LINAMIDE (LENALIDOMIDE) 25MG CAPSULES 18`S

Lenalidomide is an immunomodulatory drug (IMiD) that exerts its anti-cancer activity through multiple mechanisms: it activates the E3 ubiquitin ligase cereblon (CRBN), leading to selective degradation of transcription factors Ikaros (IKZF1) and Aiolos (IKZF3) in myeloma and lymphoma cells; enhances T-cell and NK-cell immune responses against cancer cells; inhibits tumour neoangiogenesis (blood vessel formation); and has direct anti-proliferative and pro-apoptotic effects.

Lenalidomide is used to treat adults with:

•       Multiple myeloma (MM) — as combination therapy (with dexamethasone, bortezomib, or daratumumab) at various stages including newly diagnosed and relapsed/refractory disease; and as maintenance therapy after autologous stem cell transplant (ASCT).

•       Myelodysplastic syndromes (MDS) — specifically transfusion-dependent anaemia due to low/intermediate-1 risk MDS associated with deletion 5q cytogenetic abnormality.

•       Mantle cell lymphoma (MCL) — relapsed/refractory, after prior treatment.

•       Follicular lymphoma (FL) — in combination with rituximab.

Take capsules orally once daily on days 1–21 of a 28-day cycle (for MM/MDS), or continuously (for some protocols). Swallow whole — do not open, crush, or chew (teratogenic powder hazard). Take with or without food at the same time each day.

Doses vary by indication, renal function, and tolerability: typical MM maintenance 10–25 mg/day; MDS 10 mg/day. Your haematologist prescribes the exact dose and schedule.

Lenalidomide is absolutely contraindicated in: pregnancy; women of childbearing potential not using two reliable contraceptive methods; patients not enrolled in the mandatory REMS/pregnancy prevention programme; and known hypersensitivity.

Use with caution in: renal impairment — dose must be adjusted based on creatinine clearance (CrCl 30–60: 10 mg/day; CrCl <30: 7.5 mg/day; dialysis: 5 mg 3x/week post-dialysis). Hepatic impairment: no specific dose adjustment — use with caution.

•       Erythropoiesis-stimulating agents (ESAs) and hormone replacement therapy: increase VTE risk — avoid if possible.

•       Digoxin: lenalidomide increases digoxin levels by ~14% — monitor digoxin levels.

•       Warfarin: INR monitoring required — lenalidomide has complex anticoagulant interactions.

•       Dexamethasone (standard combination partner): increases VTE risk — mandatory thromboprophylaxis.

Store below 30°C. Original capsule blister. Keep out of reach of children. Do not open or crush. Return any unused capsules to the pharmacy immediately — never discard in household waste.

Lenalidomide is a powerful anti-cancer medicine for blood cancers, but it carries serious risks that require strict safety measures. The pregnancy prevention programme is absolutely non-negotiable — birth defects with thalidomide analogues are severe and irreversible.

VTE (blood clot in leg or lung) is common with lenalidomide, especially in combination with dexamethasone. You will be prescribed a blood thinner (aspirin, heparin injection, or warfarin) — take it consistently. Report any leg pain, swelling, sudden breathlessness, or chest pain immediately.

Do not share lenalidomide with anyone. Do not donate blood while taking it or for 4 weeks after stopping.

Ledomide and Linamide are branded generics of lenalidomide (Revlimid). Confirm the specific strength and pack size carefully at dispensing — 10 mg (21 caps) is typically for MDS and some myeloma maintenance protocols; 25 mg (28 caps) is the standard MM combination dose. Renal dose adjustment is critical — confirm CrCl at every dispensing cycle.

All pharmacists dispensing lenalidomide must be trained in and compliant with the applicable REMS (US) or Pregnancy Prevention Programme (EU) — confirm enrolment status before each supply.

Thromboprophylaxis stratification: aspirin 75–100 mg/day for low-risk patients; LMWH or warfarin (INR 2–3) for high-risk (prior VTE, immobility, or combined with high-dose dexamethasone).

I am a male patient — why do I need to use contraception?

Lenalidomide is present in semen. Condom use prevents a female partner from being exposed to the drug through sexual contact. This applies even if you or your partner are not planning pregnancy.

What is VTE and why is blood clot prevention so important?

VTE (venous thromboembolism — DVT or PE) is a known serious risk with lenalidomide, especially combined with dexamethasone. Without preventive anticoagulation, the risk can be 10–26% in some protocols. Your prescribed blood thinner reduces this risk significantly — do not stop it without your haematologist's advice.

What happens to unused capsules?

Return all unused capsules to the pharmacy immediately. Never dispose of them in household waste or flush them — they are teratogenic and must be disposed of safely.

Can I have vaccinations?

Inactivated vaccines (flu, pneumococcal, and COVID-19) are generally safe and recommended. Live vaccines should generally be avoided during treatment. Discuss with your haematologist.

What is a 'second primary malignancy'?

Lenalidomide (like other IMiDs) may slightly increase the lifetime risk of developing a second cancer. Regular screening and follow-up with your haematologist are important to detect any new malignancy early.