Revlimid Dosage
Generic name: lenalidomide
Dosage form: capsule
This dosage information does not include all the information needed to use Revlimid safely and effectively. See full prescribing information for Revlimid.
The information at Drugs.com is not a substitute for medical advice. ALWAYS consult your doctor or pharmacist.
​REVLIMIDshould be taken orally at about the same time each day, either with or without food. REVLIMID capsules should be swallowed whole with water. The capsules should not be opened, broken, or chewed.
Multiple Myeloma
​The recommended starting dose of REVLIMID is 25 mg once daily on Days 1-21 of repeated 28-day cycles. The recommended dose of dexamethasone is 40 mg once daily on Days 1-4, 9-12, and 17-20 of each 28-day cycle for the first 4 cycles of therapy and then 40 mg once daily orally on Days 1-4 every 28 days. Treatment is continued or modified based upon clinical and laboratory findings.
Dose Adjustments for Hematologic Toxicities During Multiple Myeloma Treatment
Dose modification guidelines, as summarized below, are recommended to manage Grade 3 or 4 neutropenia or thrombocytopenia or other Grade 3 or 4 toxicity judged to be related to lenalidomide.
Platelet counts
Thrombocytopenia in MM
| When Platelets | Recommended Course |
|---|---|
| Fall to <30,000/mcL | Interrupt REVLIMID treatment, follow CBC weekly |
| Return to ≥30,000/mcL | Restart REVLIMID at 15 mg daily |
| For each subsequent drop <30,000/mcL | Interrupt REVLIMID treatment |
| Return to ≥30,000/mcL | Resume REVLIMID at 5 mg less than the previous dose. Do not dose below 5 mg daily |
Absolute Neutrophil counts (ANC)
Neutropenia in MM
| When Neutrophils | Recommended Course |
|---|---|
| Fall to <1000/mcL | Interrupt REVLIMID treatment, add G-CSF, follow CBC weekly |
| Return to ≥1,000/mcL and neutropenia is the only toxicity | Resume REVLIMID at 25 mg daily |
| Return to ≥1,000/mcL and if other toxicity | Resume REVLIMID at 15 mg daily |
| For each subsequent drop <1,000/mcL | Interrupt REVLIMID treatment |
| Return to ≥1,000/mcL | Resume REVLIMID at 5 mg less than the previous dose. Do not dose below 5 mg daily |
Other Grade 3 / 4 Toxicities in MM
For other Grade 3/4 toxicities judged to be related to REVLIMID, hold treatment and restart at next lower dose level when toxicity has resolved to ≤ Grade 2.
Starting Dose Adjustment for Renal Impairment in MM
Since REVLIMID is primarily excreted unchanged by the kidney, adjustments to the starting dose of REVLIMID are recommended to provide appropriate drug exposure in patients with moderate or severe renal impairment and in patients on dialysis. Based on a pharmacokinetic study in patients with renal impairment due to nonmalignant conditions, REVLIMID starting dose adjustment is recommended for patients with CLcr < 60 mL/min. Non-dialysis patients with creatinine clearances less than 11 mL/min and dialysis patients with creatinine clearances less than 7 mL/min have not been studied. The recommendations for initial starting doses for patients with multiple myeloma (MM) are as follows:
| Category | Renal Function (Cockcroft-Gault) |
Dose |
|---|---|---|
| Moderate Renal Impairment |
CLcr 30-60 mL/min | 10 mg Every 24 hours |
| Severe Renal Impairment |
CLcr < 30 mL/min (not requiring dialysis) |
15 mg Every 48 hours |
| End Stage Renal Disease |
CLcr < 30 mL/min (requiring dialysis) |
5 mg Once daily. On dialysis days, administer the dose following dialysis. |
After initiation of REVLIMID therapy, subsequent REVLIMID dose modification should be based on individual patient treatment tolerance, as described elsewhere in this section.
Myelodysplastic Syndromes
​The recommended starting dose of REVLIMID is 10 mg daily. Treatment is continued or modified based upon clinical and laboratory findings.
