Live Vaccines
Contraindicated
Database
Immunosuppression — disseminated infection
Avoid live vaccines
Source: Kimi deep-research + Cla
Drug reference
Lenalidomide
Immunomodulatory imide (thalidomide analogue) · Antineoplastic
Also known as Revlimid, CC-5013
START
Myeloma 25 mg PO daily days 1–21 q28d with dexamethasone; del(5q) MDS 10 mg daily
TYPICAL MAX
25 mg/day (renal/indication-adjusted)
STOP IF
Pregnancy, thromboembolism, severe cytopenia, SJS/TEN/DRESS
WATCH
CBC (weekly initially), thrombosis prophylaxis, pregnancy testing/REMS, renal function
CDSCO approvedSchedule HNPPA price-controlledATC L04AX04
KDIGO 2024 + manufacturer label
- ONSET
- 1h · absorption
- PEAK
- 1h · Cmax
- t½
- 3h · plasma t½
- DURATION
- 4w · 28-day cycle
EXCRETION
~90% renal (≈70% unchanged)
route + CYP
INTERACTIONS
12 major
incl. contraindicated
PREGNANCY
Contraindicated — potent human teratogen; REMS, two contraception methods, pregnancy testing
FDA category + note
Top interactionssee all 12 →
- Live VaccinesContraindicatedDatabaseKimi deep-research + Cla
- AdalimumabSevereDatabaseDDInter
- AtezolizumabSevereDatabaseDDInter
- AtorvastatinSevereDatabaseDDInter
Available in India
55 branded formulations. Look up specific brands in the Drugs workspace.
Mechanism
Binds cereblon (CRL4-CRBN E3 ligase), redirecting ubiquitination/degradation of Ikaros (IKZF1) and Aiolos (IKZF3) → direct anti-myeloma/anti-clonal effects, T/NK immune activation, anti-angiogenic and erythropoietic effects (del(5q) MDS).
Indications
Multiple myeloma (with dexamethasone; maintenance post-ASCT)Transfusion-dependent anaemia in del(5q) myelodysplastic syndromeMantle cell lymphoma; follicular/marginal-zone lymphoma (with rituximab)
Dosing
- Adult
- Multiple myeloma: 25 mg PO once daily days 1–21 of 28-day cycles (with dexamethasone). del(5q) MDS: 10 mg once daily. Adjust for cytopenias/renal function.
- Pediatric
- Not established.
- Renal adjustment
- CrCl 30–60: 10 mg daily; CrCl <30 (not dialysis): 15 mg every 48 h; dialysis: 5 mg daily after dialysis (myeloma starting points).
- Hepatic adjustment
- No specific adjustment (limited data); monitor.
- Geriatric
- More cytopenias/infection; monitor, adjust.
- Max dose
- 25 mg/day (myeloma); lower by indication/renal function
Pharmacokinetics
Onset
Cycle-based
Peak effect
~0.5–1.5 h (Cmax)
Duration
21/28-day cycle
Half-life
~3 h
Bioavailability
High oral absorption
Protein binding
~30%
Metabolism
Limited hepatic; mostly unchanged
Excretion
~90% renal (≈70% unchanged)
Contraindications
- Pregnancy (REMS — potent teratogen)
- Hypersensitivity to lenalidomide
Side effects
Common
Neutropenia, thrombocytopenia, anaemiaDiarrhoea/constipation, fatigueRash, muscle crampsPeripheral oedema
Serious
- Venous and arterial thromboembolism (DVT/PE/MI/stroke)
- Severe myelosuppression
- Second primary malignancies
- Severe cutaneous reactions (SJS/TEN/DRESS)
- Tumour lysis syndrome; hepatotoxicity
- Embryo-fetal death/severe birth defects
Pregnancy & lactation
Pregnancy
Contraindicated — potent human teratogen; REMS, two contraception methods, pregnancy testing
Lactation
Do not breastfeed during therapy
Drug interactions
Adalimumab
Severe
Database
Drug interaction classified as: synergy.
Source: DDInter
Atezolizumab
Severe
Database
Drug interaction classified as: others
Source: DDInter
Atorvastatin
Severe
Database
Drug interaction classified as: synergy.
Source: DDInter
Avelumab
Severe
Database
Drug interaction classified as: others
Source: DDInter
Baricitinib
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Cerivastatin
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Certolizumab
Severe
Database
Drug interaction classified as: synergy.
Source: DDInter
Cladribine
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Clozapine
Severe
Database
Drug interaction classified as: synergy.
Source: DDInter
Conestat Alfa
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Conjugated Estrogens
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Related guidelines
Iron deficiency anaemia in pregnancy
FOGSI · Obstetrics & Gynaecology · 2017
Blood transfusion in obstetrics and gynaecology
FOGSI · Obstetrics & Gynaecology · 2024
Iron deficiency anaemia in adults
ICMR · Hematology · 2023
Iron deficiency anaemia in pregnancy
ICMR · Obstetrics & Gynaecology · 2022
Empirical antimicrobial use in common syndromes
ICMR · Infectious Diseases · 2019
Ask House about Lenalidomide
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: Goodman & Gilman 14e, Harrison 22e, Katzung, BNF·Verified: 2026-05-19 · House clinical team·Cockpit curated: 2026-05-19