Side Effects of Revlimid: What You Need to Know

Introduction

If you have blood cancer, your doctor might suggest Revlimid (lenalidomide) as a treatment option.

Revlimid is a prescription drug that’s taken to treat certain types of the following blood cancers in adults:

• multiple myeloma
• myelodysplastic syndrome
• mantle cell lymphoma
• follicular lymphoma
• marginal zone lymphoma

Revlimid comes as a capsule that you swallow. It’s typically used as a long-term treatment. Your doctor might prescribe Revlimid along with another cancer treatment.

Keep reading to learn about Revlimid’s mild and serious side effects. For more information about Revlimid, including details about its uses, see this in-depth article on the drug.

What are the more common side effects of Revlimid?

Some people may develop mild or serious side effects during Revlimid treatment. Some side effects are more common than others. Which side effects are more common can vary depending on which condition you’re taking Revlimid for.

These are just a few of the more common side effects reported by people who took Revlimid in studies:

• diarrhea
• fatigue (low energy)
• decreased blood cell levels*†
• constipation†
• skin rash or itchiness

* Revlimid has a boxed warning for this side effect. This is the most serious warning from the Food and Drug Administration (FDA).
† To learn more about this side effect, see the “Side effects explained” section below.

What are the mild side effects of Revlimid?

It’s possible to have mild side effects of Revlimid treatment. Examples of mild side effects that have been reported include:

• diarrhea
• fatigue (low energy)
• mildly decreased blood cell levels
• constipation*
• skin rash or itchiness
• insomnia (trouble sleeping)
• edema (swelling due to excess fluid in your hands, legs, or feet)
• weakness and dizziness
• nausea or vomiting
• fever
• respiratory (airway and lung) infection, such as the common cold or bronchitis (inflammation of the tubes that carry air from your windpipe into your lungs)
• gastroenteritis (stomach flu)
• cough
• shortness of breath
• pain in your back or joints
• headache
• muscle cramps
• nose bleeds

* To learn more about this side effect, see the “Side effects explained” section below.

In most cases, these side effects should be temporary. And some may be easily managed, too. But if you have any symptoms that are ongoing or that bother you, talk with your doctor or pharmacist. And do not stop taking Revlimid unless your doctor recommends this.

Revlimid may cause mild side effects other than the ones listed above. See the Revlimid prescribing information for details.

Note: After the Food and Drug Administration (FDA) approves a drug, it tracks side effects of the medication. If you’d like to notify the FDA about a side effect you’ve had with Revlimid, visit MedWatch.

What are the serious side effects of Revlimid?

Serious side effects from Revlimid aren’t common, but can occur. Serious side effects can include:

• tumor lysis syndrome (a group of symptoms that occur due to the rapid breakdown of cancer cells)
• tumor flare reaction (worsening of cancerous tumors)
• arrhythmia (irregular heart rate) or other heart problems
• severe diarrhea
• certain types of cancer, such as skin cancer or acute myeloid leukemia
• stroke (decreased or blocked blood flow in part of the brain)
• severe skin reaction
• liver failure
• febrile neutropenia (a condition that causes fever and low levels of white blood cells called neutrophils)
• severely decreased blood cell levels*†
• dangerous blood clots*†
• eye problems†
• neuropathy (nerve damage)†
• allergic reaction†

If you develop serious side effects while taking Revlimid, call your doctor right away. If the side effects seem life threatening or if you think you’re having a medical emergency, immediately call 911 or your local emergency number.

* Revlimid has a boxed warning for this side effect. This is the most serious warning from the Food and Drug Administration (FDA).
† To learn more about this side effect, see the “Side effects explained” section below.

FAQs about Revlimid’s side effects

Get answers to some frequently asked questions about Revlimid’s side effects.

Can the stronger doses of Revlimid (10 mg, 15 mg, 20 mg, and 25 mg) increase my risk of side effects?

Yes, it’s possible that taking higher doses of Revlimid can make certain side effects more likely. These can include:

• thrombocytopenia (low levels of platelets), and
• neutropenia (low levels of neutrophils, a type of white blood cell)

If you develop these side effects while taking a higher dose, your doctor may have you stop treatment until the side effect eases. Then, they’ll likely restart your Revlimid treatment with a lower dose.

Where can I see pictures of skin rashes caused by Revlimid?

A skin rash and itchiness are common side effects of Revlimid. To see pictures of what this rash may look like, see this website. For more pictures, you can see this study of rashes that occurred in people who took Revlimid along with rituximab (Rituxan).

Does taking Revlimid lead to hair loss?

