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Lenalidomide Side Effects

In Summary

Commonly reported side effects of lenalidomide include: pneumonia, upper respiratory tract infection, urinary tract infection, neutropenia, thrombocytopenia, abdominal pain, anemia, arthralgia, asthenia, back pain, constipation, cough, diarrhea, dizziness, dyspnea, dyspnea on exertion, edema, epistaxis, fatigue, headache, hypokalemia, insomnia, limb pain, muscle cramps, nasopharyngitis, nausea, peripheral edema, pharyngitis, pruritus, skin rash, vomiting, anorexia, and xeroderma. Other side effects include: febrile neutropenia, cellulitis, chest pain, depression, dysuria, hypertension, hypoesthesia, hypomagnesemia, hypothyroidism, increased serum alanine aminotransferase, leukopenia, loose stools, myalgia, night sweats, pain, palpitations, peripheral neuropathy, rhinitis, upper abdominal pain, bruise, diaphoresis, dysgeusia, ecchymoses, erythema, and xerostomia. See below for a comprehensive list of adverse effects.

For the Consumer

Applies to lenalidomide: oral capsule

In addition to its needed effects, some unwanted effects may be caused by lenalidomide. In the event that any of these side effects do occur, they may require medical attention.

Major Side Effects

You should check with your doctor immediately if any of these side effects occur when taking lenalidomide:

More common:
  • Black, tarry stools
  • bleeding gums
  • blood in the urine or stools
  • chest pain
  • chills
  • convulsions
  • cough
  • decreased urine
  • difficult or labored breathing
  • dry mouth
  • fever
  • increased thirst
  • irregular heartbeat
  • loss of appetite
  • lower back or side pain
  • mood changes
  • muscle pain or cramps
  • nausea or vomiting
  • numbness or tingling in the hands, feet, or lips
  • painful or difficult urination
  • pale skin
  • pinpoint red spots on the skin
  • sore throat
  • sores, ulcers, or white spots on the lips or in the mouth
  • swollen glands
  • tightness in the chest
  • unusual bleeding or bruising
  • unusual tiredness or weakness
Less common:
  • Chest discomfort
  • confusion
  • difficulty with speaking
  • double vision
  • headache
  • inability to move the arms, legs, or facial muscles
  • inability to speak
  • pain or discomfort in the arms, jaw, back or neck
  • slow speech
  • sweating
Incidence not known:
  • Anxiety
  • blistering, peeling, or loosening of the skin
  • clay-colored stools
  • dark-colored urine
  • depressed mood
  • diarrhea
  • difficulty having a bowel movement (stool)
  • dizziness or lightheadedness
  • dry skin and hair
  • fainting
  • fast heartbeat
  • feeling cold
  • general feeling of tiredness or weakness
  • hair loss
  • hoarseness or husky voice
  • itching or rash
  • joint pain, stiffness, or swelling
  • large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
  • muscle cramps and stiffness
  • pain, redness, or swelling in the arm or leg
  • red skin lesions, often with a purple center
  • red, irritated eyes
  • sensitivity to heat
  • slowed heartbeat
  • stomach pain, continuing
  • sudden shortness of breath or troubled breathing
  • swelling of the feet or lower legs
  • trouble sleeping
  • unpleasant breath odor
  • vomiting of blood
  • weight gain or loss
  • yellow eyes or skin

Minor Side Effects

Some of the side effects that can occur with lenalidomide may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:

More common:
  • Abnormal or decreased touch sensation
  • bloody nose
  • blurred vision
  • body aches or pain
  • bruising
  • burning while urinating
  • burning, numbness, tingling, or painful sensations
  • change in taste
  • cough-producing mucus
  • difficulty with moving
  • drowsiness or tiredness
  • ear congestion
  • fast, slow, irregular, pounding, or racing heartbeat or pulse
  • flushing or redness of the skin
  • increased sweating or night sweats
  • irritability
  • itching, pain, redness, swelling, tenderness, or warmth on the skin
  • lack or loss of strength
  • large, flat, blue or purplish patches in the skin
  • loose stools
  • loss of interest or pleasure
  • muscle spasms, stiffness, or twitching
  • pain or tenderness around the eyes and cheekbones
  • seizures
  • shivering
  • tender, swollen glands in the neck
  • trembling
  • trouble concentrating
  • trouble swallowing
  • unsteadiness or awkwardness
  • upper abdomen or stomach pain
  • voice changes
  • weakness in the arms, hands, legs, or feet

