Is Revlimid Chemotherapy? Plus, 5 More FAQs

Revlimid (lenalidomide) is an oral medication taken once a day to treat blood cancers such as multiple myeloma, myelodysplastic syndromes, and certain types of non-Hodgkin lymphoma.

If you’ve been prescribed Revlimid, it’s normal to have several questions. Is Revlimid chemotherapy? Is it considered a high-risk medication? Here, we’ll answer frequently asked questions about Revlimid.

1. Is Revlimid chemotherapy?

No, Revlimid isn’t chemotherapy. Revlimid is an immunomodulator. It works by “modulating” or changing how well your immune system recognizes cancer cells.

Our immune systems serve many functions that contribute to our overall health. One of these jobs is to detect and remove cancer cells from the body. But cancer cells can sometimes camouflage themselves and hide from the immune system. When this happens, the cancer can keep growing and spreading throughout the body.

Revlimid helps the immune system see cancer cells more clearly and stop them in their tracks. It also curbs the growth of new blood vessels, which cancer cells need for nutrients and to help them grow.

2. Who should take Revlimid?

Revlimid treats adults with certain kinds of blood cancers, including multiple myeloma and myelodysplastic syndromes. It can be used to treat certain non-Hodgkin lymphomas, too, such as mantle cell lymphoma, follicular lymphoma, and marginal zone lymphoma.

You may be told to take Revlimid alone or in combination with other cancer medications, depending on the situation.

3. Is Revlimid a high-risk medication?

Yes, Revlimid is considered a high-risk medication. It has a boxed warning about its risks of birth defects, blood clots, and low blood counts. A boxed warning is the strongest warning that the FDA can give a prescription medication. It doesn’t mean the medication is unsafe to use, but it’s important to have proper safeguards in place.

The medication is only available through a Risk Evaluation and Mitigation Strategies (REMS) medication safety program. Under this program, only certified healthcare professionals (HCPs) can prescribe the medication, and only certified pharmacies can dispense it. People who plan on taking Revlimid must enroll in the REMS program and agree to its safety requirements.

Birth defects

If a woman is exposed to Revlimid during pregnancy, there’s a higher risk of birth defects or fetal death. The Revlimid REMS program requires several precautions to reduce the risk of pregnancy.

Women taking Revlimid who could become pregnant must adhere to these contraceptive requirements:

• Use two highly effective forms of birth control while taking Revlimid. This is required 4 weeks before starting the medication up until 4 weeks after stopping the medication.

• Weekly pregnancy tests are needed during the first month of treatment (and then every 2 to 4 weeks, depending on how regular your menstrual cycle is).

Men are equally responsible for preventing pregnancy. Revlimid can affect sperm and cause harm to an unborn baby. Men taking Revlimid must:

• Always use a latex or synthetic condom when having sex with a pregnant woman or a woman who could become pregnant. You’ll need to do this while taking Revlimid up until 4 weeks after stopping the medication. This is important even if you’ve had a vasectomy.

• Avoid donating sperm while taking Revlimid and 4 weeks after stopping the medication.

If you’re taking Revlimid and had unprotected sex, think your birth control failed, or have become pregnant, stop taking the medication right away and call your HCP. If you can’t reach them, you can call the REMS call center at 1-888-423-5436 for help.

Low blood counts

​​Low blood counts is another risk listed in Revlimid’s boxed warning. It can reduce the number of white blood cells in your body, making it harder to fight off infections. It can also lower platelet counts, which are needed to help your blood clot and stop bleeding.

Your HCP should check your blood counts often, especially when you first start taking Revlimid. They’ll be able to look out for any decrease in blood counts that could signal trouble. If you start to notice any signs or symptoms of infection, bleeding, or bruising, let your HCP know right away. This could be a sign that your blood counts are too low.

