Pomalidomide is contraindicated in pregnancy. Pomalidomide is a thalidomide analogue. Thalidomide is a known human teratogen that causes severe birth defects or embryo-fetal death. In females of reproductive potential, obtain 2 negative pregnancy tests before starting pomalidomide treatment. Females of reproductive potential must use 2 forms of contraception or continuously abstain from heterosexual sex during and for 4 weeks after stopping pomalidomide treatment. Pomalidomide is only available through a restricted distribution program called the Pomalyst Risk Evaluation and Mitigation Strategy (REMS). Information about the POMALYST REMS program is available at www.pomalystrems.com or by calling the REMS Call Center at 1-888-423-5436.
Deep venous thrombosis (DVT), pulmonary embolism (PE), myocardial infarction, and stroke occur in patients with multiple myeloma treated with pomalidomide. Prophylactic antithrombotic measures were employed in clinical trials. Thromboprophylaxis is recommended, and the choice of regimen should be based on assessment of the patient's underlying risk factors.
Kaposi sarcoma: Note: Patients received thromboprophylaxis with low-dose aspirin throughout treatment (Ref). In patients with AIDS-related Kaposi sarcoma, continue highly active antiretroviral therapy (HAART). ANC should be ≥1,000/mm3 and platelets ≥75,000/mm3 prior to initiating new cycles of therapy.
Oral: 5 mg once daily on days 1 to 21 of 28-day cycles (Ref); continue until disease progression or unacceptable toxicity.
Multiple myeloma, relapsed/refractory: Note: ANC should be ≥500/mm3 and platelets ≥50,000/mm3 prior to initiating new cycles of therapy. Thromboprophylaxis is recommended (regimen should be based on assessment of the patient’s underlying risk factors). Institute appropriate management if at risk for tumor lysis syndrome.
Oral: 4 mg once daily on days 1 to 21 of 28-day cycles (in combination with dexamethasone); continue until disease progression or unacceptable toxicity (Ref).
Off-label combinations: Oral: 4 mg once daily on days 1 to 21 of 28-day cycles (in combination with elotuzumab and dexamethasone) until disease progression or unacceptable toxicity (Ref) or 4 mg once daily on days 1 to 21 of 28-day cycles (in combination with daratumumab and dexamethasone) until disease progression (Ref) or 4 mg once daily on days 1 to 21 of 28-day cycles (in combination with daratumumab/hyaluronidase and dexamethasone) until disease progression or unacceptable toxicity (Ref) or 4 mg once daily on days 1 to 21 of 28-day cycles (in combination with isatuximab and dexamethasone) until disease progression (Ref).
Missed doses: May administer a missed dose if within 12 hours of usual dosing time. If >12 hours, skip the dose for that day and resume usual dosing the following day. Do not take 2 doses to make up for a skipped dose.
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Kenar D. Jhaveri, MD; Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.
Altered kidney function: Oral:
CrCl ≥15 mL/minute: No dosage adjustment necessary (Ref).
CrCl <15 mL/minute: Administer 75% to 100% of the usual indication-specific dose depending on patient-specific factors (Ref). Note: Pharmacokinetic evaluations (using data extrapolated from dialysis-dependent patients on nondialysis days) suggest increased pomalidomide exposure (Ref); however, studies in patients with multiple myeloma and severe kidney impairment suggest that 100% of the dose can be administered with acceptable tolerability, although with frequent grade ≥3 adverse events that may necessitate dose adjustment (Ref).
Augmented renal clearance (measured urinary CrCl ≥130 mL/minute/1.73 m2):
Note: Augmented renal clearance (ARC) is a condition that occurs in certain critically ill patients without organ dysfunction and with normal serum creatinine concentrations. Young patients (<55 years of age) admitted post trauma or major surgery are at highest risk for ARC, as well as those with sepsis, burns, or hematologic malignancies. An 8- to 24-hour measured urinary CrCl is necessary to identify these patients (Ref).
Oral: No dose adjustment necessary (Ref).
Hemodialysis, intermittent (thrice weekly): Dialyzable (exact % unknown):
Note: Pharmacokinetic evaluations suggest increased pomalidomide exposure (Ref); however, studies in patients with multiple myeloma and severe kidney impairment, including those on dialysis, suggest that 100% of the dose can be administered with acceptable tolerability, although with frequent grade ≥3 adverse events that may necessitate dose adjustment (Ref).
Oral: Administer 75% to 100% of the usual indication-specific dose depending on patient-specific factors. When a scheduled dose falls on a dialysis day, administer after dialysis (Ref).
Peritoneal dialysis: Oral: No data available. Dose as for patients with CrCl <15 mL/minute (Ref).
CRRT:
Note: Drug clearance is dependent on the effluent flow rate, filter type, and method of renal replacement. Recommendations are based on high-flux dialyzers and effluent flow rates of 20 to 25 mL/kg/hour (or ~1,500 to 3,000 mL/hour), unless otherwise noted. Close monitoring of response and adverse reactions (eg, hematological toxicity) due to drug accumulation is important.
Oral: No data available. No dosage adjustment necessary (Ref).
PIRRT (eg, sustained, low-efficiency diafiltration):
Note: Drug clearance is dependent on the effluent flow rate, filter type, and method of renal replacement. Close monitoring of response and adverse reactions (eg, hematological toxicity) due to drug accumulation is important.
Oral: No data available. Administer 75% to 100% of the usual indication-specific dose. When scheduled dose falls on a PIRRT day, administer after PIRRT (Ref).
Hepatic impairment prior to treatment:
Kaposi sarcoma:
Mild, moderate, or severe impairment (Child-Pugh class A, B, or C): Initial: 3 mg once daily.
Multiple myeloma:
Mild or moderate impairment (Child-Pugh class A or B): Initial: 3 mg once daily.
Severe impairment (Child-Pugh class C): Initial: 2 mg once daily.
Hepatotoxicity during treatment: If liver enzymes are elevated, stop pomalidomide and evaluate; after liver enzymes return to baseline, may consider restarting at a lower dose.
