Page 1 POMALIDOMIDE ORAL CHEMOTHERAPY EDUCATION Name of your medication Generic name — pomalidomide PAH muh LIH doh mide Brand name — Pomalyst® PAH muh list Approved uses Pomalidomide is used to treat patients with multiple myeloma in combination with another medication, dexamethasone. Dose and schedule Taking pomalidomide as instructed is important to allow your treatment to be as effective as possible, so here are some key points to remember. Your dose may vary, but the usual dose of pomalidomide is 4 milligrams 4 mg to be taken by mouth on days 1–21 of each 28 day treatment cycle. The dose may be adjusted by your care provider based on your individual needs. Pomalidomide can be taken with or without food, but at the same time each day. Pomalidomide should be taken whole and not crushed, cut, dissolved, or opened. If you are unable to swallow pomalidomide, talk to your care provider or pharmacist for possible options. If you miss a dose of pomalidomide: Only take the missed dose if it has been less than 12 hours since you were supposed to take it. Then, take the next dose at the regularly scheduled time. Do not take the missed dose if it has been more than 12 hours since you should have taken it. Simply take the next dose at the regularly scheduled time. Do not take two doses at one time. Be sure to write down if you miss a dose and let your care provider know about any missed doses. Storage and handling Handle pomalidomide with care. Just like when chemotherapy is given into the vein, this drug can be toxic, and exposure of the drug to others should be limited. Store pomalidomide at room temperature 68°F–77°F in a dry location away from light. Keep pomalidomide out of reach of children and pets. Leave pomalidomide in the provided packaging until it is ready to be taken. Whenever possible, you should give pomalidomide to yourself and follow the steps below. If a family member, friend, or caregiver needs to give the pomalidomide to you, they also need to follow these steps: 1. Wash hands with soap and water. 2. Put on gloves to avoid touching the medication. Gloves are not necessary if you give the drug to yourself. 3. Gently transfer the pomalidomide from its package to a small medicine or other disposable cup. 4. Administer the medicine immediately by mouth with water. 5. Remove gloves and do not use them for anything else. 6. Throw gloves and medicine cup in household trash. POMALIDOMIDE ORAL CHEMOTHERAPY EDUCATION Page 2 7. Wash hands with soap and water. If a daily pill box or pill reminder is used, a separate one should be used for pomalidomide. Do not mix other medications into the box with pomalidomide. The person filling the box or reminder should wear gloves. Gloves are not necessary if you are filling the box or reminder. When empty, the box or reminder should be washed with soap and water before refilling. Be sure to wash hands with soap and water after the task is complete, whether or not gloves are worn. If you have any unused pomalidomide, do not throw it in the trash and do not flush it down the sink or toilet. Talk to your care provider or pharmacist about proper disposal of pomalidomide. If you are traveling, put your pomalidomide in a sealed plastic bag. Ask your pharmacist if any additional travel precautions are needed. Handling body fluids and waste Pomalidomide remains in your body for several days after it is taken, so some of the drug may be present in urine, stool, sweat, or vomit. Once you have started to take pomalidomide, it is important to follow the instructions below every day for as long as your treatment lasts. This will keep yourself, loved ones, and the environment as safe as possible. Pregnant women should avoid touching anything that may be soiled with body fluids from the patient. Toilet and septic systems You may use the same toilet, septic tank, and/or sewer that you usually use. If you have a low flow toilet, close the lid and flush twice to ensure all waste has been discarded. If the toilet or toilet seat becomes soiled with urine, stool, or vomit, clean the surfaces before other people use the toilet. Wash hands with soap and water after using the toilet. If you need a bedpan, be sure your caregiver knows to wear gloves to assist with cleanup and to wash the bedpan with soap and water every day. If you do not have good control of bladder or bowels, use a disposable pad with a plastic back, a diaper, or a sheet to absorb body waste. Wash any skin that has been exposed to body waste or pomalidomide with soap and water. Linens or clothing that are soiled with body fluids or body waste should be washed separately from other linens and clothing. If you do not have a washer, place the soiled linens in a plastic bag until they can be washed. Wash hands with soap and water after touching linens or clothing that may be soiled with body fluids. Drug and food interactions Pomalidomide has many drug interactions. Inform your care providers of all prescription medications, over the counter