Revlimid (Lenalidomide) - Oral

Warning:

Revlimid carries a boxed warning of embryo-fetal toxicity. A boxed warning is the highest safety-related warning that can be assigned to a medication by the U.S. Food and Drug Administration (FDA).

Embryo-fetal toxicity means there is a significant risk of harm of birth defects or fetal death if taken during pregnancy. Revlimid also has the possibility of causing very low white blood cell and red blood cell counts, which could lead to severe infection or bleeding. In addition, Revlimid can potentially cause venous and arterial blood clots, which could lead to stroke, heart attack, or pulmonary embolism. Talk to your healthcare provider about how to take your medication safely.

What Is Revlimid?

Revlimid (lenalidomide) is an oral medication used to treat certain blood cancers and lymphomas. It is in the drug class of immunomodulators.

Revlimid works in a few different ways to kill cancer cells. One of the ways is by stopping cancer cells from making blood vessels to feed themselves. It also can work by helping the immune system see and attack cancer cells. Additionally, Revlimid can stop cancer cells from making more copies of themselves, eventually destroying the cancer cells.

This medication comes in capsule form to take by mouth.

Drug Facts

Generic Name: Lenalidomide

Brand Name(s): Revlimid

Drug Availability: Capsule

Administration Route:  Oral

Therapeutic Classification: Immunomodulator

Available Generically: No

Controlled Substance: N/A

Active Ingredient: Lenalidomide

Dosage Form(s): Capsules

What Is Revlimid Used For?

Revlimid has been approved to treat multiple types of cancer. These include:

  • Multiple myeloma (MM), when used along with a steroid, dexamethasone
  • Following stem cell transplant for MM
  • Myelodysplastic syndrome (MDS) with a 5q deletion abnormality
  • Mantle cell lymphoma, which has come back after two previous treatments (one being a medication called bortezomib)
  • Follicular lymphoma that has been treated previously and used in combination with rituximab
  • Marginal zone lymphoma, which has been treated previously and used in combination with rituximab

How to Take Revlimid

Revlimid is often given in cycles, or a prescribed period when you take the medication daily, followed by a rest period with no medication. This process then repeats as directed by your oncologist.

You will take Revlimid once a day as prescribed. It should be taken around the same time each day, with or without food.

Never open or crush the capsules; swallow them whole with water.

Storage

Store your Revlimid capsules in their original container. They should be kept at room temperature (between 68 F and 77 F) and out of the reach of any children or pets. 

How Long Does Revlimid Take to Work?

It may take a few months of therapy before there is any noticeable change in the state of your cancer. Your oncologist will order lab work and imaging studies to see how cancer responds to treatment.

What Are the Side Effects of Revlimid?

This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 800-FDA-1088.

Common Side Effects

The most common side effects that can occur when taking Revlimid include:

Severe Side Effects

Notify your healthcare provider right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you have a medical emergency. Serious side effects and their symptoms can include the following:

  • Significantly decreased blood counts, which can lead to infections or bleeding
  • Blood clots in the veins or arteries that could lead to stroke, heart attack, or pulmonary embolism
  • Liver failure, with symptoms such as fatigue, a yellowish appearance of the skin and eyes (jaundice), itching sensations, and confusion
  • Thyroid disorders, such as hypothyroidism and hyperthyroidism, with symptoms like fatigue, insomnia, and hair loss
  • Tumor lysis syndrome, with symptoms including fatigue, nausea or vomiting, abnormal heart rhythms, blood in the urine, and muscle spasms
  • Severe skin reactions, such as Stevens-Johnson syndrome, toxic epidermal necrolysis, drug rash and eosinophilia and systemic symptoms (DRESS) syndrome
  • Tumor flare reaction, which can cause painful and swollen lymph nodes, fever, and skin rash

Long-Term Side Effects

Studies found that those who took Revlimid for MM were at an increased risk of developing a different type of cancer, most often acute myeloid leukemia and myelodysplastic syndrome. There was also an increased risk of developing non-melanoma skin cancer.

Report Side Effects

Revlimid may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your healthcare provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Revlimid Should I Take?