Hematologic toxicities:
Toxicity |
Severity |
Dose modification |
---|---|---|
Neutropenia |
ANC 500 to <1,000/mm3 |
If day 1 of cycle, withhold pomalidomide until ANC ≥1,000/mm3, then resume pomalidomide at the same dose. If during the cycle, continue pomalidomide at the current dose. |
ANC <500/mm3 |
Withhold pomalidomide until ANC ≥1,000/mm3, then resume pomalidomide at the same dose. | |
Neutropenic fever |
ANC <1,000/mm3 and a single temperature ≥38.3°C or ANC <1,000/mm3 and sustained temperature ≥38°C for >1 hour |
Withhold pomalidomide until ANC ≥1,000/mm3, then resume pomalidomide with the dose reduced by 1 mg from the previous dose. |
Thrombocytopenia |
Platelets 25,000 to <50,000/mm3 |
If day 1 of cycle, withhold pomalidomide until platelets ≥50,000/mm3, then resume pomalidomide at the same dose. If during the cycle, continue pomalidomide at the current dose. |
Platelets <25,000/mm3 |
Permanently discontinue pomalidomide. | |
Permanently discontinue pomalidomide if unable to tolerate a dose of 1 mg once daily. |
Toxicity |
Severity |
Dose modification |
---|---|---|
Neutropenia |
ANC <500/mm3 or neutropenic fever (fever ≥38.5°C and ANC <1,000 /mm3) |
Withhold pomalidomide treatment, follow CBC weekly. When ANC returns to ≥500/mm3, resume pomalidomide with the dose reduced by 1 mg from the previous dose. |
For each subsequent ANC drop of <500/mm3 |
Withhold pomalidomide treatment. When ANC returns to ≥500/mm3, resume pomalidomide with the dose reduced by 1 mg from the previous dose. | |
Thrombocytopenia |
Platelets <25,000/mm3 |
Withhold pomalidomide treatment, follow CBC weekly. When platelets return to ≥50,000/mm3, resume pomalidomide with the dose reduced by 1 mg from the previous dose. |
For each subsequent drop <25,000/mm3 |
Withhold pomalidomide treatment. When platelets return to ≥50,000/mm3, resume pomalidomide with the dose reduced by 1 mg from the previous dose. | |
Permanently discontinue pomalidomide if unable to tolerate a dose of 1 mg once daily. |
Nonhematologic toxicities (Kaposi sarcoma and multiple myeloma):
Grade 2 or 3 skin rash: Consider interrupting or discontinuing pomalidomide.
Angioedema, anaphylaxis, grade 4 rash, skin exfoliation, bullae, or any other severe dermatologic toxicity (eg, Stevens-Johnson syndrome, toxic epidermal necrolysis, or drug reaction with eosinophilia and systemic symptoms): Permanently discontinue.
Other grade 3 or 4 toxicities: Withhold pomalidomide treatment until toxicity has resolved to ≤ grade 2, then may restart pomalidomide with the dose reduced by 1 mg less than the previous dose.
Refer to adult dosing.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
>10%:
Cardiovascular: Peripheral edema (25%)
Dermatologic: Skin rash (21%), pruritus (15%)
Endocrine & metabolic: Hypercalcemia (21%), hyperglycemia (11%), hypokalemia (12%), hyponatremia (11%), weight loss (15%)
Gastrointestinal: Constipation (36%), decreased appetite (23%), diarrhea (35%), nausea (36%), vomiting (14%)
Hematologic & oncologic: Anemia (38%; grades 3/4: 23%), leukopenia (13%; grades 3/4: 7%), neutropenia (53%; grades 3/4: 48%), thrombocytopenia (26%; grades 3/4: 22%)
Nervous system: Anxiety (13%), confusion (12%), dizziness (22%), fatigue (≤58%), headache (15%), myasthenia (14%), peripheral neuropathy (21%)
Neuromuscular & skeletal: Arthralgia (17%), asthenia (≤58%), back pain (35%), muscle spasm (21%), musculoskeletal chest pain (23%), musculoskeletal pain (12%), ostealgia (12%)
Renal: Increased serum creatinine (19%), renal failure syndrome (15%)
Respiratory: Cough (17%), dyspnea (36%), epistaxis (17%), pneumonia (28%; includes streptococcal pneumonia), upper respiratory tract infection (37%)
Miscellaneous: Fever (23%)
1% to 10%:
Dermatologic: Hyperhidrosis (7%), night sweats (5%), xeroderma (9%)
Endocrine & metabolic: Dehydration (<10%), hypocalcemia (6%)
Genitourinary: Urinary tract infection (10%)
Hematologic & oncologic: Febrile neutropenia (<10%; grades 3/4: 6%), lymphocytopenia (4%; grades 3/4: 2%)
Infection: Sepsis (<10%)
Nervous system: Chills (10%), insomnia (7%)
Neuromuscular & skeletal: Limb pain (7%), tremor (10%)
Respiratory: Oropharyngeal pain (6%), productive cough (9%)
<1%: Endocrine & metabolic: Weight gain
Frequency not defined:
Cardiovascular: Acute myocardial infarction, angina pectoris, arterial thromboembolism, atrial fibrillation, cardiac failure, cerebrovascular accident, deep vein thrombosis, hypotension, ischemic heart disease, pulmonary embolism, septic shock, syncope, venous thromboembolism
Dermatologic: Cellulitis
Endocrine & metabolic: Hyperkalemia
Gastrointestinal: Abdominal pain, Clostridioides difficile associated diarrhea
Genitourinary: Pelvic pain, urinary retention, urinary tract infection with sepsis
Hepatic: Hepatic failure, hepatoxicity, hyperbilirubinemia, increased serum alanine aminotransferase
Infection: Bacteremia, neutropenic sepsis, viral infection
Nervous system: Altered mental status, falling, impaired consciousness, noncardiac chest pain, vertigo
Neuromuscular & skeletal: Bone fracture, vertebral compression fracture
Respiratory: Bronchospasm, interstitial pulmonary disease, lobar pneumonia, pneumonia due to Pneumocystis jirovecii, pulmonary infection, respiratory failure, respiratory syncytial virus infection
Miscellaneous: Failure to thrive, multiorgan failure, physical health deterioration
Postmarketing:
Dermatologic: Severe dermatological reaction, Stevens-Johnson syndrome, toxic epidermal necrolysis
Endocrine & metabolic: Hyperthyroidism, hypothyroidism
Gastrointestinal: Gastrointestinal hemorrhage
Hematologic & oncologic: Basal cell carcinoma of skin, pancytopenia, squamous cell carcinoma of skin, tumor lysis syndrome
Hepatic: Increased liver enzymes
Hypersensitivity: Anaphylaxis, angioedema, hypersensitivity reaction
Immunologic: Drug reaction with eosinophilia and systemic symptoms, organ transplant rejection
Infection: Herpes zoster infection, reactivation of HBV
Nervous system: Progressive multifocal leukoencephalopathy (Ueno 2020)
Severe hypersensitivity (eg, angioedema, anaphylaxis) to pomalidomide or any component of the formulation; pregnancy.
