Adalimumab
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Drug reference
Thalidomide
Immunosuppressant · Treatment of Leprosy Reactions
ImmunosuppressantTreatment of Leprosy Reactions
CDSCO approvedSchedule H
EXCRETION
—
not curated
INTERACTIONS
12 major
SEVERE in our sources
PREGNANCY
Teratogenic; contraindicated in pregnancy
FDA category + note
Top interactionssee all 12 →
- AdalimumabSevereDatabaseDDInter
- AldesleukinSevereDatabaseDDInter
- AltretamineSevereDatabaseDDInter
- AnastrozoleSevereDatabaseDDInter
Mechanism
Thalidomide inhibits TNF-α production from activated monocytes and has anti-angiogenic activity by inhibiting basic fibroblast growth factor (bFGF)-induced neovascularization. Its mechanism involves binding to cereblon (CRBN), a component of the E3 ubiquitin ligase complex, redirecting its substrate specificity to target transcription factors (IKZF1, IKZF3) for proteasomal degradation. Its notorious teratogenicity is now understood to involve cereblon-mediated degradation of the transcription factor SALL4, which is essential for limb development.
Indications
Severe type II reactions (erythema nodosum leprosum) in corticosteroid-dependent patientserythema nodosum leprosumnewly diagnosed MMheavily pretreated relapsed/refractory MMENL (erythema nodosum leprosum, as an alternative to prednisolone)multiple myelomavarious conditions where cytokines play an important roleCancer associated cachexiaErythema nodosum leprosum (ENL)
Dosing
- Adult
- programme. Increased doses of clofazimine are also useful. Paucibacillary leprosy should be treated with rifampicin and dapsone for 6 months. If treatment is interrupted the regimen should be recommenced where it was left off to complete the full course. Neither the multibacillary nor the paucibacillary antileprosy regimen is sufficient to treat tuberculosis.…
Pharmacokinetics
Half-life
about 6 h (enantiomers)
Bioavailability
slow absorption (oral), highly variable
Protein binding
without significant binding to plasma proteins
Metabolism
spontaneous hydrolysis in all body fluids (main elimination path for enantiomers); inactive hydrolysis products undergo CYP-mediated metabolism
Excretion
in the urine (thalidomide and metabolites), unchanged in feces (non-absorbed portion)
Contraindications
- Pregnancy
- Women of child-bearing potential unless they comply with a pregnancy prevention programme
- pregnancy (highly teratogenic)
Side effects
Common
sedationconstipationfatiguenumbness of toes and feetmuscle crampsweaknesssigns of pyramidal tract involvementcarpal tunnel syndrome
Serious
- Teratogenicity
- peripheral sensory neuropathy (10%–30% of patients, dose- and time-dependent)
- thromboembolic events (deep vein thrombosis, stroke, myocardial infarction)
- phocomelia (teratogenic)
- multiple defects of internal organs (teratogenic)
- highly teratogenic
- Teratogenic effect
Pregnancy & lactation
Pregnancy
Teratogenic; contraindicated in pregnancy
Drug interactions
Aldesleukin
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Altretamine
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Anastrozole
Severe
Database
Drug interaction classified as: synergy.
Source: DDInter
Asparaginase Erwinia Chrysanthemi
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Asparaginase Escherichia Coli
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Atezolizumab
Severe
Database
Drug interaction classified as: others
Source: DDInter
Avelumab
Severe
Database
Drug interaction classified as: others
Source: DDInter
Axitinib
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Azacitidine
Severe
Database
Drug interaction classified as: synergy.
Source: DDInter
Baricitinib
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Betamethasone
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Related guidelines
Other Immunosuppressant drugs
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Sources: KD Tripathi 7e, Goodman & Gilman 14e, BNF·Verified: 2026-05-13 · House clinical team