medications, vitamins, and herbal products. Talk with your care provider or pharmacist before taking new medications or supplements, or receiving any vaccines. Serious side effects Pomalidomide can cause serious birth defects. Do not take pomalidomide if you are pregnant or think you might be pregnant. Pomalidomide can increase your risk of having a blood clot. POMALIDOMIDE ORAL CHEMOTHERAPY EDUCATION Page 3 Side Effects of Pomalidomide The common side effects that have been known to happen in more than 30% of patients taking pomalidomide are listed in the left side of this table. You MAY NOT experience these side effects. Options to help manage any side effects that do occur are included on the right side of this table. These should be discussed with your care provider. If you experience any side effect you cannot manage or that is not listed here, contact your care provider. Possible Side Effect Management Fatigue You may be more tired than usual or have less energy. Stay as active as possible, but know it is okay to rest as needed, too. Try to do some activity every day. Plan your activities, and do them at a time of day when you feel a bit more energetic. Avoid operating heavy machinery if you feel too tired. You might notice that you are more pale than usual. Decreased white blood cells WBCs and increased risk for infection Your WBCs should be monitored by a simple blood test. When your WBCs are low, you are at a greater risk of having an infection. Take the following precautions to protect yourself from infection. Wash your hands often, especially before eating and after using the bathroom. Avoid crowds and people with fevers, flu, or other infection. Bathe regularly to keep good personal hygiene. Contact your care provider if you experience any signs or symptoms of an infection: Fever temperature more than 100.4°F or 38°C Chills Sore throat Burning with urination Unusual tiredness A sore that becomes red, is draining, or does not heal Check with your care provider before taking any medicine for a fever or chills. Decreased hemoglobin, part of the red blood cells that carry iron and oxygen Your hemoglobin should be monitored using a blood test. When your hemoglobin is low, you may notice that you get tired or fatigued more easily. Try to get 7–8 hours of sleep per night. Avoid operating heavy machinery if you feel too tired. Find a balance between work and rest. Stay as active as possible, but know that it is okay to rest as needed. You might notice that you are more pale than usual. Let your health care provider know right away if you experience any of the following: Shortness of breath Dizziness Palpitations Continued on the next page POMALIDOMIDE ORAL CHEMOTHERAPY EDUCATION Page 4 Possible Side Effect Management Shortness of breath Call your care provider right away if you develop shortness of breath, because this could be a sign of a blood clot in your lungs or an infection, such as pneumonia. Constipation Monitor how many bowel movements you have each day. Drink 8–10 glasses of water or fluid each day, unless your care provider has instructed you to limit your fluid intake because of some other health problem. Stay active and exercise, if possible. Eat foods high in fiber, like raw fruits and vegetables. Contact your care provider if you have not had a bowel movement in three or more days. Your care provider may recommend over the counter medications to help with your constipation. A daily stool softener, such as docusate Colace® , and/or a laxative, such as senna Senokot® , may be helpful. If these do not help within 48 hours, tell your provider. Diarrhea loose and/ or urgent bowel movements Monitor how many bowel movements you have each day. Drink 8–10 glasses of water or fluid each day unless your care provider has instructed you to limit your fluid intake because of some other health problem. Eat small, frequent meals throughout the day rather than a few large meals. Eat bland, low fiber foods e.g., bananas, applesauce, potatoes, chicken, rice, toast . Avoid high fiber foods e.g., raw vegetables, raw fruits, whole grains . Avoid foods that cause gas e.g., broccoli, beans . Avoid lactose containing foods e.g., yogurt, milk . Avoid spicy, fried, and greasy foods. Contact your provider if any of the following occur: The number of bowel movements you have in a day increases by four or more. You feel dizzy or lightheaded. Your care provider may recommend an over the counter medication called loperamide Imodium® to help with your diarrhea, but talk to your care provider before starting this medication. Back pain Keep a diary of your pain, including a description of when and where the pain is occurring, what it feels like, and how long it lasts. Stay as active as possible, but know that it is okay to rest as needed, too. Tell your care provider if pain interferes with your activity. If the pain bothers you, ask your provider what you may use to help with this discomfort. Take only pain medication that has been prescribed or recommended