Canadian labeling: Additional contraindications (not in the US labeling): Hypersensitivity to thalidomide or lenalidomide; breastfeeding; women of childbearing potential not using 2 effective means of contraception; male patients unable to comply with required contraceptive measures.
Concerns related to adverse effects:
• Bone marrow suppression: Neutropenia, anemia, and thrombocytopenia commonly occur, including grades 3 and 4 events. Neutropenic fever has also been reported.
• CNS effects: May cause dizziness and/or confusion; caution patients to avoid tasks that require mental alertness (eg, operating machinery or driving). Avoid concomitant medications that may exacerbate dizziness and confusion.
• Dermatologic reactions: Severe cutaneous reactions, including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reaction with eosinophilia and systemic symptoms (DRESS), have been reported; may be fatal. DRESS may manifest as a cutaneous reaction (eg, rash, exfoliative dermatitis), eosinophilia, fever, and/or lymphadenopathy with systemic complications, which may include hepatitis, nephritis, pneumonitis, myocarditis, and/or pericarditis.
• Hepatotoxicity: Hepatic failure (with fatalities) has been reported; elevated bilirubin and ALT have also been observed.
• Hypersensitivity: Hypersensitivity, including angioedema and anaphylactic reactions, have been reported.
• Interstitial lung disease (ILD): ILD and related events (eg, pneumonitis) have been reported.
• Neuropathy: Peripheral and sensory neuropathy occurred in clinical trials, including some cases of grade 3 neuropathy, although no cases of grade 4 neuropathy were observed.
• Secondary malignancy: Acute myelogenous leukemia (AML) as a secondary malignancy has been reported in patients receiving pomalidomide in the investigational treatment of condition(s) other than multiple myeloma.
• Thromboembolic events: Venous and arterial thromboembolic events such as deep vein thrombosis, pulmonary embolism, myocardial infarction (MI), and stroke have occurred in multiple myeloma patients during pomalidomide therapy. Clinical trials utilized antithrombotic prophylaxis. Arterial thrombotic events also included cerebrovascular ischemia and ischemic heart disease. Advise patients to promptly seek medical attention should symptoms (shortness of breath, chest pain, or arm or leg swelling) occur.
• Tumor lysis syndrome: Patients with a high tumor burden may be at risk for tumor lysis syndrome.
Disease-related concerns:
• Hepatic impairment: Use with caution; pomalidomide is hepatically metabolized and systemic exposure may be increased.
• Multiple myeloma: An increase in mortality was noted in 2 clinical studies in patients with multiple myeloma who received pembrolizumab in combination with a thalidomide analogue and dexamethasone. Pembrolizumab should not be used to treat multiple myeloma in combination with a thalidomide analogue and dexamethasone unless as part of a clinical trial.
Special populations:
• Cigarette smokers: Cigarette smoking may induce CYP1A2-mediated metabolism of pomalidomide, potentially reducing its systemic exposure and efficacy.
Other warnings/precautions:
• Blood donation: Patients should not donate blood during pomalidomide treatment and for 4 weeks after therapy discontinuation.
• REMS program: Due to the embryo-fetal risk, pomalidomide is only available through a restricted distribution program (Pomalyst REMS). Pomalidomide should only be prescribed to patients who can understand and comply with the conditions of the Pomalyst REMS program. Prescribers and pharmacies must be certified with the REMS program.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Capsule, Oral:
Pomalyst: 1 mg, 2 mg, 3 mg [contains fd&c blue #2 (indigotine,indigo carmine)]
Pomalyst: 4 mg [contains fd&c blue #1 (brilliant blue), fd&c blue #2 (indigotine,indigo carmine)]
No
Capsules (Pomalyst Oral)
1 mg (per each): $1,369.77
2 mg (per each): $1,369.77
3 mg (per each): $1,369.77
4 mg (per each): $1,369.77
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Capsule, Oral:
Pomalyst: 1 mg, 2 mg, 3 mg [contains fd&c blue #2 (indigotine,indigo carmine)]
Pomalyst: 4 mg [contains fd&c blue #1 (brilliant blue), fd&c blue #2 (indigotine,indigo carmine)]
Generic: 1 mg, 2 mg, 3 mg, 4 mg
In Canada, pomalidomide is only available through a restricted distribution program called RevAid. Only physicians and pharmacists registered with the program are authorized to prescribe or dispense pomalidomide. Patients must also be registered and meet all conditions of the program. Two negative pregnancy tests with a sensitivity of at least 25 milliunits/mL are required prior to initiating therapy in women of childbearing potential. Further information is available at 1-888-738-2431 or www.RevAid.ca.
Oral: Administer with or without food. Swallow whole with water; do not break, chew, or open the capsules.
Hazardous agent (NIOSH 2024 [table 1]).
Use appropriate precautions for receiving, handling, storage, preparation, dispensing, transporting, administration, and disposal. Follow NIOSH and USP 800 recommendations and institution-specific policies/procedures for appropriate containment strategy (NIOSH 2023; NIOSH 2024; USP-NF 2020).
An FDA-approved patient medication guide, which is available with the product information and as follows, must be dispensed with this medication:
Pomalyst: https://www.accessdata.fda.gov/drugsatfda_docs/label/2025/204026s034lbl.pdf#page=33
Kaposi sarcoma: Treatment of AIDS-related Kaposi sarcoma in adults after failure of highly active antiretroviral therapy (HAART); treatment of Kaposi sarcoma in HIV-negative adults.
Multiple myeloma, relapsed/refractory: Treatment of multiple myeloma (in combination with dexamethasone) in adults who have received at least 2 prior therapies, including lenalidomide and a proteasome inhibitor, and have demonstrated disease progression on or within 60 days of completion of the last therapy.
Pomalidomide may be confused with lenalidomide, thalidomide
The Institute for Safe Medication Practices (ISMP) includes this medication among its list of drugs (contraindicated in pregnancy) which have a heightened risk of causing significant patient harm when used in error (High-Alert Medications in Community/Ambulatory Care Settings).
Substrate of CYP1A2 (Major), CYP2C19 (Minor), CYP2D6 (Minor), CYP3A4 (Minor), P-glycoprotein (Minor); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential;
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.
