Pomalidomide
IMiDs
Immunomodulatory imide drugs (IMiDs)High alert
An error with this medicine can cause serious harm: double checks and protocols are used.Pregnancy: contraindicated
Contraindicated in pregnancy. As a thalidomide analogue it can cause severe birth defects or fetal death: pregnancy tests and two reliable contraceptive methods are required in a…
A thalidomide relative for relapsed multiple myeloma and Kaposi sarcoma. Strong birth-defect risk, clots and low blood counts.
Quick facts
- Group
- Immunomodulatory imide drugs (IMiDs)
- Target
- Cereblon (CRBN), substrate receptor of the CRL4 E3 ubiquitin ligase
- Used for
- Multiple myeloma · Kaposi sarcoma
- Key effects
- Fatigue · Constipation · Swelling of the limbs
- Monitor
- Pregnancy tests before · Complete blood count
- ATC
- L04AX06
No doses: the clinician sets them by the current guideline.
Mechanism of action
The structure shows pomalidomide in human cereblon, bound to DDB1 and to a zinc finger of SALL4, a protein whose drug-induced loss is linked to thalidomide birth defects.
Pomalidomide binds cereblon, part of a ubiquitin ligase. The drug changes cereblon's surface so it tags new proteins, mainly the transcription factors Ikaros and Aiolos, for destruction by the proteasome. Myeloma cells that depend on them die, while T and NK cells become more active. Loss of other tagged proteins in the embryo, such as SALL4, explains the birth defects of this drug family.
- Binds cereblon in the CRL4 ubiquitin ligase
- Ikaros and Aiolos are tagged and destroyed
- Myeloma cells die and T and NK cells are activated
Indications
- Multiple myeloma, with dexamethasone, after at least two prior therapies including lenalidomide and a proteasome inhibitor. Multiple myeloma →
- Kaposi sarcoma, AIDS-related after failure of antiretroviral therapy, or in HIV-negative adults. Kaposi sarcoma →
Adverse effects
Common
- Fatigue, weakness
- Constipation, diarrhoea, nausea
- Swelling of the limbs
- Back, joint and muscle pain
- Dizziness and confusion
- Tremor, sweating, rash
Contraindications
- Pregnancy
- Hypersensitivity to pomalidomide
Key interactions
- Strong CYP1A2 inhibitors (fluvoxamine, ciprofloxacin)
- Raise pomalidomide exposure and toxicity; avoided.
- Tobacco smoking
- May make pomalidomide less effective.
What is monitored
- Pregnancy tests before and during treatment (restricted distribution programme)
- Complete blood count
- Liver tests
- Signs of thrombosis; a preventive antithrombotic medicine is often given
Administration and safety
- Available only through a restricted risk-management programme.
- Capsules swallowed whole with water; not opened, broken or chewed, and handled as little as possible.
- Skin or eyes touched by capsule contents are washed with water at once.
- No sharing, and no blood or sperm donation during treatment and shortly after.
Pregnancy and breastfeeding
Contraindicated in pregnancy. As a thalidomide analogue it can cause severe birth defects or fetal death: pregnancy tests and two reliable contraceptive methods are required in a restricted programme, and men use condoms.
Nursing care
- Confirm negative pregnancy tests and two reliable contraceptive methods in women who could conceive; men use condoms.
- Teach the signs of DVT, pulmonary embolism, heart attack and stroke.
- Teach to report fever, bleeding or bruising; check blood counts.
- Ask about smoking and strong CYP1A2 inhibitors such as fluvoxamine or ciprofloxacin.
Pharmacokinetics
- Absorption
- Oral capsules, with or without food.
- Metabolism
- Liver, mainly CYP1A2 and CYP3A4; strong CYP1A2 inhibitors raise exposure.
Test yourself
Think of the answer, then tap the question to see it.
Which protein does pomalidomide bind?
Cereblon, the substrate receptor of the CRL4 E3 ubiquitin ligase.
Which two transcription factors are degraded?
Ikaros (IKZF1) and Aiolos (IKZF3).
Which two boxed warnings does pomalidomide carry?
Embryo-fetal toxicity and venous and arterial thromboembolism.
Which drug interaction raises pomalidomide exposure?
Strong CYP1A2 inhibitors such as fluvoxamine or ciprofloxacin.
Connections
← Back to the class: Immunomodulatory imide drugs (IMiDs)
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: DailyMed - POMALIDOMIDE capsule (DailyMed (U.S. National Library of Medicine), 2026); Pomalidomide: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2020); Pomalidomide - NCI (National Cancer Institute, 2020); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).
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Representative model, for educational purposes only.