No, Revlimid isn’t known to cause hair loss. This side effect wasn’t seen in people who took the drug in studies.

But hair loss could be caused by other cancer treatments you may be taking. Talk with your doctor if you’re concerned about hair loss during Revlimid treatment.

Are certain side effects more likely when Revlimid is taken with dexamethasone to treat multiple myeloma?

Revlimid is taken with dexamethasone (DexPak) to treat multiple myeloma (MM) in most adults. Taking these drugs together may increase your risk of certain serious side effects, such as:

• severely decreased blood cell levels,* such as low levels of white blood cells or platelets
• liver failure
• blood clots that lead to heart attack or stroke* (decreased or blocked blood flow in part of the brain)

Revlimid can be prescribed by itself (without dexamethasone or other drugs) to treat MM in people who’ve had a type of stem cell transplant called auto-HSCT. This use of Revlimid is known as maintenance therapy. You can talk with your doctor to discuss if a stem cell transplant or Revlimid maintenance therapy could be options for you.

* Revlimid has a boxed warning for this side effect. This is the most serious warning from the Food and Drug Administration (FDA). To learn more about this side effect, see the “Side effects explained” section below.

Can stopping Revlimid cause withdrawal symptoms?

No, stopping Revlimid shouldn’t cause withdrawal symptoms. These are effects that can happen if you stop taking a drug your body has become dependent on.

Revlimid stays in your system for up to 4 weeks after stopping treatment. So it’s possible that you could still experience side effects of the drug after your last dose.

Stopping Revlimid may lead to your cancer progressing (getting worse). So you shouldn’t stop taking Revlimid without first discussing it with your doctor. They may suggest a different treatment plan for you.

Side effects explained

Learn more about some of the side effects Revlimid may cause.

Severely decreased blood cell levels

Revlimid has a boxed warning for severely decreased levels of certain blood cells. These include platelets and white blood cells. A boxed warning is the most serious warning from the Food and Drug Administration (FDA).

In studies of Revlimid, these blood disorders were very common. And in many cases, the disorders were severe.

Symptoms of a blood disorder depend on which type of blood cells are affected. Revlimid may cause thrombocytopenia (low levels of platelets, which are blood cells that help stop bleeding after an injury). It can also cause neutropenia (low levels of neutrophils, a type of white blood cell).

Thrombocytopenia can cause the following symptoms:

• excessive bruising
• bleeding more than usual after a minor cut or injury
• nose bleeds
• bleeding gums
• blood in your mucus, vomit, or stool
• heavy vaginal bleeding

Neutropenia itself doesn’t cause symptoms, but it raises your risk of getting infections. This is because white blood cells are part of your immune system. These cells fight germs that cause infections, such as bacteria and viruses. Without enough white blood cells, you may get infections more easily than usual.

Infection symptoms can vary, but generally include:

• fever
• chills
• body aches or other flu-like symptoms

What might help

Tell your doctor if you have possible symptoms of a blood disorder with Revlimid treatment. And tell them if you have infection symptoms or if you’re getting infections frequently.

While you’re taking Revlimid, your doctor will monitor your blood cell levels using a blood test called a complete blood count (CBC). They’ll likely check your CBC weekly or monthly during treatment.

If your blood cells become low, your doctor may have you temporarily stop taking Revlimid. Taking a break from treatment may be enough for your blood cell levels to return to normal on their own. Then when you restart treatment, your doctor may lower your dose.

In some cases, your doctor may give you a blood transfusion. This is a procedure in which you receive blood cells from a donor. You may be prescribed a type of drug called a granulocyte colony-stimulating factor, such as filgrastim (Neupogen) if you develop severe neutropenia.

Talk with your doctor if you have questions about monitoring or treating blood disorders from Revlimid.

Dangerous blood clots

Revlimid has a boxed warning for dangerous blood clots. These clots include deep vein thrombosis (DVT) and pulmonary embolism (PE). DVTs are serious blood clots that form in a deep vein (often in the leg). With PE, the clot travels to your lungs.

Symptoms of blood clots can include:

• shortness of breath
• chest pain
• swelling or warmth in your leg or arm

In studies, people taking Revlimid with dexamethasone for multiple myeloma had an increased risk of blood clots that led to heart attack or stroke. These conditions can be life threatening.

What might help

If you develop any symptoms that could be caused by a blood clot, tell your doctor or seek emergency medical care right away.

Your doctor may prescribe a blood thinner medication to help prevent blood clots. They may also recommend ways to reduce other risk factors for blood clots. These may include managing high blood pressure and high cholesterol, and quitting smoking.