5-Aminosalicylic Acid Derivatives: May increase myelosuppressive effects of Myelosuppressive Agents. Risk C: Monitor
Abatacept: Anti-TNF Agents may increase immunosuppressive effects of Abatacept. Risk X: Avoid
Abrocitinib: May increase immunosuppressive effects of Immunosuppressants (Miscellaneous Oncologic Agents). Risk X: Avoid
Acrivastine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Alcohol (Ethyl): CNS Depressants may increase CNS depressant effects of Alcohol (Ethyl). Risk C: Monitor
Alizapride: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Amisulpride (Oral): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Anakinra: Anti-TNF Agents may increase adverse/toxic effects of Anakinra. An increased risk of serious infection during concomitant use has been reported. Risk X: Avoid
Antithymocyte Globulin (Equine): Immunosuppressants (Miscellaneous Oncologic Agents) may increase adverse/toxic effects of Antithymocyte Globulin (Equine). Specifically, these effects may be unmasked if the dose of immunosuppressive therapy is reduced. Immunosuppressants (Miscellaneous Oncologic Agents) may increase immunosuppressive effects of Antithymocyte Globulin (Equine). Specifically, infections may occur with greater severity and/or atypical presentations. Risk C: Monitor
Antithyroid Agents: Myelosuppressive Agents may increase neutropenic effects of Antithyroid Agents. Risk C: Monitor
Articaine: May increase CNS depressant effects of CNS Depressants. Management: Consider reducing the dose of articaine if possible when used in patients who are also receiving CNS depressants. Monitor for excessive CNS depressant effects with any combined use. Risk D: Consider Therapy Modification
Azelastine (Nasal): May increase CNS depressant effects of CNS Depressants. Risk X: Avoid
Baricitinib: Immunosuppressants (Miscellaneous Oncologic Agents) may increase immunosuppressive effects of Baricitinib. Risk X: Avoid
BCG Products: Immunosuppressants (Miscellaneous Oncologic Agents) may decrease therapeutic effects of BCG Products. Immunosuppressants (Miscellaneous Oncologic Agents) may increase adverse/toxic effects of BCG Products. Specifically, the risk of vaccine-associated infection may be increased. Risk X: Avoid
Benperidol: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Bisphosphonate Derivatives: Angiogenesis Inhibitors (Systemic) may increase adverse/toxic effects of Bisphosphonate Derivatives. Specifically, the risk for osteonecrosis of the jaw may be increased. Risk C: Monitor
Blonanserin: CNS Depressants may increase CNS depressant effects of Blonanserin. Management: Use caution if coadministering blonanserin and CNS depressants; dose reduction of the other CNS depressant may be required. Strong CNS depressants should not be coadministered with blonanserin. Risk D: Consider Therapy Modification
Brexanolone: CNS Depressants may increase CNS depressant effects of Brexanolone. Risk C: Monitor
Brimonidine (Topical): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Brincidofovir: Immunosuppressants (Miscellaneous Oncologic Agents) may decrease therapeutic effects of Brincidofovir. Risk C: Monitor
Brivudine: May increase adverse/toxic effects of Immunosuppressants (Miscellaneous Oncologic Agents). Risk X: Avoid
Broccoli: May decrease serum concentration of CYP1A2 Substrates (High risk with Inducers). Risk C: Monitor
Bromopride: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Bromperidol: May increase CNS depressant effects of CNS Depressants. Risk X: Avoid
Buclizine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Buprenorphine: CNS Depressants may increase CNS depressant effects of Buprenorphine. Management: Consider reduced doses of other CNS depressants, and avoiding such drugs in patients at high risk of buprenorphine overuse/self-injection. Initiate buprenorphine at lower doses in patients already receiving CNS depressants. Risk D: Consider Therapy Modification
BusPIRone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Canakinumab: Anti-TNF Agents may increase adverse/toxic effects of Canakinumab. Specifically, the risk for serious infections and/or neutropenia may be increased. Risk X: Avoid
Cannabinoid-Containing Products: CNS Depressants may increase CNS depressant effects of Cannabinoid-Containing Products. Risk C: Monitor
Cannabis: May decrease serum concentration of CYP1A2 Substrates (High risk with Inducers). Risk C: Monitor
Certolizumab Pegol: Anti-TNF Agents may increase immunosuppressive effects of Certolizumab Pegol. Risk X: Avoid
Cetirizine (Systemic): May increase CNS depressant effects of CNS Depressants. Management: Consider avoiding this combination if possible. If required, monitor for excessive sedation or CNS depression, limit the dose and duration of combination therapy, and consider CNS depressant dose reductions. Risk D: Consider Therapy Modification
Chikungunya Vaccine (Live): Immunosuppressants (Miscellaneous Oncologic Agents) may increase adverse/toxic effects of Chikungunya Vaccine (Live). Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Miscellaneous Oncologic Agents) may decrease therapeutic effects of Chikungunya Vaccine (Live). Risk X: Avoid
Chloral Hydrate/Chloral Betaine: CNS Depressants may increase CNS depressant effects of Chloral Hydrate/Chloral Betaine. Management: Consider alternatives to the use of chloral hydrate or chloral betaine and additional CNS depressants. If combined, consider a dose reduction of either agent and monitor closely for enhanced CNS depressive effects. Risk D: Consider Therapy Modification
Chloramphenicol (Ophthalmic): May increase adverse/toxic effects of Myelosuppressive Agents. Risk C: Monitor
Chloramphenicol (Systemic): Myelosuppressive Agents may increase myelosuppressive effects of Chloramphenicol (Systemic). Risk X: Avoid
Chlormethiazole: May increase CNS depressant effects of CNS Depressants. Management: Monitor closely for evidence of excessive CNS depression. The chlormethiazole labeling states that an appropriately reduced dose should be used if such a combination must be used. Risk D: Consider Therapy Modification
Chlorphenesin Carbamate: May increase adverse/toxic effects of CNS Depressants. Risk C: Monitor
Ciprofloxacin (Systemic): May increase serum concentration of Pomalidomide. Management: Avoid concomitant use of pomalidomide and ciprofloxacin when possible. If coadministration is considered necessary, consider reducing the pomalidomide dose to 2 mg and monitoring patients for increased pomalidomide effects/toxicities. Risk D: Consider Therapy Modification
Cladribine: Immunosuppressants (Miscellaneous Oncologic Agents) may increase immunosuppressive effects of Cladribine. Risk X: Avoid
