Revlimid (Lenalidomide) for Multiple Myeloma

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Revlimid (lenalidomide) is a prescription medication approved by the U.S. Food and Drug Administration (FDA) for treating adults with multiple myeloma.

What Members Say

MHT logo These insights are based on 17,857 comments about Revlimid from MyMyelomaTeam members. These are the experiences of a small number of individuals and are not meant to be medical advice.

Benefits:

Maintenance dosing often feels manageable, especially with 21 days on and seven days off.
Dose reductions sometimes make treatment easier to stay on long term.
Taking Revlimid by mouth at home avoids infusion-center visits for this part of treatment.
Taking it at the same time daily can fit into a regular routine.

Considerations:

Diarrhea is one of the most common challenges and can become chronic.
Low blood counts, infections, and treatment breaks often require close monitoring.
Rash, hives, and itching can happen and sometimes lead to dose changes.
Insurance approvals, specialty pharmacy refills, and copays can delay treatment.

How Revlimid Works and How It’s Taken

Revlimid is a type of medication called an immunomodulatory drug that works by changing proteins inside myeloma cells and immune cells. This can slow cancer cell growth, trigger cell death, and help immune cells attack the cancer. In multiple myeloma, this helps reduce abnormal cell activity.

Doctors prescribe Revlimid with dexamethasone to treat adults with multiple myeloma.

Revlimid is given as a capsule taken by mouth, typically once daily on days 1 through 21 of repeated 28-day cycles. It should be taken at about the same time each day and may be taken with or without food.

Revlimid capsules should be swallowed whole with water. Do not open, break, or chew them. If powder from a capsule touches your skin, wash the area with soap and water.

If the powder gets in your eyes, nose, or mouth, flush well with water.

Typical Dosing for Multiple Myeloma

The recommended dose of Revlimid for multiple myeloma is 25 milligrams by mouth once daily on days 1 through 21 of repeated 28-day cycles, used in combination with dexamethasone. If side effects affect blood cell counts or other serious treatment-related side effects happen, a doctor may pause treatment or restart it at a lower dose.

Treatment is usually continued until the disease gets worse or side effects become unacceptable.

For maintenance treatment after an autologous stem cell transplant, the usual starting dose is 10 milligrams once daily every day of a 28-day cycle. After three cycles, the doctor may increase the dose to 15 milligrams once daily if it is tolerated.

This information is based on the prescribing information, but your healthcare provider may tailor your treatment plan. Always follow their guidance.

Top Advice From Members on Revlimid

These insights are based on 17,857 comments about Revlimid from MyMyelomaTeam members.

Members who use Revlimid often say that side effects and dosing can take some trial and error with their care team. Many also stress the value of reporting new symptoms quickly, keeping up with labs, and asking about practical help for issues like diarrhea, fatigue, infections, and cost.

1

Talk to your doctor about dose changes if side effects are hard.
“Talk to your onc about cutting the Revlimid dosage down.”

“I was taking 15 milligrams of Revlimid and asked my doctor to try reducing it to 10 milligrams in maintenance because of low platelet levels, and platelet count went to low normal range along with improving other blood counts.”
2

Tell your doctor right away about rashes or allergic reactions.
“I had a severe rash over entire body. They dropped my dose to 5 milligrams, no reaction.”
3

Keep track of diarrhea and ask about ways to manage it.
“My multiple myeloma specialist prescribed a bile acid sequestrant twice per day to help control my diarrhea side effect from Revlimid. It has the side benefit of reducing cholesterol too. It works if you take it 30 minutes before eating breakfast or supper. A huge relief.”
4

Ask about practical help with timing, cost, and access.
“My oncologist was able to get me a grant that has paid my copays from day one. Ask your oncologist if they might be able to help you out with something similar.”

Connect with others who understand life with multiple myeloma. Join MyMyelomaTeam for free.

Revlimid Side Effects

In clinical trials of Revlimid used with dexamethasone to treat adults with multiple myeloma, the most common side effects occurred in about 3 percent to 45 percent of people.

Reported in about 10 percent to 45 percent of people:

Diarrhea
Fatigue (tiredness)
Constipation
Anemia (low red blood cell counts)
Neutropenia (low levels of neutrophils, which are white blood cells that help fight infection)
Peripheral edema (swelling in the arms, hands, legs, or feet)
Back pain
Nausea
Asthenia (weakness)
Insomnia (trouble sleeping)
Rash
Dyspnea (shortness of breath)
Leukopenia (low white blood cell counts)
Muscle cramps or spasms
Abdominal pain (belly pain)
Pyrexia (fever)
Upper respiratory tract infection, such as a cold-like infection
Bronchitis, an infection or swelling in the airways of the lungs
Nasopharyngitis, which is irritation or infection in the nose and throat
Cough
Dizziness
Decreased appetite
Thrombocytopenia (low levels of platelets, which help blood clot)
Tremor, which means shaking that you cannot fully control

Reported in about 3 percent to 10 percent of people:

Gastroenteritis, which is irritation or infection in the stomach and intestines

Serious Side Effects and Warnings

Revlimid can cause serious side effects that may require immediate medical attention. These include:

