Pomalidomide and dexamethasone

Pomalidomide and dexamethasone are a combination of cancer drugs.

This combination is a treatment for people whose myeloma has come back (relapsed) after trying other treatments including lenalidomide and bortezomib.

Pomalidomide is also known as Imnovid. How to pronounce these drug names are in the brackets below:

• pomalidomide (pom-a-lid-oh-mide)
• dexamethasone (deks-ah-meth-uh-zone)

How does pomalidomide and dexamethasone work?

Pomalidomide is a targeted cancer drug and works in a number of ways, including:

• stopping the myeloma cells developing
• stopping blood vessel growth that help cancer cells grow and survive (It is a type of anti angiogenic drug) 
• encouraging the immune system to kill the myeloma cells

Dexamethasone is a steroid. It helps pomalidomide to work better and to kill myeloma cells.

How do you take pomalidomide and dexamethasone?

You take pomalidomide as capsules with a glass of water. You need to swallow the capsules whole. Don’t break or chew them. You should take them at the same time every day. You can take pomalidomide with or without food.

When removing pomalidomide from the blister pack it’s suggested you press at one end of the capsule to remove it. This is to help prevent damaging or breaking the capsule.

You take dexamethasone as tablets. You take them after a meal or with milk as they can irritate your stomach. Taking dexamethasone tablets after breakfast might help to stop difficulty in sleeping (insomnia).

Taking your tablets or capsules

You should take the right dose, not more or less.

Talk to your healthcare team before you stop taking or miss a dose of a cancer drug.

How often do you have pomalidomide and dexamethasone?

You have pomalidomide and dexamethasone as cycles of treatment. This means that you have the drugs and then a rest to allow your body to recover.

A cycle of pomalidomide and dexamethasone lasts 28 days (4 weeks).

You have this treatment for as long as it’s working and the side effects aren’t too bad.  

You usually have each cycle of treatment in the following way:

You then start the next cycle of treatment. 

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Before each cycle of treatment you have a urine test to check your papraprotein levels.

What are the side effects of pomalidomide and dexamethasone?

Side effects can vary from person to person. They also depend on what other treatments you're having. 

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects 

• your side effects aren’t getting any better

• your side effects are getting worse

Early treatment can help manage side effects better. 

We haven't listed all the side effects here. Talk to your healthcare team if you have any new symptoms that you think might be a side effect of your treatment.

Remember it is very unlikely that you will have all of these side effects. But you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Increased risk of getting an infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, cough, headaches, feeling cold and shivery, pain or burning feeling when weeing, or generally feeling unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Breathlessness and looking pale

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Bruising, bleeding gums or nosebleeds

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae).

Less commonly you might notice blood in your poo. Or it might look darker, black or like tar.

This treatment can cause bleeding on the brain but this is less common. Symptoms can include headaches, feeling or being sick, weakness in one side of the body, difficulty speaking, loss of balance, changes to your eyesight or confusion. 

Let your healthcare team know if you have any of these symptoms.

Constipation or diarrhoea 

Tell your healthcare team if you have diarrhoea or constipation. They can give you medicine to help. 

Muscle spasms, bone or pelvic pain

This treatment might cause muscle spasms or bone pain. You might also have pain in the area between your hip bones (pelvic pain).

Let your treatment team know if you have muscle spasms or pain, they can give you medicines to help reduce it.

Lung problems

You might develop a cough or breathing problems. This could be due to infection, such as pneumonia and bronchitis. Less commonly you might have scarring of the lungs.

Let your doctor or nurse know straight away if you suddenly become breathless, have changes to your breathing, feel tired and weak, develop flu-like symptoms or a cough.

Fluid build up (oedema)

You may have swelling of your hands and legs due to a build up of fluid (oedema). 

Loss of appetite

You might lose your appetite for various reasons while having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.

Tiredness and weakness (fatigue)

You might feel very tired and as though you lack energy.

Various things can help you to reduce tiredness and cope with it, for example exercise. Some research has shown that taking gentle exercise can give you more energy. It is important to balance exercise with resting.

High temperature (fever)

If you get a high temperature, let your healthcare team know straight away. Ask them if you can take paracetamol to help lower your temperature.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:

• a skin rash that can be itchy and the rash might be raised, red and appear patchy

• heart problems - such as changes to your heartbeat, heart rhythm or chest pain that can spread to arms, neck and jaw and makes you feel sweaty, breathless and sick (heart attack)

• kidney changes – your kidneys might stop working properly and you might not be able to pass urine (wee). Let your healthcare team know if this happens. You have regular blood tests to check how well your kidneys are working

• dizziness

• confusion

• loss of consciousness (fainting)

• a high level of an enzyme called ALT in your blood – it helps to pick up when your liver might be injured or inflamed - you have regular blood tests to check for this

• a build up of a substance called uric acid in the body that can cause a type of arthritis called gout. This can affect any joint and make it red, hot, swollen and painful. Let your healthcare team know if you notice this

• high levels of potassium in the blood. This can cause changes to your heart rhythm

• low levels of sodium in the blood that can make you feel tired or confused. Your muscles may twitch or you may have seizures (fits). Speak to your healthcare team if you notice these symptoms

• numbness or tingling in your fingers or toes

• feeling shaky (tremor)

• you or everything around you feels like it’s spinning or moving in your head (vertigo). It may also affect your balance

• blood clots that can be life threatening - signs are pain, redness and swelling where the clot is. Feeling breathless can be a sign of a blood clot in the lung. Contact your advice line or doctor straight away if you have any of these symptoms

• swelling of the lips, face, tongue and throat (angioedema) that can lead to difficulty breathing. This is caused by an allergic reaction to the treatment

Rare side effects

These side effects happen in fewer than 1 in 100 people (less than 1%). You might have one or more of them. They include:

• inflammation of the liver (hepatitis)
• a second cancer such as basal cell carcinoma (BCC) or squamous cell carcinoma (SCC)
• high levels of a substance called bilirubin in the blood - symptoms include yellowing of the skin or whites of the eyes (jaundice)
• high levels of chemicals in your blood due to the breakdown of tumour cells (tumour lysis syndrome) - you have regular blood tests to check for this
• a stroke

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do you need to know?

Other medicines, foods and drink

Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

Pregnancy and contraception

Pomalidomide can cause birth defects in children. So, you must not become pregnant or get someone pregnant while having treatment. Talk to your doctor or nurse about effective contraception before starting treatment. They will make sure that you understand the risks of taking pomalidomide.

Women

Women who are able to become pregnant need to agree to use effective contraception:

• for 4 weeks before starting treatment

• during treatment

• for 4 weeks after finishing treatment

You also take pregnancy tests before starting treatment and every 4 weeks while having treatment.

Pregnant women should not touch or handle pomalidomide. You must store it in a place where pregnant women or children cannot reach it.

Men

Pomalidomide is present in semen during treatment. All men taking pomalidomide should use condoms during sexual intercourse. This needs to continue for 7 days after the treatment ends. 

Loss of fertility

You may not be able to become pregnant or get someone pregnant after treatment with this drug. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.    

Breastfeeding

It is not known whether these drugs come through into the breast milk. Doctors usually advise that you don’t breastfeed during this treatment.

Other conditions

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.

You can have:

• other vaccines, but they might not give you as much protection as usual
• the flu vaccine (as an injection)
• the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system recovers from treatment.

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

For further information about each drug and the possible side effects go to the electronic Medicines Compendium (eMC) website. You can find patient information leaflets for each drug on this website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.