CloZAPine: Myelosuppressive Agents may increase adverse/toxic effects of CloZAPine. Specifically, the risk for neutropenia may be increased. Risk C: Monitor
CNS Depressants: May increase adverse/toxic effects of CNS Depressants. Risk C: Monitor
Coccidioides immitis Skin Test: Coadministration of Immunosuppressants (Miscellaneous Oncologic Agents) and Coccidioides immitis Skin Test may alter diagnostic results. Management: Consider discontinuing these oncologic agents several weeks prior to coccidioides immitis skin antigen testing to increase the likelihood of accurate diagnostic results. Risk D: Consider Therapy Modification
COVID-19 Vaccine (Inactivated Virus): Immunosuppressants (Miscellaneous Oncologic Agents) may decrease therapeutic effects of COVID-19 Vaccine (Inactivated Virus). Risk C: Monitor
COVID-19 Vaccine (mRNA): Immunosuppressants (Miscellaneous Oncologic Agents) may decrease therapeutic effects of COVID-19 Vaccine (mRNA). Management: Give a 3-dose primary series for all patients aged 6 months and older taking immunosuppressive medications or therapies. Booster doses are recommended for certain age groups. See CDC guidance for details. Risk D: Consider Therapy Modification
COVID-19 Vaccine (Subunit): Immunosuppressants (Miscellaneous Oncologic Agents) may decrease therapeutic effects of COVID-19 Vaccine (Subunit). Risk C: Monitor
CYP1A2 Inducers (Moderate): May decrease serum concentration of Pomalidomide. Risk C: Monitor
CYP1A2 Inhibitors (Moderate): May increase serum concentration of Pomalidomide. Risk C: Monitor
CYP1A2 Inhibitors (Strong): May increase serum concentration of Pomalidomide. Management: Avoid when possible. If coadministration is necessary, reduce the pomalidomide dose to 2 mg and monitor for increased pomalidomide effects/toxicities. Risk D: Consider Therapy Modification
Dantrolene: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Daridorexant: May increase CNS depressant effects of CNS Depressants. Management: Dose reduction of daridorexant and/or any other CNS depressant may be necessary. Use of daridorexant with alcohol is not recommended, and the use of daridorexant with any other drug to treat insomnia is not recommended. Risk D: Consider Therapy Modification
Deferiprone: Myelosuppressive Agents may increase neutropenic effects of Deferiprone. Management: Avoid the concomitant use of deferiprone and myelosuppressive agents whenever possible. If this combination cannot be avoided, monitor the absolute neutrophil count more closely. Risk D: Consider Therapy Modification
Dengue Tetravalent Vaccine (Live): Immunosuppressants (Miscellaneous Oncologic Agents) may decrease therapeutic effects of Dengue Tetravalent Vaccine (Live). Immunosuppressants (Miscellaneous Oncologic Agents) may increase adverse/toxic effects of Dengue Tetravalent Vaccine (Live). Specifically, the risk of vaccine-associated infection may be increased. Risk X: Avoid
Denosumab: May increase immunosuppressive effects of Immunosuppressants (Miscellaneous Oncologic Agents). Management: Consider the risk of serious infections versus the potential benefits of coadministration of denosumab and immunosuppressants. If combined, monitor patients for signs/symptoms of serious infections. Risk D: Consider Therapy Modification
Deucravacitinib: May increase immunosuppressive effects of Immunosuppressants (Miscellaneous Oncologic Agents). Risk X: Avoid
DexmedeTOMIDine: CNS Depressants may increase CNS depressant effects of DexmedeTOMIDine. Management: Monitor for increased CNS depression during coadministration of dexmedetomidine and CNS depressants, and consider dose reductions of either agent to avoid excessive CNS depression. Risk D: Consider Therapy Modification
Diazoxide Choline: May increase serum concentration of CYP1A2 Substrates (High risk with Inhibitors). Risk X: Avoid
Difelikefalin: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Difenoxin: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Dihydralazine: CNS Depressants may increase hypotensive effects of Dihydralazine. Risk C: Monitor
Dimethindene (Topical): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Dothiepin: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Doxylamine: CNS Depressants may increase CNS depressant effects of Doxylamine. Risk C: Monitor
DroPERidol: May increase CNS depressant effects of CNS Depressants. Management: Consider dose reductions of droperidol or of other CNS agents (eg, opioids, barbiturates) with concomitant use. Risk D: Consider Therapy Modification
Emedastine (Systemic): May increase CNS depressant effects of CNS Depressants. Management: Consider avoiding this combination if possible. If required, monitor for excessive sedation or CNS depression, limit the dose and duration of combination therapy, and consider CNS depressant dose reductions. Risk C: Monitor
Entacapone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Erythropoiesis-Stimulating Agents: May increase thrombogenic effects of Pomalidomide. Risk C: Monitor
Esketamine (Nasal): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Estrogen Derivatives: May increase thrombogenic effects of Pomalidomide. Risk C: Monitor
Etrasimod: May increase immunosuppressive effects of Immunosuppressants (Miscellaneous Oncologic Agents). Risk X: Avoid
Fexinidazole: Myelosuppressive Agents may increase myelosuppressive effects of Fexinidazole. Risk X: Avoid
Filgotinib: May increase immunosuppressive effects of Immunosuppressants (Miscellaneous Oncologic Agents). Risk X: Avoid
Flunarizine: CNS Depressants may increase CNS depressant effects of Flunarizine. Risk X: Avoid
Flunitrazepam: CNS Depressants may increase CNS depressant effects of Flunitrazepam. Management: Reduce the dose of CNS depressants when combined with flunitrazepam and monitor patients for evidence of CNS depression (eg, sedation, respiratory depression). Use non-CNS depressant alternatives when available. Risk D: Consider Therapy Modification
HydrOXYzine: May increase CNS depressant effects of CNS Depressants. Management: Consider a decrease in the CNS depressant dose, as appropriate, when used together with hydroxyzine. Increase monitoring of signs/symptoms of CNS depression in any patient receiving hydroxyzine together with another CNS depressant. Risk D: Consider Therapy Modification
Inebilizumab: Immunosuppressants (Miscellaneous Oncologic Agents) may increase immunosuppressive effects of Inebilizumab. Risk C: Monitor
Influenza Virus Vaccines: Immunosuppressants (Miscellaneous Oncologic Agents) may decrease therapeutic effects of Influenza Virus Vaccines. Management: Administer influenza vaccines at least 2 weeks prior to initiating immunosuppressants if possible. If vaccination occurs less than 2 weeks prior to or during therapy, revaccinate at least 3 months after therapy discontinued if immune competence restored. Risk D: Consider Therapy Modification
