Thalidomide

What is thalidomide?

Thalidomide is a medicine that is used to treat multiple myeloma and other cancers. It also used to treat certain skin disorders and other conditions.

You may hear thalidomide called by its brand name, Thalomid. Thalidomide comes as a capsule.

Before giving thalidomide to your child

Tell your doctor if your child:

• has ever reacted badly to thalidomide or any other medicine
  
• may be sexually active or pregnant

Talk with your child's doctor or pharmacist if your child has any of the following conditions. Precautions may need to be taken with this medicine if your child has:

• epilepsy (seizures)
  
• low white blood cells
  
• ever had problems with tingling, burning, numbness or pain in the hands or feet

How should you give your child thalidomide?

• Before handling thalidomide capsules for your child, be sure to speak to the doctor or pharmacist if you could be pregnant or might become pregnant. You may need to take extra care when giving your child this medicine.
• Give thalidomide exactly as your doctor or pharmacist tells you to, even if your child seems better.
  
• Give thalidomide on an empty stomach, preferably at least 1 hour after the evening meal.
  
• Give the evening dose at bedtime, since thalidomide can cause sleepiness.
  
• It is best if your child can try to swallow the capsule whole. However, if your child cannot swallow capsules, the capsule can be opened and mixed with a soft food (such as pudding or applesauce) and given right after mixing.
  
• If your child throws up after taking thalidomide, do not give a second dose. Call your doctor or nurse during office hours for advice.

What should you do if your child misses a dose of thalidomide?

• Give the missed dose as soon as you remember.
  
• If it is almost time for the next dose, skip the missed dose. Give the next dose at the regular time.
  
• Do not give your child 2 doses to make up for 1 missed dose.
  What are the possible side effects of this medicine?

Your child may have some of these side effects while they take thalidomide. Check with your child's doctor if your child continues to have any of these side effects and they do not go away, or they bother your child:

• constipation
  
• diarrhea (loose, watery stools)
  
• dizziness
  
• drowsiness
  
• nausea (stomach upset) or mild stomach pain
  
• headache
  
• tremor (slight shaking movements)
  
• if diabetic, uncontrolled blood sugars

Call your child's doctor during office hours if your child has any of these side effects:

• skin rash or itching
  
• irritability or mood changes
  
• if your child may have become pregnant or had unprotected sex
  numbness, burning, tingling or pain in the hands, arms, feet or legs
  
• puffiness of the hands or feet

Most of the following side effects are not common, but they may be a sign of a serious problem. Call your child's doctor right away or take your child to Emergency if your child has any of these side effects:

• severe muscle weakness
  
• pain or swelling of the legs
  
• fever, chills, cough
  
• pain or burning when passing urine
  
• swelling of eyes, mouth, or face
  
• trouble breathing
  
• chest pain
  
• fast or uneven heartbeat
  
• sores on the skin, severe redness of the skin
  
• unusual bleeding or bruising

What safety measures should you take when your child is using thalidomide?

For girls of childbearing age

If your child is able to bear children, she must have a pregnancy test within 24 hours before starting thalidomide treatment and during treatment. This is routine.

Thalidomide should NEVER be used in PREGNANT women as it can result in a deformed fetus.

If your child is sexually active, she must use 2 effective birth control methods at the same time for at least 1 month before starting thalidomide treatment, during treatment, and for at least 4 weeks after taking thalidomide.

For boys

If your child is sexually active, he must always use a condom during sexual intercourse while taking thalidomide and for 4 weeks after he stops taking thalidomide.

For all children

Keep all appointments at the clinic or doctor's office so that the doctor can monitor for side effects that may be caused by thalidomide.

Thalidomide can lower the number of white blood cells in the blood temporarily, which increases your child's chances of getting an infection. Your child can take the following precautions to prevent infections, especially when the blood count is low:

• Avoid people with infections, such as a cold or the flu.
  
• Avoid places that are very crowded with large groups of people.
  
• Be careful when brushing or flossing your child's teeth. Your doctor, nurse or dentist may suggest different ways to clean your child's mouth and teeth.
  
• You and your child shouldn't touch your child's eyes or inside their nose without washing hands first.
  
• Your child's nurse will review with you what to do in case of fever.

Thalidomide may cause drowsiness or dizziness. Be sure your child is safe doing activities like climbing stairs. Do not give other medicines that cause drowsiness, such as antihistamines or pain relievers, without checking with your doctor.

While your child is taking thalidomide, they will be more sensitive to the sun. The skin will burn more easily than normal. To prevent sunburn, your child should wear sunscreen and protective clothing when outdoors.

Constipation is a common side effect of thalidomide. Have your child drink lots of fluid and encourage foods that are high in fibre (fresh fruits and vegetables, whole grains, bran, prunes) to try to avoid constipation. If there is a change in your child's pattern of bowel movements, speak to your child's doctor or pharmacist. A medicine (laxative) may be needed.

Check with your child's doctor or pharmacist before giving your child any other medicines (prescription, non-prescription, herbal, or natural products).

What other important information should you know about thalidomide?

• Keep a list of all medications your child is on to show the doctor or pharmacist.
• Do not share your child's medicine with others. Do not give anyone else's medicine to your child.
• Make sure you always have enough thalidomide to last through weekends, holidays, and vacations. Call your pharmacy at least 2 days before your child runs out of medicine to order refills.
• Thalidomide is not currently on the market in Canada, and supplies are obtained from out of the country. Please tell your child's doctor or pharmacist well in advance before your supply runs out to avoid any problems or interruption in treatment.
• Keep thalidomide at room temperature in a cool, dry place away from sunlight. Do NOT store it in the bathroom or kitchen.
• Do not keep any medicines that are out of date. Check with your pharmacist about the best way to throw away outdated or leftover medicines.
  

Keep thalidomide out of your child’s sight and reach and locked up in a safe place. If your child takes too much thalidomide, call your local Poison Information Centre at one of these numbers. These calls are free. 

• Call 1-844 POISON-X, or 1-844-764-7669, from anywhere in Canada except Quebec.
• Call 1-800-463-5060 if you live in Quebec.