• Thalidomide tragedy – A serious adverse effect:
    • In the 1960s, drug as a sedative & anti-emetic drug for morning sickness.
    • Banned due to teratogenic effects (phocomelia).
    • Re-introduced & marketed recently for anticancer drug in multiple myeloma & melanoma.
    • Due to its anti-cancer properties, immunomodulatory & anti-angiogenic characteristics.
  • Two enantiomers of thalidomide (R & S) are present.
    • Both are inter-convertible within body.
    • Hence, racemic mixture is used.

Drug groups:

1. Immunomodulatory derivatives of thalidomide are called IMiDs.

  • Eg: Lenalidomide.
    • More potent & non-teratogenic derivative.
    • Approved as first-line therapy for multiple myeloma, combined with dexamethasone & bortezomib.
    • Approved recently for mantle cell lymphoma.
    • Also used for myelodysplastic syndrome.
  • Adverse effect: 
    • Can cause peripheral sensory neuropathy.

2. SelCIDs (Selective Cytokine Inhibitory Drugs):

  • Thalidomide analogs. 
  • Are phosphodiesterase-4 (PDE-4) inhibitors with potent anti-TNFα activity.
  • Eg: Pomalidomide – Newer thalidomide analog.
    • Has anti-angiogenic & immunomodulatory properties.
    • Indicated for treatment of relapsed & refractory multiple myeloma.
  • MOA: 
    • Directly inhibits both tumor cell & vascular compartments of myeloma cancers.
    • This dual activity of pomalidomide is more efficacious than thalidomide in vitro & in vivo.

Major actions:

  • Inhibition of angiogenesis
  • Inhibition of TNF- a
  • Increased IL-10 production
  • Reduces phagocytosis
  • Alteration of adhesion molecule expression
  • Enhance cell-mediated immunity via interactions with T- cells.


  • Multiple myelomas at initial diagnosis
  • In solid tumors like AIDS-related Kaposi’s sarcoma
  • Relapsed/refractory cases of multiple myeloma
  • Erythema nodosum leprosum – Provides dramatic relief; Daily dosage: 200-300 mg
  • DOC – For steroid-resistant cases
  • Skin manifestations of SLE
  • AIDS-related aphthous ulcers
  • AIDS-related wasting syndrome
  • Prevention of graft versus host disease (GVHD) after transplantation
  • Rheumatoid arthritis
  • Ankylosing spondylitis
  • Crohn’s disease
  • Behcet’s syndrome
  • In steroid-resistant type 2 lepra reaction.

Adverse effects:

  • Teratogenicity
  • Peripheral neuropathy
  • Sedation & constipation in cancer patients.
  • Rash
  • Hypothyroidism
  • Increased risk of DVT
  • Congenital abnormalities: 
    • Phocomelia (defect in development of long bones)
    • Polydactyly
    • Syndactyly
    • External ear defects (from agenesis to pre-auricular tags)
    • Mobius syndrome – 
      • Rare congenital condition of facial paralysis & inability to move laterally.
      • Resulting in IV & VII CN paralysis & abnormalities in gut musculature.

Exam Important


  • Thalidomide tragedy is a serious adverse effect happened in the 1960s, on using the drug as a sedative & anti-emetic drug for morning sickness.
  • Thalidomide was banned due to teratogenic effects (phocomelia).
  • Thalidomide has been re-introduced & marketed recently for anticancer drug in multiple myeloma & melanoma.
  • Though thalidomide has teratogenic effects, it also possesses anti-cancer properties, immunomodulatory & anti-angiogenic characteristics. 
  • Thalidomide acts by inhibiting angiogenesis.
  • Two enantiomers of thalidomide (R & S), are inter-convertible within body.
  • Thalidomide are indicated for multiple myelomas at initial diagnosis,its relapsed/refractory states, erythema nodosum leprosum & skin manifestations of SLE.
  • Thalidomide is used in steroid-resistant type-2 lepra reaction.
  • Daily dosage of thalidomide for controlling ENL is 200-300 mg.
  • Major adverse effects of thalidomide includes, teratogenicity, peripheral neuropathy, sedation & constipation in cancer patients.
  • Thalidomide causes congenital abnormalities particularly phocomelia (defect in development of long bones).
  • Immunomodulatory derivatives of thalidomide are called IMiDs.
  • Lenalidomide is an ImiD’s, which is more potent & non-teratogenic derivative.
  • Lenalidomide is approved as first-line therapy for multiple myeloma, combined with dexamethasone & bortezomib.
  • Lenalidomide is approved recently for mantle cell lymphoma.
  • Lenalidomide can cause peripheral sensory neuropathy.
  • Sel CID’s are Selective Cytokine Inhibitory Drugs.
  • Sel CID’s are thalidomide analogs.
  • Sel CID’s are phosphodiesterase-4 (PDE-4) inhibitors with potent anti-TNFα activity.
  • Pomalidomide is a SelCIDs (Selective Cytokine Inhibitory Drugs).
  • Pomalidomide is used for treatment of relapsed & refractory multiple myeloma.
  • Pomalidomide acts by directly inhibiting both tumor cell & vascular compartments of myeloma cancers.
  • Pomalidomide is more efficacious than thalidomide.


Don’t Forget to Solve all the previous Year Question asked on THALIDOMIDE

Module Below Start Quiz

This site uses Akismet to reduce spam. Learn how your comment data is processed.

%d bloggers like this:
Malcare WordPress Security