Ixabepilone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Kava Kava: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Ketotifen (Systemic): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Kratom: May increase CNS depressant effects of CNS Depressants. Risk X: Avoid
Leflunomide: Immunosuppressants (Miscellaneous Oncologic Agents) may increase immunosuppressive effects of Leflunomide. Management: Increase the frequency of chronic monitoring of platelet, white blood cell count, and hemoglobin or hematocrit to monthly, instead of every 6 to 8 weeks, if leflunomide is coadministered with immunosuppressive agents. Risk D: Consider Therapy Modification
Lemborexant: May increase CNS depressant effects of CNS Depressants. Management: Dosage adjustments of lemborexant and of concomitant CNS depressants may be necessary when administered together because of potentially additive CNS depressant effects. Close monitoring for CNS depressant effects is necessary. Risk D: Consider Therapy Modification
Levocetirizine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Linezolid: May increase myelosuppressive effects of Myelosuppressive Agents. Risk C: Monitor
Lisuride: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Lofepramine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Lofexidine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Loxapine: CNS Depressants may increase CNS depressant effects of Loxapine. Management: Consider reducing the dose of CNS depressants administered concomitantly with loxapine due to an increased risk of respiratory depression, sedation, hypotension, and syncope. Risk D: Consider Therapy Modification
Magnesium Sulfate: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Melitracen [INT]: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Mequitazine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Metergoline: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Methotrimeprazine: CNS Depressants may increase CNS depressant effects of Methotrimeprazine. Methotrimeprazine may increase CNS depressant effects of CNS Depressants. Management: Reduce the usual dose of CNS depressants by 50% if starting methotrimeprazine until the dose of methotrimeprazine is stable. Monitor patient closely for evidence of CNS depression. Risk D: Consider Therapy Modification
Methoxyflurane: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Metoclopramide: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
MetyroSINE: CNS Depressants may increase sedative effects of MetyroSINE. Risk C: Monitor
Minocycline (Systemic): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Moxonidine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Mumps- Rubella- or Varicella-Containing Live Vaccines: Immunosuppressants (Miscellaneous Oncologic Agents) may decrease therapeutic effects of Mumps- Rubella- or Varicella-Containing Live Vaccines. Mumps- Rubella- or Varicella-Containing Live Vaccines may increase adverse/toxic effects of Immunosuppressants (Miscellaneous Oncologic Agents). Specifically, the risk of vaccine-associated infection may be increased. Risk X: Avoid
Nabilone: May increase CNS depressant effects of CNS Depressants. Risk X: Avoid
Nadofaragene Firadenovec: Immunosuppressants (Miscellaneous Oncologic Agents) may increase adverse/toxic effects of Nadofaragene Firadenovec. Specifically, the risk of disseminated adenovirus infection may be increased. Risk X: Avoid
Nalfurafine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Natalizumab: Immunosuppressants (Miscellaneous Oncologic Agents) may increase immunosuppressive effects of Natalizumab. Risk X: Avoid
Noscapine: CNS Depressants may increase adverse/toxic effects of Noscapine. Risk X: Avoid
Ocrelizumab: Immunosuppressants (Miscellaneous Oncologic Agents) may increase immunosuppressive effects of Ocrelizumab. Risk C: Monitor
Ofatumumab: Immunosuppressants (Miscellaneous Oncologic Agents) may increase immunosuppressive effects of Ofatumumab. Risk C: Monitor
Olaparib: Myelosuppressive Agents may increase myelosuppressive effects of Olaparib. Risk C: Monitor
Olopatadine (Nasal): May increase CNS depressant effects of CNS Depressants. Risk X: Avoid
Opicapone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Opioid Agonists: CNS Depressants may increase CNS depressant effects of Opioid Agonists. Management: Avoid concomitant use of opioid agonists and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Risk D: Consider Therapy Modification
Opipramol: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Orphenadrine: CNS Depressants may increase CNS depressant effects of Orphenadrine. Risk X: Avoid
Oxomemazine: May increase CNS depressant effects of CNS Depressants. Risk X: Avoid
Oxybate Salt Products: CNS Depressants may increase CNS depressant effects of Oxybate Salt Products. Management: Consider alternatives to this combination when possible. If combined, dose reduction or discontinuation of one or more CNS depressants (including the oxybate salt product) should be considered. Interrupt oxybate salt treatment during short-term opioid use Risk D: Consider Therapy Modification
OxyCODONE: CNS Depressants may increase CNS depressant effects of OxyCODONE. Management: Avoid concomitant use of oxycodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Risk D: Consider Therapy Modification
Paliperidone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Paraldehyde: CNS Depressants may increase CNS depressant effects of Paraldehyde. Risk X: Avoid
Pembrolizumab: May increase adverse/toxic effects of Thalidomide Analogues. Specifically, mortality may be increased when this combination is used for treatment of refractory multiple myeloma. Risk X: Avoid
Perampanel: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Periciazine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Pidotimod: Immunosuppressants (Miscellaneous Oncologic Agents) may decrease therapeutic effects of Pidotimod. Risk C: Monitor
Pimecrolimus: May increase immunosuppressive effects of Immunosuppressants (Miscellaneous Oncologic Agents). Risk X: Avoid
Pipamperone: May increase adverse/toxic effects of CNS Depressants. Risk C: Monitor
Piribedil: CNS Depressants may increase CNS depressant effects of Piribedil. Risk C: Monitor
Pizotifen: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Pneumococcal Vaccines: Immunosuppressants (Miscellaneous Oncologic Agents) may decrease therapeutic effects of Pneumococcal Vaccines. Risk C: Monitor
