HIGHLIGHTS OF PRESCRIBING INFORMATION
These highlights do not include all the information needed to use
REVLIMID
®
safely and effectively. See full prescribing information for
REVLIMID.
REVLIMID (lenalidomide) capsules, for oral use
Initial U.S. Approval: 2005
WARNING: EMBRYO-FETAL TOXICITY, HEMATOLOGIC
TOXICITY, and VENOUS and ARTERIAL
THROMBOEMBOLISM
See full prescribing information for complete boxed warning.
EMBRYO-FETAL TOXICITY
Lenalidomide, a thalidomide analogue, caused limb
abnormalities in a developmental monkey study similar to birth
defects caused by thalidomide in humans. If lenalidomide is used
during pregnancy, it may cause birth defects or embryo-fetal
death.
Pregnancy must be excluded before start of treatment. Prevent
pregnancy during treatment by the use of two reliable methods
of contraception (5.1).
REVLIMID is available only through a restricted distribution
program, called the REVLIMID REMS
®
program (5.2, 17).
HEMATOLOGIC TOXICITY. REVLIMID can cause significant
neutropenia and thrombocytopenia (5.3).
VENOUS AND ARTERIAL THROMBOEMBOLISM
Significantly increased risk of deep vein thrombosis (DVT) and
pulmonary embolism (PE), as well as risk of myocardial
infarction and stroke in patients with multiple myeloma
receiving REVLIMID with dexamethasone. Anti-thrombotic
prophylaxis is recommended (5.4).
--------------------------RECENT MAJOR CHANGES----------------------------
Indications and Usage, Follicular Lymphoma (1.4) 5/19
Indications and Usage, Marginal Zone Lymphoma (1.5) 5/19
Dosage and Administration (2.4, 2.5) 5/19
---------------------------INDICATIONS AND USAGE----------------------------
REVLIMID is a thalidomide analogue indicated for the treatment of adult
patients with:
Multiple myeloma (MM), in combination with dexamethasone (1.1).
MM, as maintenance following autologous hematopoietic stem cell
transplantation (auto-HSCT) (1.1).
Transfusion-dependent anemia due to low- or intermediate-1-risk
myelodysplastic syndromes (MDS) associated with a deletion 5q
abnormality with or without additional cytogenetic abnormalities (1.2).
Mantle cell lymphoma (MCL) whose disease has relapsed or progressed
after two prior therapies, one of which included bortezomib (1.3).
Previously treated follicular lymphoma (FL), in combination with a
rituximab product (1.4).
Previously treated marginal zone lymphoma (MZL), in combination
with a rituximab product (1.5).
Limitations of Use:
REVLIMID is not indicated and is not recommended for the treatment
of patients with chronic lymphocytic leukemia (CLL) outside of
controlled clinical trials (1.4).
-----------------------DOSAGE AND ADMINISTRATION-----------------------
MM combination therapy: 25 mg once daily orally on Days 1-21 of
repeated 28-day cycles. (2.1).
MM maintenance therapy following auto-HSCT: 10 mg once daily
continuously on Days 1-28 of repeated 28-day cycles (2.1).
MDS: 10 mg once daily (2.2).
MCL: 25 mg once daily orally on Days 1-21 of repeated 28-day cycles
(2.3).
FL or MZL: 20 mg once daily orally on Days 1-21 of repeated 28-day
cycles for up to 12 cycles (2.4).
Renal impairment: Adjust starting dose based on the creatinine
clearance value (2.5).
For concomitant therapy doses, see Full Prescribing Information (2.1,
2.4, 14.1, 14.4).
----------------------DOSAGE FORMS AND STRENGTHS---------------------
Capsules: 2.5 mg, 5 mg, 10 mg, 15 mg, 20 mg, and 25 mg (3).
-------------------------------CONTRAINDICATIONS------------------------------
Pregnancy (Boxed Warning, 4.1, 5.1, 8.1).
Demonstrated severe hypersensitivity to lenalidomide (4.2, 5.9).
-----------------------WARNINGS AND PRECAUTIONS-----------------------
Increased mortality: serious and fatal cardiac adverse reactions occurred
in patients with CLL treated with REVLIMID (5.5).
Second Primary Malignancies (SPM): Higher incidences of SPM were
observed in controlled trials of patients with MM receiving REVLIMID
(5.6).
Increased Mortality: Observed in patients with MM when
pembrolizumab was added to dexamethasone and a thalidomide
analogue (5.7).
Hepatotoxicity: Hepatic failure including fatalities; monitor liver
function. Stop REVLIMID and evaluate if hepatotoxicity is suspected
(5.8).
Cutaneous Reactions, including fatalities: Hypersensitivity, angioedema,
Stevens-Johnson syndrome, toxic epidermal necrolysis, drug reaction
with eosinophilia and systemic symptoms; discontinue REVLIMID if
reactions are suspected. Do not resume REVLIMID if these reactions are
verified (5.9).
Tumor lysis syndrome (TLS) including fatalities: Monitor patients at
risk of TLS (i.e., those with high tumor burden) and take appropriate
precautions (5.10).
Tumor flare reaction: Serious tumor flare reactions have occurred
during investigational use of REVLIMID for chronic lymphocytic
leukemia and lymphoma (5.11).
Impaired Stem Cell mobilization: A decrease in the number of CD34+
cells collected after treatment (> 4 cycles) with REVLIMID has been
reported. Consider early referral to transplant center (5.12).
Early mortality in MCL: Higher rate of early deaths have occurred in
patients with MCL (5.14).
-------------------------------ADVERSE REACTIONS------------------------------
MM: Most common adverse reactions (≥20%) include diarrhea, fatigue,
anemia, constipation, neutropenia, leukopenia, peripheral edema,
insomnia, muscle cramp/spasms, abdominal pain, back pain, nausea,
asthenia, pyrexia, upper respiratory tract infection, bronchitis,
nasopharyngitis, gastroenteritis, cough, rash, dyspnea, dizziness,
decreased appetite, thrombocytopenia, and tremor (6.1).
MDS: Most common adverse reactions (>15%) include
thrombocytopenia, neutropenia, diarrhea, pruritus, rash, fatigue,
constipation, nausea, nasopharyngitis, arthralgia, pyrexia, back pain,
peripheral edema, cough, dizziness, headache, muscle cramp, dyspnea,
pharyngitis, and epistaxis (6.1).
Non-Hodgkin’s Lymphoma (NHL: MCL, FL or MZL): Most common
adverse reactions (≥
15%) included neutropenia, thrombocytopenia,
anemia, leukopenia, diarrhea, constipation, nausea, fatigue, pyrexia,
cough, upper respiratory tract infection, and rash (6.1).
To report SUSPECTED ADVERSE REACTIONS contact Celgene
Corporation at 1-888-423-5436 or FDA at 1-800-FDA-1088 or
www.fda.gov/medwatch.
-------------------------------DRUG INTERACTIONS------------------------------
Digoxin: Monitor digoxin plasma levels periodically due to increased
C
max
and AUC with concomitant REVLIMID therapy (7.1).
Concomitant use of erythropoietin stimulating agents or estrogen
containing therapies with REVLIMID may increase the risk of
thrombosis (7.2).
--------------------------USE IN SPECIFIC POPULATIONS---------------------
Lactation: Advise not to breastfeed (8.2).
See 17 for PATIENT COUNSELING INFORMATION and Medication
Guide
Revised: 5/2019
Reference ID: 4439576