by your care provider. Continued on the next page POMALIDOMIDE ORAL CHEMOTHERAPY EDUCATION Page 5 Possible Side Effect Management Respiratory tract infection Wash your hands often, especially before eating and after using the bathroom. Avoid people with fevers, flu, or other infections. Maintain good personal hygiene. Report symptoms of a respiratory infection e.g., cough, sneezing, runny nose, fever, scratchy or sore throat to your provider. If you experience ANY uncontrolled side effect, call your physician or healthcare center immediately: INSTITUTIONAL CONTACT INFO Pregnancy, sexual activity, and contraception Women should not become pregnant and men should not get a partner pregnant while taking pomalidomide, during any treatment breaks, and for at least four weeks after stopping this medication. Do not take pomalidomide if you are pregnant or think you might be pregnant. Pomalidomide can cause serious birth defects. If you think you might be pregnant, notify your care provider right away. Women of childbearing age and potential must have two negative pregnancy tests prior to starting pomalidomide and will need to repeat this test with each cycle or sooner. Women of childbearing age and potential should use two forms of birth control or go without having sex during treatment with pomalidomide and for at least four weeks after stopping treatment. Men who are taking pomalidomide must always wear a latex or synthetic condom during sex, during treatment breaks, and for at least four weeks after stopping pomalidomide because the drug can be found in sperm. Notify your healthcare provider if you have unprotected sex with a woman. Do not donate sperm while taking this medication, during treatment breaks, and for four weeks after stopping this medication. Do not breastfeed while taking pomalidomide and for a minimum of four weeks after the last dose of pomalidomide. It is safe to hug and kiss, but the special precautions described above are required before sexual activity. Blood product donation It is recommended that you do not donate blood or blood products, such as platelets, while receiving pomalidomide and for at least one month after your last dose of pomalidomide. Obtaining medication Talk with your care provider about how to obtain your pomalidomide. Pomalidomide is only available through a Risk Evaluation and Mitigation Strategy REMS program, and prescribers, patients, and pharmacies must be certified with this REMS program. POMALIDOMIDE ORAL CHEMOTHERAPY EDUCATION Page 6 Only a 28 day supply of medication can be obtained from the pharmacy at one time, and this medication cannot have automatic refills. PHARMACY OR SPECIALTY PHARMACY CONTACT INFO Additional resources Product website: www.pomalyst.com Product prescribing information: www.celgene.com/content/uploads/pomalyst pi.pdf Product resources: celgenepatientsupport.com Updated – August 21, 2017 Additional instructions Important notice: The Association of Community Cancer Centers ACCC , Hematology/Oncology Pharmacy Association HOPA , National Community Oncology Dispensing Association, Inc. NCODA , and Oncology Nursing Society ONS have collaborated in gathering information for and developing this patient education guide. This guide represents a brief summary of the medication derived from information provided by the drug manufacturer and other resources. This guide does not cover all existing information related to the possible uses, directions, doses, precautions, warnings, interactions, adverse effects, or risks associated with this medication and should not substitute for the advice of a qualified healthcare professional. Provision of this guide is for informational purposes only and does not constitute or imply endorsement, recommendation, or favoring of this medication by ACCC, HOPA, NCODA, or ONS, who assume no liability for and cannot ensure the accuracy of the information presented. The collaborators are not making any representations with respect to the medications whatsoever, and any and all decisions, with respect to such medications, are at the sole risk of the individual consuming the medication. All decisions related to taking this medication should be made with the guidance and under the direction of a qualified healthcare professional. Permission: Oral Chemotherapy Education OCE sheets are provided as a free educational resource for patients with cancer in need of concise, easy to understand information about oral cancer drugs. Healthcare providers are permitted to copy and distribute the sheets to patients as well as direct patients to the OCE website for information. However, commercial reproduction or reuse, as well as rebranding or reposting of any type, are strictly prohibited without permission of the copyright holder. Please email permission requests and licensing inquiries to This email address is being protected from spambots. You need JavaScript enabled to view it.. Copyright © 2017 by Hematology/Oncology Pharmacy Association. All rights reserved.