MULTIPLE MYELOMA KNOWLEDGE CENTER

How is Thalomid administered?

Thalomid® (thalidomide, Celgene) is administered orally and is available in 50 mg, 100 mg, 150 mg, and 200 mg dose capsules. According to the manufacturer’s label, the dose of Thalomid is 200 mg per day. However, your doctor may choose to start treatment at a lower dose to help reduce the likelihood of side effects. When the starting dose is lower, it may be gradually increased by 50 mg or 100 mg to achieve maximum effectiveness, and patients are monitored closely to ensure that side effects remain manageable. For best results, Thalomid should be taken once daily with water, preferably at bedtime, and at least 1 hour after the evening meal.

When used in combination with dexamethasone, Thalomid is taken in 28-day treatment cycles. The usual (standard) dose of dexamethasone is 40 mg, taken on days 1-4, 9-12, and 17-20 of each month for the first 4 months. Starting at month 5, dexamethasone is taken only on days 1-4 of each month.

Studies of dexamethasone in combination with Revlimid® (lenalidomide, Celgene), a drug chemically related to Thalomid, have shown that lower doses of dexamethasone may be more effective than the so-called standard dose. With a low-dose schedule, dexamethasone (40 mg) is taken 1 day a week. Based on these findings, the combination of Thalomid and low-dose dexamethasone is now being investigated.

The optimal length of treatment with Thalomid has not been determined. Individuals with multiple myeloma typically continue to take Thalomid as long as the side effects remain manageable and disease does not progress.

Your doctor will evaluate the response to treatment with Thalomid after about 1 month. Some sign of benefit may be seen within this time, but it is usually 2-3 months before response occurs. Because a response can often improve with continued treatment, discontinuing Thalomid therapy after a short period of time may fail to provide the full therapeutic benefit of the drug. Increasing the dose slowly and managing side effects may help individuals continue treatment with Thalomid. Once a good response has been achieved, your doctor may reduce the Thalomid dose for maintenance therapy.

If you do not have a response after 3 months of treatment, your doctor may increase the dose of Thalomid or may add another drug to your treatment regimen.