Dose Adjustments for Hematologic Toxicities During MDS Treatment
Patients who are dosed initially at 10 mg and who experience thrombocytopenia should have their dosage adjusted as follows:
Platelet counts
If thrombocytopenia develops WITHIN 4 weeks of starting treatment at 10 mg daily in MDS
| If baseline ≥100,000/mcL | |
|---|---|
| When Platelets | Recommended Course |
| Fall to <50,000/mcL | Interrupt REVLIMID treatment |
| Return to ≥50,000/mcL | Resume REVLIMID at 5 mg daily |
| If baseline <100,000/mcL | |
| When Platelets | Recommended Course |
| Fall to 50% of the baseline value | Interrupt REVLIMID treatment |
| If baseline ≥60,000/mcL and returns to ≥50,000/mcL |
Resume REVLIMID at 5 mg daily |
| If baseline <60,000/mcL and returns to ≥30,000/mcL |
Resume REVLIMID at 5 mg daily |
If thrombocytopenia develops AFTER 4 weeks of starting treatment at 10 mg daily in MDS
| When Platelets | Recommended Course |
|---|---|
| <30,000/mcL or <50,000/mcL with platelet transfusions |
Interrupt REVLIMID treatment |
| Return to ≥30,000/mcL (without hemostatic failure) |
Resume REVLIMID at 5 mg daily |
Patients who experience thrombocytopenia at 5 mg daily should have their dosage adjusted as follows:
If thrombocytopenia develops during treatment at 5 mg daily in MDS
| When Platelets | Recommended Course |
|---|---|
| <30,000/mcL or <50,000/mcL with platelet transfusions |
Interrupt REVLIMID treatment |
| Return to ≥30,000/mcL (without hemostatic failure) |
Resume REVLIMID at 2.5 mg every other day |
Patients who are dosed initially at 10 mg and experience neutropenia should have their dosage adjusted as follows:
Absolute Neutrophil counts (ANC)
If neutropenia develops WITHIN 4 weeks of starting treatment at 10 mg daily in MDS
| If baseline ANC ≥1,000/mcL | |
|---|---|
| When Neutrophils | Recommended Course |
| Fall to <750/mcL | Interrupt REVLIMID treatment |
| Return to ≥1,000/mcL | Resume REVLIMID at 5 mg daily |
| If baseline ANC <1,000/mcL | |
| When Neutrophils | Recommended Course |
| Fall to <500/mcL | Interrupt REVLIMID treatment |
| Return to ≥500/mcL | Resume REVLIMID at 5 mg daily |
If neutropenia develops AFTER 4 weeks of starting treatment at 10 mg daily in MDS
| When Neutrophils | Recommended Course |
|---|---|
| <500/mcL for ≥7 days or <500/mcL associated with fever (≥38.5°C) |
Interrupt REVLIMID treatment |
| Return to ≥500/mcL | Resume REVLIMID at 5 mg daily |
Patients who experience neutropenia at 5 mg daily should have their dosage adjusted as follows:
If neutropenia develops during treatment at 5 mg daily in MDS
| When Neutrophils | Recommended Course |
|---|---|
| <500/mcL for ≥7 days or <500/mcL associated with fever (≥38.5°C) |
Interrupt REVLIMID treatment |
| Return to ≥500/mcL | Resume REVLIMID at 2.5 mg every other day |
Other Grade 3 / 4 Toxicities in MDS
For other Grade 3/4 toxicities judged to be related to REVLIMID, hold treatment and restart at next lower dose level when toxicity has resolved to ≤ Grade 2.
Starting Dose Adjustment for Renal Impairment in MDS:
Since REVLIMID is primarily excreted unchanged by the kidney, adjustments to the starting dose of REVLIMID are recommended to provide appropriate drug exposure in patients with moderate or severe renal impairment and in patients on dialysis. Based on a pharmacokinetic study in patients with renal impairment due to nonmalignant conditions, REVLIMID starting dose adjustment is recommended for patients with CLcr < 60 mL/min. Non-dialysis patients with creatinine clearances less than 11 mL/min and dialysis patients with creatinine clearances less than 7 mL/min have not been studied. The recommendations for initial starting doses for patients with myelodysplastic syndromes (MDS) are as follows:
| Category | Renal Function (Cockcroft-Gault) |
Dose |
|---|---|---|
| Moderate Renal Impairment |
CLcr 30-60 mL/min | 5 mg Every 24 hours |
| Severe Renal Impairment |
CLcr < 30 mL/min (not requiring dialysis) | 2.5 mg Every 24 hours |
| End Stage Renal Disease |
CLcr < 30 mL/min (requiring dialysis) | 2.5 mg once daily. On dialysis days, administer the dose following dialysis. |
After initiation of REVLIMID therapy, subsequent REVLIMID dose modification should be based on individual patient treatment tolerance, as described elsewhere in this section.