Drug Content Provided and Reviewed by IBM Micromedex®

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (capsules):
    • For anemia in patients with myelodysplastic syndrome:
      • Adults—At first, 10 milligrams (mg) once a day. Your doctor may adjust your dose as needed.
      • Children—Use and dose must be determined by your doctor.
    • For follicular lymphoma or marginal zone lymphoma:
      • Adults—At first, 20 milligrams (mg) once a day. This medicine is taken on Days 1 to 21 of repeated 28-day cycles for up to 12 cycles. Your doctor may adjust your dose as needed.
      • Children—Use and dose must be determined by your doctor.
    • For mantle cell lymphoma:
      • Adults—At first, 25 milligrams (mg) once a day. This medicine is taken on Days 1 to 21 of repeated 28-day cycles. Your doctor may adjust your dose as needed.
      • Children—Use and dose must be determined by your doctor.
    • For multiple myeloma after stem cell transplant:
      • Adults—At first, 10 milligrams (mg) once a day. This medicine is taken on Days 1 to 28 of repeated 28-day cycles. Your doctor may adjust your dose as needed.
      • Children—Use and dose must be determined by your doctor.
    • For multiple myeloma in combination with dexamethasone:
      • Adults—At first, 25 milligrams (mg) once a day. This medicine is taken on Days 1 to 21 of repeated 28-day cycles. Your doctor may adjust your dose as needed.
      • Children—Use and dose must be determined by your doctor.

Modifications

Your dose may need to be changed if you experience significant decreases in white blood cell or platelet counts. It may also be held or modified if other side effects are severe. Your healthcare provider will let you know whether a different dosage is necessary.

Missed Dose

If you miss a dose, take it within 12 hours of the time it should have been taken. If more than 12 hours have passed since the missed dose, skip the missed dose and take the next one as scheduled. Do not take double doses to make up for a missed one.

Overdose: What Happens If I Take Too Much Revlimid?

There isn’t a specific dose of Revlimid that is defined as an overdose. In clinical trials, higher than normal doses resulted in skin changes such as itching or rash. However, there can potentially be significant decreases in blood counts that could cause complications. Notify your oncology team if you take too much of your medication.

What Happens If I Overdose on Revlimid?

If you think you or someone else may have overdosed on Revlimid, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses or isn't breathing after taking Revlimid, call 911 immediately.

Precautions

Drug Content Provided and Reviewed by IBM Micromedex®

It is very important that your doctor check your progress closely at regular visits to see if the medicine is working properly and to allow for a change in the dose. Blood and urine tests may be needed to check for any unwanted effects.

Women should take the necessary precautions to avoid pregnancy while using lenalidomide. Begin 2 forms of reliable contraception 4 weeks before starting lenalidomide. Continue contraceptive measures during treatment and for at least 4 weeks after the last dose. Routine pregnancy tests are necessary with this medicine. Call your doctor for emergency contraception information if you think you are pregnant.

Men, even those who have had a vasectomy, must prevent pregnancy in their sexual partners during treatment with this medicine and for at least 4 weeks after the last dose. Do not donate sperm while using this medicine. Call your doctor for emergency contraception information if you think your sexual partner may be pregnant.

Do not donate blood during treatment and for at least 4 weeks after the last dose.

This medicine lowers the number of some types of blood cells in your body. Because of this, you may bleed or get infections more easily. To help with these problems, avoid being near people who are sick or have infections. Wash your hands often. Stay away from rough sports or other situations where you could be bruised, cut, or injured. Brush and floss your teeth gently. Be careful when using sharp objects, including razors and fingernail clippers.

This medicine may increase your risk of having blood clots. Check with your doctor right away if you have anxiety, chest pain, fainting, a fast heartbeat, trouble breathing, or pain, redness, or swelling in the arm or leg.

This medicine may increase your risk of having a heart attack or stroke. This is more likely to occur if you already have a heart disease, high cholesterol, or if you smoke. Check with your doctor right away if you are having chest pain or discomfort, fast or irregular heartbeat, nausea, vomiting, pain or discomfort in the arms, jaw, back, or neck, sweating, or trouble breathing.

Do not receive pembrolizumab together with dexamethasone and lenalidomide or similar medicines if you have multiple myeloma.

Serious liver problems can occur with this medicine. Check with your doctor right away if you have pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, vomiting, or yellow skin or eyes.

Serious skin reactions, including Stevens-Johnson syndrome, toxic epidermal necrolysis, and drug reaction with eosinophilia and systemic symptoms (DRESS) can occur with this medicine. Check with your doctor right away if you have black, tarry stools, blistering, peeling, or loosening of the skin, chest pain, chills, cough, diarrhea, itching, joint or muscle pain, painful or difficult urination, red irritated eyes, red skin lesions, often with a purple center, sore throat, sores, ulcers, or white spots in the mouth or on the lips, swollen glands, unusual bleeding or bruising, or unusual tiredness or weakness while you are using this medicine.

Lenalidomide may cause a serious type of reaction called tumor lysis syndrome. Call your doctor right away if you have a decrease or change in urine amount, joint pain, stiffness, or swelling, lower back, side, or stomach pain, a rapid weight gain, swelling of the feet or lower legs, or unusual tiredness or weakness.