Poliovirus Vaccine (Live/Trivalent/Oral): Immunosuppressants (Miscellaneous Oncologic Agents) may decrease therapeutic effects of Poliovirus Vaccine (Live/Trivalent/Oral). Immunosuppressants (Miscellaneous Oncologic Agents) may increase adverse/toxic effects of Poliovirus Vaccine (Live/Trivalent/Oral). Specifically, the risk of vaccine-associated infection may be increased. Risk X: Avoid
Polymethylmethacrylate: Immunosuppressants (Miscellaneous Oncologic Agents) may increase hypersensitivity effects of Polymethylmethacrylate. Management: Use caution when considering use of bovine collagen-containing implants such as the polymethylmethacrylate-based Bellafill brand implant in patients who are receiving immunosuppressants. Consider use of additional skin tests prior to administration. Risk D: Consider Therapy Modification
Pramipexole: CNS Depressants may increase sedative effects of Pramipexole. Risk C: Monitor
Primaquine: May increase serum concentration of CYP1A2 Substrates (High risk with Inhibitors). Risk C: Monitor
Procarbazine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Promazine: May increase myelosuppressive effects of Myelosuppressive Agents. Risk C: Monitor
Rabies Vaccine: Immunosuppressants (Miscellaneous Oncologic Agents) may decrease therapeutic effects of Rabies Vaccine. Management: Complete rabies vaccination at least 2 weeks before initiation of immunosuppressant therapy if possible. If combined, check for rabies antibody titers, and if vaccination is for post exposure prophylaxis, administer a 5th dose of the vaccine. Risk D: Consider Therapy Modification
Rilmenidine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Rilonacept: Anti-TNF Agents may increase adverse/toxic effects of Rilonacept. Risk X: Avoid
Ritlecitinib: Immunosuppressants (Miscellaneous Oncologic Agents) may increase immunosuppressive effects of Ritlecitinib. Risk X: Avoid
Ropeginterferon Alfa-2b: CNS Depressants may increase adverse/toxic effects of Ropeginterferon Alfa-2b. Specifically, the risk of neuropsychiatric adverse effects may be increased. Management: Avoid coadministration of ropeginterferon alfa-2b and other CNS depressants. If this combination cannot be avoided, monitor patients for neuropsychiatric adverse effects (eg, depression, suicidal ideation, aggression, mania). Risk D: Consider Therapy Modification
Ropeginterferon Alfa-2b: Myelosuppressive Agents may increase myelosuppressive effects of Ropeginterferon Alfa-2b. Management: Avoid coadministration of ropeginterferon alfa-2b and other myelosuppressive agents. If this combination cannot be avoided, monitor patients for excessive myelosuppressive effects. Risk D: Consider Therapy Modification
ROPINIRole: CNS Depressants may increase sedative effects of ROPINIRole. Risk C: Monitor
Rotigotine: CNS Depressants may increase sedative effects of Rotigotine. Risk C: Monitor
Ruxolitinib (Topical): Immunosuppressants (Miscellaneous Oncologic Agents) may increase immunosuppressive effects of Ruxolitinib (Topical). Risk X: Avoid
Sipuleucel-T: Immunosuppressants (Miscellaneous Oncologic Agents) may decrease therapeutic effects of Sipuleucel-T. Management: Consider reducing the dose or discontinuing the use of immunosuppressants prior to initiating sipuleucel-T therapy. Risk D: Consider Therapy Modification
Sphingosine 1-Phosphate (S1P) Receptor Modulators: May increase immunosuppressive effects of Immunosuppressants (Miscellaneous Oncologic Agents). Risk C: Monitor
Suvorexant: CNS Depressants may increase CNS depressant effects of Suvorexant. Management: Dose reduction of suvorexant and/or any other CNS depressant may be necessary. Use of suvorexant with alcohol is not recommended, and the use of suvorexant with any other drug to treat insomnia is not recommended. Risk D: Consider Therapy Modification
Tacrolimus (Topical): Immunosuppressants (Miscellaneous Oncologic Agents) may increase immunosuppressive effects of Tacrolimus (Topical). Risk X: Avoid
Talimogene Laherparepvec: Immunosuppressants (Miscellaneous Oncologic Agents) may increase adverse/toxic effects of Talimogene Laherparepvec. Specifically, the risk of infection from the live, attenuated herpes simplex virus contained in talimogene laherparepvec may be increased. Risk X: Avoid
Tertomotide: Immunosuppressants (Miscellaneous Oncologic Agents) may decrease therapeutic effects of Tertomotide. Risk X: Avoid
Thalidomide: CNS Depressants may increase CNS depressant effects of Thalidomide. Risk X: Avoid
Tobacco (Smoked): May increase adverse/toxic effects of Pomalidomide. Specifically, the risk for thrombosis may be increased. Tobacco (Smoked) may decrease serum concentration of Pomalidomide. Risk C: Monitor
Tofacitinib: Immunosuppressants (Miscellaneous Oncologic Agents) may increase immunosuppressive effects of Tofacitinib. Risk X: Avoid
Trimeprazine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Typhoid Vaccine: Immunosuppressants (Miscellaneous Oncologic Agents) may decrease therapeutic effects of Typhoid Vaccine. Immunosuppressants (Miscellaneous Oncologic Agents) may increase adverse/toxic effects of Typhoid Vaccine. Specifically, the risk of vaccine-associated infection may be increased. Risk X: Avoid
Ublituximab: Immunosuppressants (Miscellaneous Oncologic Agents) may increase immunosuppressive effects of Ublituximab. Risk C: Monitor
Upadacitinib: Immunosuppressants (Miscellaneous Oncologic Agents) may increase immunosuppressive effects of Upadacitinib. Risk X: Avoid
Vaccines (Live): Immunosuppressants (Miscellaneous Oncologic Agents) may decrease therapeutic effects of Vaccines (Live). Immunosuppressants (Miscellaneous Oncologic Agents) may increase adverse/toxic effects of Vaccines (Live). Specifically, the risk of vaccine-associated infection may be increased. Risk X: Avoid
Vaccines (Non-Live/Inactivated/Non-Replicating): Immunosuppressants (Miscellaneous Oncologic Agents) may decrease therapeutic effects of Vaccines (Non-Live/Inactivated/Non-Replicating). Management: Give non-live/inactivated/non-replicating vaccines at least 2 weeks prior to initiation of immunosuppressants when possible. Patients vaccinated less than 14 days before or during therapy should be revaccinated at least 3 months after therapy is complete. Risk D: Consider Therapy Modification
Valerian: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor
Vedolizumab: Anti-TNF Agents may increase adverse/toxic effects of Vedolizumab. Risk X: Avoid
Yellow Fever Vaccine: Immunosuppressants (Miscellaneous Oncologic Agents) may decrease therapeutic effects of Yellow Fever Vaccine. Immunosuppressants (Miscellaneous Oncologic Agents) may increase adverse/toxic effects of Yellow Fever Vaccine. Specifically, the risk of vaccine-associated infection may be increased. Risk X: Avoid
