor right away. These symptoms can include leg or arm swelling, pain, and redness or discoloration.

If you have symptoms of PE, heart attack, or stroke while taking Revlimid, call 911 or your local emergency number right away. These symptoms can include pain, pressure, or tightness in your chest, arm, neck, or jaw, shortness of breath, dizziness, and sudden weakness or numbness in one side of your face or body.

Risk of fetal harm if used during pregnancy: Revlimid is similar to a drug called thalidomide, which is known to cause congenital abnormalities (commonly known as birth defects) and pregnancy loss if used during pregnancy. It’s likely Revlimid can also cause these effects. Due to this risk, your doctor will likely not prescribe Revlimid if you are pregnant or planning to become pregnant.

Revlimid is only available through the Revlimid Risk Evaluation and Mitigation Strategy (REMS) program. REMS programs are an FDA requirement to ensure certain drugs are prescribed and taken safely. As part of this program, your doctor will only prescribe Revlimid if certain requirements are met. These include:

  • If you can become pregnant: You should use two forms of birth control or not have sex for 4 weeks before starting Revlimid, during Revlimid treatment, and for 4 weeks after stopping Revlimid. You will need to have two negative pregnancy tests before starting Revlimid and periodic pregnancy tests throughout your treatment.
  • If you are male*: Revlimid can pass into semen. While taking Revlimid and for at least 4 weeks after your last dose, you should use condoms during sexual activity with any person who is pregnant or can become pregnant. You should not donate sperm during this time.

* Sex and gender exist on spectrums. Use of the terms “male” and “female” in this article refers to the sex assigned at birth.

If you have questions or concerns about any of these warnings, talk with your doctor.

Other warnings

In addition to boxed warnings, Revlimid has other warnings.

If any of the following medical conditions or other health factors are relevant to you, talk with your doctor before taking Revlimid:

  • if you have a history of rash during past treatment with a similar drug called thalidomide
  • if you have chronic lymphocytic leukemia (CLL)
  • if you have liver problems
  • if you have kidney problems
  • if you have thyroid problems
  • if you are breastfeeding
  • alcohol consumption
  • if you’ve had an allergic reaction to Revlimid or any of its ingredients

How much Revlimid costs depends on several factors. These can include your prescribed treatment regimen, your insurance plan, the pharmacy you use, and your location.

Revlimid is a brand-name drug that’s also available as a generic. Brand-name drugs usually cost more than generics. To learn about this drug’s generic form, talk with your doctor or pharmacist.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.