This medicine may increase your risk of getting certain cancers (eg, acute myelogenous leukemia, myelodysplastic syndrome). Talk to your doctor if you have concerns about this risk.

This medicine may cause a tumor flare reaction. Tell your doctor if you have swollen and painful lymph nodes, a mild fever, pain, or a rash.

This medicine may cause a serious allergic reactions, including anaphylaxis and angioedema, which can be life-threatening and require immediate medical attention. Tell your doctor right away if you have a rash, itching, hoarseness, large, hive-like swelling on face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs, trouble breathing, or trouble swallowing after using this medicine.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

What Are Reasons I Shouldn’t Take Revlimid?

Do not take Revlimid if you are pregnant. Due to the significant risk of birth defects or death of a fetus, there are strict protocols that should be followed for those able to become pregnant while taking Revlimid.

Two negative pregnancy tests must be obtained before Revlimid will be dispensed to those of reproductive potential. Those who are sexually active must confirm the use of two forms of birth control or abstain from sexual activity while taking the medication and for four weeks after stopping it.

You should also avoid Revlimid if you are allergic to lenalidomide or any ingredients of the medications.

What Other Medications Interact With Revlimid?

To avoid potential interactions, tell your healthcare provider about any other medicines you take or plan to take, including over-the-counter (OTC) nonprescription products, vitamins, herbs, supplements, and plant-based medicines.

Revlimid should be used with caution when taken along with medications called erythropoietin stimulating agents or estrogen-containing medications. Taking these with Revlimid increases the risk of developing blood clots. 

Lanoxin (digoxin), a heart medication, should also be used cautiously with Revlimid. There is a potential for these medications to interact and cause too much digoxin to be absorbed into the body.

Talk with your pharmacist or healthcare provider for more detailed information about medication interactions with Revlimid.

What Medications Are Similar?

Thalomid is another immunomodulator that is also used to treat MM. However, with the rise of newer therapies, it isn’t prescribed as often anymore.

Pomalyst (pomalidomide), another immunomodulator, is a newer medication used to treat MM. To take Pomalyst, two other medications (one to include Revlimid and the other a proteasome inhibitor) had to have failed to treat MM.

These medications are not taken along with Revlimid.

Frequently Asked Questions

  • What is Revlimid used for?

    Revlimid is used to treat multiple types of cancer, including:

    • Multiple myeloma
    • Myelodysplastic syndrome
    • Mantle cell lymphoma
    • Follicular lymphoma
    • Marginal zone lymphoma
  • How does Revlimid work?

    Revlimid works in a few ways to treat cancer. It helps the immune system recognize cancer cells to attack them. It also prevents cancer cells from making blood vessels for themselves and inhibits cancer cell replication.

  • What steps need to be taken to get Revlimid?

    Due to the high risk of causing birth defects, Revlimid is dispensed with a Risk Evaluation and Mitigation Strategy (REMS) program. This requires the person taking it to confirm that they cannot become pregnant, and if they can, they must agree to use two forms of birth control during treatment. If you are able to become pregnant, you'll be asked to take monthly pregnancy tests. You will also not be able to donate blood while taking Revlimid.

    The program also requires contraceptive use. Under the program, individuals must:

    • Use a latex or synthetic condom, also referred to as an external condom (even if a vasectomy is performed) during sexual contact with an individual who is or who may become pregnant while on Revlimid and for up to four weeks after the drug is stopped.
    • Not donate sperm while taking lenalidomide or during any breaks in taking lenalidomide.

How Can I Stay Healthy While Taking Revlimid?

Hearing about the potential side effects and safety risks of any medication can be overwhelming. However, consulting with your healthcare team can help you better understand your treatment so that you feel more at ease.

What's more, there are things that you can do to lower your chances of certain side effects. For example, you may be able to take aspirin to prevent the development of blood clots. In addition, ask your oncologist about ways to stay healthy throughout your treatment. Finally, report any side effects to your healthcare team, so they can help you manage them and keep you on therapy.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended to replace medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. DailyMed. Label: Revlimid- lenalidomide capsule.

  2. Taleb BA. Tumour flare reaction in cancer treatments: a comprehensive literature review. Anticancer Drugs. 2019;30(9):953-958. doi:10.1097/CAD.0000000000000814

  3. International Myeloma Foundation. Thalomid (thalidomide) for treatment in myeloma.

  4. MedlinePlus. Pomalidomide.

By Julie Scott, MSN, ANP-BC, AOCNP
Julie is an Adult Nurse Practitioner with oncology certification and a healthcare freelance writer with an interest in educating patients and the healthcare community.