For Healthcare Professionals

Applies to lenalidomide: oral capsule


Hematologic side effects including thrombocytopenia (61.5%), neutropenia (58.8%), anemia (11.5%), leukopenia (8.1%), febrile neutropenia (5.4%), warm type hemolytic anemia, splenic infarction, bone marrow depression, coagulopathy, hemolysis, hemolytic anemia, pancytopenia, aggravated anemia, decreased hemoglobin, and refractory anemia have been reported.[Ref]

Thrombotic or thromboembolic events, including deep vein thrombosis, pulmonary embolism, thrombosis, and intracranial venous sinus thrombosis were reported more frequently in patients treated with the lenalidomide/dexamethasone combination. The number of patients experiencing a thrombotic event in the combination arm were 43/346 (12%) compared with those in the placebo/dexamethasone arm 14/345 (4%).[Ref]


Gastrointestinal side effects including diarrhea (48.6%), constipation (23.6%), nausea (23.6%), abdominal pain (12.2%), vomiting (10.1%), upper abdominal pain (8.1%), dry mouth (6.8%), loose stools (6.1%), gastrointestinal hemorrhage, ischemic colitis, intestinal perforation, rectal hemorrhage, colonic polyp, diverticulitis, dysphagia, gastritis, gastroenteritis, gastroesophageal reflux disease, obstructive inguinal hernia, irritable bowel syndrome, melena, pancreatitis (due to biliary obstruction), pancreatitis (not otherwise specified), perirectal abscess, pseudomembranous colitis, peptic ulcer hemorrhage, oral infection, small intestinal obstruction, and upper gastrointestinal hemorrhage have been reported.[Ref]


Rashes have been characterized as morbilliform, urticarial, dermatitic, acneform, and undefined.[Ref]

Dermatologic side effects including pruritus (41.9%), rash (35.8%), dry skin (14.2%), contusion (8.1%), night sweats (8.1%), increased sweating (6.8%), ecchymosis (5.4%), erythema (5.4%), skin desquamation, erythema multiforme, and acute febrile neutrophilic dermatosis have been reported. Twelve reports of Stevens-Johnson syndrome and one report of toxic epidermal necrolysis have also been reported.[Ref]


General side effects including fatigue (31.1%), pyrexia (20.9%), peripheral edema (20.3%), asthenia (14.9%), edema (10.1%), pain (6.8%), rigors (6.1%), chest pain (5.4%), disease progression, fall, abnormal gait, intermittent pyrexia, nodule, rigors, and sudden death have been reported.[Ref]


Respiratory side effects including nasopharyngitis (23.0%), cough (19.6%), dyspnea (16.9%), pharyngitis (15.5%), epistaxis (14.9%), upper respiratory tract infections (14,9%), pneumonia (11.5%), sinusitis (8.1%), exertional dyspnea (6.8%), rhinitis (6.8%), bronchitis (6.1%), acute sinusitis, exacerbated chronic obstructive airways disease, respiratory failure, exacerbated dyspnea, interstitial lung disease, lobar pneumonia, lung infiltration, wheezing, bronchopneumopathy, hypoxia, and sinusitis have been reported.[Ref]


Musculoskeletal side effects including arthralgia (21.6%), back pain (20.9%), muscle cramps (18.2%), limb pain (10.8%), myalgia (8.8%), peripheral swelling (8.1%), femur fracture, femoral neck fracture, fractured pelvis, hip fracture, rib fracture, arthritis, aggravated arthritis, gouty arthritis, neck pain, cervical vertebral fracture, chondrocalcinosis pyrophosphate, steroid myopathy, myopathy, and spinal compression fracture have been reported.[Ref]

Nervous system

Nervous system side effects including dizziness (19.6%), headache (19.6%), hypoesthesia (6.8%), dysgeusia (6.1%), peripheral neuropathy (5.4%), cerebrovascular accident, aphasia, cerebellar infarction, depressed level of consciousness, dysarthria, migraine, spinal cord compression, subarachnoid hemorrhage, transient ischemic attack, dizziness, memory impairment, brain edema, cerebral infarction, cerebral ischemia, cerebrovascular accident, encephalitis, intracranial hemorrhage, intracranial venous sinus thrombosis, leukoencephalopathy, somnolence, and tremor have been reported.[Ref]