If you have questions about your risk of blood clots from Revlimid, talk with your doctor.

Eye problems

Revlimid may cause eye problems. In studies, blurred vision and cataracts (cloudiness in the lens of the eye) were reported. Eye problems were less common than other side effects.

Rarely, other eye problems have been reported in studies of Revlimid treatment for multiple myeloma. These include vision loss and high pressure inside the eye.

What might help

Tell your doctor right away if you notice any changes in your vision.

It’s important to have regular eye exams during Revlimid treatment. If you develop cataracts, your eye doctor may suggest cataract surgery. If you develop severe vision problems, they may recommend switching to a different treatment.

Neuropathy

Revlimid may cause neuropathy (nerve damage).

Healthy nerves work by delivering signals between your body and your brain. Neuropathy occurs when your nerves become damaged and no longer work as they should. This can lead to your nerves sending inaccurate signals to your brain, such as pain signals without a cause.

Specifically, Revlimid may cause peripheral neuropathy. This causes symptoms that mainly occur in your hands, arms, legs, and feet. These may include:

• prickling or tingling sensations
• numbness
• pain
• muscle cramping, twitching, or weakness

What might help

If you develop symptoms of neuropathy while taking Revlimid, talk with your doctor. They may recommend physical therapy or medication to help manage this side effect. Or they may suggest other ways to treat neuropathy.

If you have questions about neuropathy from Revlimid, talk with your doctor or pharmacist.

Constipation

Constipation is a common side effect of Revlimid.

With constipation, you have bowel movements less often than usual or fewer than three a week. Your stools may be hard and difficult to pass.

Revlimid commonly causes other digestive side effects besides constipation. These include diarrhea, nausea, vomiting, and belly pain.

What might help

You may be able to ease constipation from Revlimid with certain diet and lifestyle changes. These include:

• increasing your intake of fiber and foods that are high in fiber
• drinking more water and fluids
• exercising regularly

As long as your doctor says this is safe for you, over-the-counter (OTC) laxatives or stool softeners might also help with constipation.

If constipation from Revlimid becomes severe or doesn’t go away, talk with your doctor. They may suggest other ways to relieve constipation.

Allergic reaction

Like most drugs, Revlimid can cause an allergic reaction in some people.

Symptoms can be mild or serious and can include:

• skin rash
• itchiness
• flushing (temporary warmth, redness, or deepening of skin color)
• swelling under your skin, typically in your eyelids, lips, hands, or feet
• swelling of your mouth, tongue, or throat, which can make it hard to breathe

What might help

If you have mild symptoms of an allergic reaction, such as a mild rash, call your doctor right away. They may suggest an OTC antihistamine, such as Benadryl (diphenhydramine). Or they may recommend a product you apply to your skin, such as hydrocortisone cream. These treatments can help manage your symptoms.

If your doctor confirms you had a mild allergic reaction to Revlimid, they’ll decide if you should continue taking it.

If you have symptoms of a severe allergic reaction, such as swelling or trouble breathing, call 911 or your local emergency number right away. These symptoms could be life threatening and require immediate medical care.

If your doctor confirms you had a serious allergic reaction to Revlimid, they may have you switch to a different treatment.

Keeping track of side effects

During Revlimid treatment, consider keeping notes on any side effects you’re having. Then, you can share this information with your doctor. This is especially helpful to do when you first start taking new drugs or using a combination of treatments.

Your side effect notes can include things such as:

• what dose of drug you were taking when you had the side effect
• how soon after starting that dose you had the side effect
• what your symptoms were from the side effect
• how it affected your daily activities
• what other medications you were also taking
• any other information you feel is important

Keeping notes and sharing them with your doctor will help your doctor learn more about how Revlimid affects you. And your doctor can use this information to adjust your treatment plan if needed.

Warnings for Revlimid

Revlimid comes with several warnings.

Boxed warnings

Revlimid has three boxed warnings. Boxed warnings are the most serious warnings from the Food and Drug Administration (FDA).

• Fetal harm. Revlimid may cause life threatening problems in a fetus (commonly called birth defects) or pregnancy loss. See “Pregnancy and breastfeeding while taking Revlimid” below for details.
• Severely decreased blood cell levels. Revlimid may cause severely decreased levels of certain blood cells. These include platelets and certain white blood cells. These blood disorders can cause symptoms such as bruising and bleeding, and can increase your risk of infection.
• Dangerous blood clots. Taking Revlimid can increase your risk of developing serious blood clots. These include deep vein thrombosis (DVT) and pulmonary embolism (PE). These conditions can be life threatening and require immediate medical attention.