Zolpidem: CNS Depressants may increase CNS depressant effects of Zolpidem. Management: Reduce the Intermezzo brand sublingual zolpidem adult dose to 1.75 mg for men who are also receiving other CNS depressants. No such dose change is recommended for women. Avoid use with other CNS depressants at bedtime; avoid use with alcohol. Risk D: Consider Therapy Modification
Zoster Vaccine (Live/Attenuated): Immunosuppressants (Miscellaneous Oncologic Agents) may increase adverse/toxic effects of Zoster Vaccine (Live/Attenuated). Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Miscellaneous Oncologic Agents) may decrease therapeutic effects of Zoster Vaccine (Live/Attenuated). Risk X: Avoid
Zuranolone: May increase CNS depressant effects of CNS Depressants. Management: Consider alternatives to the use of zuranolone with other CNS depressants or alcohol. If combined, consider a zuranolone dose reduction and monitor patients closely for increased CNS depressant effects. Risk D: Consider Therapy Modification
[US Boxed Warning]: In females of reproductive potential, obtain two negative pregnancy tests before starting pomalidomide treatment. Females of reproductive potential must use two forms of contraception or continuously abstain from heterosexual sex during and for 4 weeks after stopping pomalidomide. Women of childbearing potential should be treated only if they are able to comply with the conditions of the Pomalyst REMS Program. Pregnancy must be avoided for ≥4 weeks prior to beginning therapy. Contraception should be used in females of reproductive potential during treatment, during treatment interruptions, and for ≥4 weeks after pomalidomide is discontinued. Two forms of effective/reliable contraception or total abstinence from heterosexual intercourse must be used by women of reproductive potential even with a history of infertility (unless due to hysterectomy). Reliable methods of birth control include one highly effective method (eg, tubal ligation, IUD, hormonal [birth control pills, injections, hormonal patches, vaginal rings, or implants], or partner's vasectomy) and one additional effective method (eg, male latex or synthetic condom, diaphragm, or cervical cap). Pregnancy tests should be performed 10 to 14 days and 24 hours prior to beginning therapy; weekly for the first 4 weeks and then every 4 weeks (every 2 weeks if menstrual cycle irregular) thereafter and during therapy interruptions for at least 4 weeks after discontinuation. Pomalidomide must be immediately discontinued for a missed period, abnormal pregnancy test, or abnormal menstrual bleeding; refer patient to a reproductive toxicity specialist if pregnancy occurs during treatment.
Pomalidomide is present in the semen of males taking this medication. Males (including those vasectomized) should use a latex or synthetic condom during any sexual contact with women of childbearing age during treatment, during treatment interruptions, and for 4 weeks after discontinuation. Male patients should not donate sperm.
[US Boxed Warning]: Pomalidomide is contraindicated in pregnancy. Pomalidomide is a thalidomide analogue. Thalidomide is a known human teratogen that causes severe birth defects or embryo-fetal death. Anomalies observed in humans following exposure to thalidomide include amelia, phocomelia, bone defects, ear and eye abnormalities, facial palsy, congenital heart defects, urinary and genital tract malformations; mortality in ~40% of infants at or shortly after birth has also been reported. Discontinue immediately if a pregnancy occurs during pomalidomide therapy.
Data collection to monitor pregnancy and infant outcomes following exposure to pomalidomide is ongoing. Any suspected fetal exposure should be reported to the FDA via the MedWatch program (1-800-332-1088) and to REMS Call Center (1-888-423-5436).
It is not known if pomalidomide is present in breast milk. Due to the potential for serious adverse reactions in the breastfed infant, breastfeeding is not recommended by the manufacturer.
CBC with differential and platelets (weekly for the first 8 weeks [multiple myeloma] or every 2 weeks for the first 12 weeks [Kaposi sarcoma]) and then monthly or as clinically necessary thereafter; renal function (ie, serum creatinine, CrCl); LFTs (monthly). Monitor for signs/symptoms of thromboembolism, neuropathy, tumor lysis syndrome (in patients at risk), hypersensitivity, dermatologic reactions, and interstitial lung disease. Consider thyroid function tests (thyroid-stimulating hormone recommended at baseline and every 2 to 3 months during treatment for structurally similar medications [Hamnvik 2011]). Monitor adherence.
Females of reproductive potential: Pregnancy test 10 to 14 days and 24 hours prior to initiating therapy, weekly during the first month, then monthly thereafter in women with regular menstrual cycles or every 2 weeks in patients with irregular menstrual cycles. Pregnancy tests should be continued for at least 4 weeks after discontinuation.
The American Society of Clinical Oncology hepatitis B virus (HBV) screening and management provisional clinical opinion (ASCO [Hwang 2020]) recommends HBV screening with hepatitis B surface antigen, hepatitis B core antibody, total Ig or IgG, and antibody to hepatitis B surface antigen prior to beginning (or at the beginning of) systemic anticancer therapy; do not delay treatment for screening/results. Detection of chronic or past HBV infection requires a risk assessment to determine antiviral prophylaxis requirements, monitoring, and follow-up.
Pomalidomide induces cell cycle arrest and apoptosis directly in multiple myeloma cells. It enhances T cell- and natural killer (NK) cell-mediated cytotoxicity, inhibits production of proinflammatory cytokines tumor necrosis factor-α (TNF-α), IL-1, IL-6, and IL-12, and inhibits angiogenesis (Zhu 2013).
Absorption: Rapid; slowed by food.
Distribution: Vdss: 62 to 138 L; semen distribution is ~67% of plasma levels (following 4 days of 2 mg/day dosing).
Protein binding: 12% to 44%.
Metabolism: Hepatic, primarily via CYP1A2 and CYP3A4; CYP2C19 and CYP2D6 (minor).
Half-life elimination: ~7.5 hours.
Time to peak: 2 to 3 hours.
Excretion: Urine (73%; 2% as unchanged drug); feces (15%; 8% as unchanged drug); Clearance: 7 to 10 L/hour.
Altered kidney function: Mean systemic pomalidomide exposure was increased by 38% in patients with severe renal impairment requiring dialysis (creatinine clearance [CrCl] <30 mL/minute requiring dialysis) and 40% in patients with end-stage renal disease (ESRD) (CrCl <15 mL/minute) on non-dialysis days.
Hepatic function impairment: Mean systemic pomalidomide exposure was increased by 51%, 58%, and 72% in patients with mild, moderate, or severe hepatic impairment (Child-Pugh class A, B, or C).