Renal side effects have included urinary tract infection (10.8%), dysuria (6.8%), increased blood creatinine, renal failure, hematuria, acute renal failure, azotemia, ureteric calculus, renal mass, Fanconi syndrome, renal tubular necrosis, urinary retention, and kidney infection.[Ref]


Metabolic side effects including hypokalemia (10.8%), hypomagnesemia (6.1%), dehydration, gout, hypernatremia, diabetes mellitus, diabetes with hyperosmolarity, diabetic ketoacidosis, and hypoglycemia have been reported.[Ref]


Other side effects have included anorexia (10.1%), cellulitis (5.4%), vertigo, infection, bacteremia, central line infection, clostridial infection, ear infection, Enterobacter sepsis, fungal infection, herpes viral infection, influenza, Klebsiella sepsis, localized infection, Pseudomonas infection, septic shock, Staphylococcal infection, urosepsis, transfusion reaction, post procedural hemorrhage, pelvic pain, and road traffic accident.[Ref]


Psychiatric side effects including insomnia (10.1%), depression (5.4%), mental status changes, delirium, delusion, psychotic disorder, and confusional state have been reported.[Ref]


Hepatic side effects including increased alanine aminotransferase (8.1%), hyperbilirubinemia, acute cholecystitis, cholecystitis, toxic hepatitis, hepatic failure, intrahepatic cholestasis, and abnormal liver function tests have been reported. A case of severe hepatotoxicity has also been reported.[Ref]


Endocrine side effects have included acquired hypothyroidism (6.8%), adrenal insufficiency, and Basedow's disease.[Ref]


Cardiovascular side effects including hypertension (6.1%) palpitations (5.4%), congestive cardiac failure, atrial fibrillation, angina pectoris, cardiac arrest, thromboembolism, cardiac failure (not otherwise specified), cardiorespiratory arrest, atrial flutter, cardiomyopathy, myocardial infarction, myocardial ischemia, aggravated atrial fibrillation, bradycardia, cardiogenic shock, pulmonary edema, supraventricular arrhythmia, tachyarrhythmia, ventricular dysfunction, increased troponin I, deep vein thrombosis, hypotension, aortic disorder, ischemia, superficial thrombophlebitis, and thrombosis have been reported.[Ref]

One study has reported that treatment of multiple myeloma with lenalidomide and high-dose dexamethasone is associated with an increased risk of venous thrombosis and that concomitant administration of erythropoietic agents may further increase the risk of thrombosis.[Ref]


Hypersensitivity side effects have included hypersensitivity (not otherwise specified).[Ref]


Oncologic side effects including acute leukemia, acute myeloid leukemia, bronchoalveolar carcinoma, lung cancer metastatic, lymphoma, and metastatic prostate cancer have been reported.[Ref]


Ocular side effects including blindness have been reported.[Ref]


1. "Product Information. Revlimid (lenalidomide)." Celgene Corporation, Summit, NJ.

2. Sviggum HP, Davis MD, Rajkumar SV, Dispenzieri A "Dermatologic adverse effects of lenalidomide therapy for amyloidosis and multiple myeloma." Arch Dermatol 142 (2006): 1298-302

3. Castaneda CP, Brandenburg NA, Bwire R, Burton GH, Zeldis JB "Erythema Multiforme/Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis in Lenalidomide-Treated Patients." J Clin Oncol (2008):

4. Hussain S, Browne R, Chen J, Parekh S "Lenalidomide-induced severe hepatotoxicity." Blood 110 (2007): 3814

5. Jena RK, Swain TR, Kansurkar SS, Swain M "Lenalidomide induced intrahepatic cholestasis in newly diagnosed patients of multiple myeloma." Eur J Clin Pharmacol (2011):

6. Bennett CL, Angelotta C, Yarnold PR, et al. "Thalidomide- and lenalidomide-associated thromboembolism among patients with cancer." JAMA 296 (2006): 2558-60

7. Knight R, DeLap RJ, Zeldis JB "Lenalidomide and venous thrombosis in multiple myeloma." N Engl J Med 354 (2006): 2079-80

Not all side effects for lenalidomide may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.

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