To learn more about severely decreased blood cell levels and dangerous blood clots, see the “Side effects explained” section above.

Other warnings

Revlimid may not be right for you if you have certain medical conditions or other factors that affect your health. Talk with your doctor about your health history before you take Revlimid. The list below includes factors to consider.

Chronic lymphocytic leukemia (CLL). If you have CLL, your doctor will likely not prescribe Revlimid. According to studies, taking Revlimid may increase your risk of death if you have CLL.

Pembrolizumab treatment. Taking Revlimid with pembrolizumab (Keytruda) for multiple myeloma may increase the risk of death. Be sure to tell your doctor about all of your current medications before taking Revlimid. If your medications include Keytruda, they’ll discuss your treatment plan and its risks and benefits.

Severe skin reaction to thalidomide. The drug thalidomide is very similar to lenalidomide (the active drug in Revlimid). If you’ve had a severe skin reaction to thalidomide in the past, your doctor will likely not prescribe Revlimid for you.

Liver or kidney problems. The liver and kidneys help to remove medications, including Revlimid, from your body. If you have liver problems or kidney problems, the drug may stay in your body longer than usual. This could increase your risk of side effects.

If you have liver or kidney problems, your doctor may not prescribe Revlimid. If they do, they’ll likely prescribe a lower dosage for you than usual.

Allergic reaction. If you’ve had an allergic reaction to Revlimid or any of its ingredients, your doctor will likely not prescribe Revlimid. Ask your doctor what other medications are better options for you.

Lactose intolerance. If you’re lactose intolerant, tell your doctor. They likely won’t prescribe Revlimid for you because it contains lactose. Ask your doctor about other medication options.

Alcohol and Revlimid

It’s usually safe to drink alcohol with Revlimid, if your doctor says this is safe for you.

But alcohol may cause some of the same side effects as Revlimid. These include nausea, vomiting, fatigue (low energy), and liver failure. Drinking alcohol while taking Revlimid could worsen these side effects.

If you drink alcohol, talk with your doctor about how much is safe to drink while taking Revlimid.

Pregnancy and breastfeeding while taking Revlimid

You should not take Revlimid during pregnancy. If you or your sexual partner can become pregnant, you should avoid pregnancy:

• while taking Revlimid,
• during any breaks in your treatment, and
• for at least 4 weeks after your last dose

Females* should also avoid pregnancy starting at least 4 weeks before Revlimid treatment.

Revlimid is not considered safe to take while breastfeeding. The effects of Revlimid on a child who is breastfed are unknown.

If you’re pregnant or breastfeeding, or planning either, talk with your doctor. They can guide you on the safest options for you and your child.

Fetal harm

Revlimid has a boxed warning for fetal harm. If taken during pregnancy, it can cause severe developmental problems in a fetus (commonly known as birth defects). It can also cause pregnancy loss.

Due to the risk of fetal harm:

• Before starting this medication, you must enroll in the Revlimid Risk Evaluation and Mitigation Strategy program. With this program, you must meet certain requirements before your doctor may prescribe Revlimid for you. As part of this program, females must have regular pregnancy testing.
• Females should avoid becoming pregnant while taking Revlimid and for at least 4 weeks before and after treatment. You should use at least two methods of birth control starting 4 weeks before Revlimid treatment. Continue using these methods to help prevent pregnancy during treatment, any time your treatment is paused, and for at least 4 weeks after your last dose. You must have two negative pregnancy test results before starting treatment. And you’ll have pregnancy tests while taking Revlimid.
• Males* taking Revlimid should use a condom during sexual contact. This should be used during treatment and for at least 4 weeks after stopping treatment. This is because Revlimid passes into sperm.

This warning is based on information about the drug thalidomide. Thalidomide is very similar to lenalidomide (the active drug in Revlimid).

If you have questions about fetal harm from Revlimid, birth control, or the REMS program, talk with your doctor or pharmacist.

* In this article, we use the terms “female” and “male” to refer to someone’s sex assigned at birth. For information about the difference between sex and gender, see this article.

What to ask your doctor

Revlimid commonly causes side effects. Most side effects are mild or can be easily managed. Some side effects are severe and require treatment. Your doctor will tell you more about monitoring you for side effects while you’re taking Revlimid.

Before starting Revlimid, you may want to ask your doctor the following questions about side effects:

• Can Revlimid cause long-term side effects?
• Are there any medications that can help prevent serious side effects of Revlimid?
• Do my medical conditions increase my risk of side effects from Revlimid?
• Can compression socks help prevent blood clots from Revlimid?