Embryo-fetal toxicity — Revlimid can cause severe birth defects or pregnancy loss if taken during pregnancy.
Low white blood cells and low platelets — These can lead to serious infections or bleeding.
Blood clots, heart attack, or stroke — Clots can occur in veins or arteries, including deep vein thrombosis or pulmonary embolism.
Second primary cancers — These can include new blood cancers such as acute myeloid leukemia or myelodysplastic syndromes, as well as solid tumors.
Severe liver problems — These can include liver failure.
Severe skin reactions — These can include Stevens-Johnson syndrome, toxic epidermal necrolysis, or DRESS.
Severe allergic reactions — These can include angioedema or anaphylaxis.
Tumor lysis syndrome — This is a dangerous reaction that can happen when many cancer cells break down quickly.
Thyroid disorders — These can include hypothyroidism or hyperthyroidism.
Pneumonitis — Lung inflammation can cause cough or trouble breathing.
Viral reactivation — This can include hepatitis B or shingles.
Progressive multifocal leukoencephalopathy (PML) — This is a rare, serious brain infection.

Other warnings may apply in certain situations. Revlimid is not recommended for chronic lymphocytic leukemia outside clinical trials. It is also not recommended with pembrolizumab and dexamethasone for multiple myeloma outside clinical trials.

Revlimid may affect stem cell collection, so people who may need a stem cell transplant should talk with their doctor early in treatment.

How To Save on Revlimid

Bristol Myers Squibb, the manufacturer of Revlimid, offers the BMS Access Support Co-Pay Assistance Program. Eligible people with commercial insurance may pay as little as $0. If you have government insurance or no insurance, the website offers information on other ways to save on your prescription.

The BMS Access Support Co-Pay Assistance Program also offers benefits review, prior authorization assistance, and appeals process support. To learn more, visit bmscopay.com or call 800-861-0048.

What To Know Before Taking Revlimid

Before starting Revlimid, your doctor will check your blood counts. If you can become pregnant, two negative pregnancy tests will be required to confirm you are not pregnant.

Tell your doctor if you have any allergies to lenalidomide or any ingredients in Revlimid.

Tell your doctor about all medications you take, including prescription drugs, over-the-counter medicines, and supplements. This is especially important if you take digoxin, blood thinners, estrogen-containing medicines, or medicines that raise red blood cell counts, such as erythropoietin-stimulating agents. Some medicines may increase the risk of side effects, including blood clots.

Also let your doctor know if you have had cancer or nervous system problems in the past. Tell your doctor if you are lactose intolerant. Revlimid capsules contain lactose.

Do not take Revlimid if you are pregnant or if you have had a severe allergic reaction to lenalidomide, such as angioedema, Stevens-Johnson syndrome, or toxic epidermal necrolysis.

Do not donate blood while taking Revlimid, during treatment breaks, and for four weeks after stopping. Males should not donate sperm during treatment, during breaks, and for four weeks after stopping Revlimid.

Revlimid is also FDA-approved to treat certain myelodysplastic syndromes with deletion 5q, mantle cell lymphoma, previously treated follicular lymphoma, and previously treated marginal zone lymphoma.

If you miss a dose and it has been less than 12 hours since your usual time, take it as soon as you remember. If more than 12 hours have passed, skip the missed dose and take your next dose at the regular time. Do not take two doses at once.

Revlimid can cause severe birth defects and must not be used during pregnancy. If you can become pregnant, you must avoid pregnancy for at least four weeks before starting, during treatment, including any breaks, and for at least four weeks after stopping Revlimid. You must use two reliable forms of birth control or abstain from heterosexual sex.

If you are male, you must use a latex or synthetic condom during any sexual contact with a female who can become pregnant while taking Revlimid and for up to four weeks after stopping. Do not breastfeed during treatment.

Community FAQs

These answers are fact-checked by our editorial staff.

How effective is Revlimid?

In a study of people with newly diagnosed multiple myeloma who were not candidates for stem cell transplant, lenalidomide plus low-dose dexamethasone given continuously led to a median progression-free survival of 25.5 months, compared with 21.2 months for melphalan, prednisone, and thalidomide.

The overall response rate was 75.1 percent with continuous lenalidomide plus dexamethasone, compared with 62.3 percent in the comparison group. Median overall survival was 58.9 months with continuous lenalidomide plus dexamethasone, compared with 48.5 months in the comparison group.

How long does Revlimid take to work for multiple myeloma?

The study information does not give one exact timeframe for when Revlimid starts working for every person. In the study of newly diagnosed multiple myeloma, the median time to first response was 1.8 months with continuous lenalidomide plus low-dose dexamethasone. This means some people responded sooner and some responded later.

Can Revlimid cause rash with multiple myeloma?

Yes. In clinical trials for newly diagnosed multiple myeloma, rash was reported in 26 percent of people taking lenalidomide plus dexamethasone, and severe rash was also reported. Severe skin reactions, including Stevens-Johnson syndrome, toxic epidermal necrolysis, and DRESS, have been reported, and severe skin reactions may require stopping treatment permanently.

What tests or monitoring are needed with Revlimid for multiple myeloma?

Blood counts should be checked every seven days for the first two cycles, on days 1 and 15 of cycle three, and then every 28 days after that. Liver enzymes should be monitored periodically, and thyroid function should be checked before treatment starts and during treatment. For females who can become pregnant, pregnancy testing is also required before starting and during treatment.