Drug Interaction Report

MONITOR CLOSELY: Concomitant treatment with agents that can cause thrombosis such as erythropoiesis- or thrombopoiesis-stimulating agents, estrogens, selective estrogen receptor modulators, or C1 esterase inhibitors may potentiate the risk of venous thromboembolic events associated with the use of pomalidomide. Deep venous thrombosis (DVT) and pulmonary embolism (PE) occur in patients with multiple myeloma treated with pomalidomide. All patients in the premarketing clinical trial were required to receive prophylactic antithrombotic treatment (81% aspirin, 16% warfarin, 21% heparin, 3% clopidogrel). The rate of DVT or PE was 3%.

MANAGEMENT: Agents that are known to cause thrombosis should be used with caution in multiple myeloma patients receiving pomalidomide. Prophylactic antithrombotic measures should be considered after assessing underlying risk factors such as health history and concomitant medications. Patients should be advised to seek medical attention if they develop potential signs and symptoms of thromboembolism such as chest pain; shortness of breath; rapid pulse; pain, swelling, and/or discoloration in an arm or leg; and numbness or weakness on one side of the body.

MONITOR: Cigarette smoking may reduce pomalidomide exposure due to induction of CYP450 1A2, the isoenzyme that is responsible for the metabolic clearance of pomalidomide along with CYP450 3A4.

MANAGEMENT: Patients should be advised that smoking may reduce the efficacy of pomalidomide therapy. Pomalidomide should be taken on an empty stomach, at least 2 hours before or 2 hours after a meal.