Blood clots

​​Revlimid can increase the risk of developing blood clots. This is especially true if you already have certain risk factors for blood clots, including:  

• A history of blood clots

• High blood pressure

• High cholesterol

• Current cigarette smoker

• Taking medications that increase risk of clotting 

To lower the chances that you develop a blood clot, your HCP may prescribe you a blood thinner while you’re taking Revlimid. Managing your blood pressure, reducing your cholesterol levels, and quitting smoking can all help reduce the risk of clots, too.

Blood clots can be life-threatening, so it’s important to be familiar with the signs and symptoms so you can get help right away. Call 911 or seek emergency care immediately if you experience shortness of breath, chest pain, or sudden arm or leg swelling at any point.

4. What are the risks and side effects of Revlimid?

There are some other Revlimid side effects that are important to be aware of. These side effects are more common than the risks described above, and they’re generally easy to manage.

• Diarrhea

• Cough

• Fatigue

• Rash

• Muscle cramps

Still, if you experience any side effects like these, let your HCP know. They can give you strategies to manage your symptoms and prevent them from getting worse.

Other Revlimid side effects

When you first begin taking Revlimid, you may notice your symptoms seem to get worse. But this doesn’t necessarily mean that the medication isn’t working. It can be a sign that Revlimid is activating your immune system. 

A “tumor flare” can happen when many immune cells gather at the site of your cancer soon after you start treatment. This can lead to swollen lymph nodes or a low-grade fever. While it’s usually not dangerous, it’s crucial you let your HCP know if you’re experiencing these symptoms.

It may sound strange, but it’s also possible for Revlimid to work too quickly. When your immune cells break down cancer cells, they release chemical substances into your bloodstream. If these substances are released too rapidly, your body may have difficulty removing them quickly enough. This can lead to a rare but life-threatening reaction called tumor lysis syndrome (TLS). 

If you experience any TLS symptoms like these, seek emergency care right away:

• Severe nausea

• Confusion

• Lack of appetite

• Muscle cramps

• Fast heart rate

• Dark urine

Rare but serious skin reactions have also happened to some people taking Revlimid. These reactions usually start off with flu-like symptoms, followed by a rash that gets worse. If this happens to you, seek emergency care immediately.

5. Does Revlimid interact with any medications or foods?

Yes, Revlimid can interact with certain medications. But the good news is that it doesn’t have any known interactions with any food.

One medication to be mindful of is digoxin. Revlimid can increase the amount of digoxin in your bloodstream. This could increase side effects seen with digoxin, such as stomach problems and blurred vision. If you’re taking both medications, your HCP should closely monitor your digoxin levels to make sure they don’t get too high.

You should also be cautious when taking Revlimid with other medications that raise the risk of blood clots. Examples of these medications include dexamethasone and estrogen-containing medications, such as birth control pills and hormone replacement therapy.

6. How long do people usually take Revlimid for?

Most people take Revlimid indefinitely. People usually only stop taking it if their cancer progresses or if side effects become too difficult to deal with. 

That being said, if you’re taking Revlimid to treat either follicular lymphoma or marginal zone lymphoma, there’s a limit to how long you’ll be taking the medication. Your HCP will determine the number of treatments you’ll need based on your individual response to Revlimid and the specifics of your condition. For these types of lymphoma, your HCP may recommend sticking to a maximum of 12 cycles, with each cycle being 28 days long.

How to save on Revlimid

There are ways to save on Revlimid, which is available as both a brand-name and generic medication. 

• Save with a copay savings card. If you have commercial insurance, you may be eligible to pay as little as $0 for Revlimid using a savings card from the manufacturer. The generic equivalent is also available for as little as $0 with a manufacturer savings card.

• Save with patient assistance programs. If you’re uninsured or underinsured, you may be eligible for a patient assistance program that offers Revlimid free of charge.

Why trust our experts?

Written by:

Vanessa Carranza, PharmD

Vanessa Carranza, PharmD, is a pharmacist who has dedicated her career to the advancement of medical education for healthcare providers, patients, and caregivers, most notably in the oncology space.

Edited by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Sonja Jacobsen, PharmD, BCPS, BCOP

Sonja Jacobsen, PharmD, BCPS, BCOP,  is a clinical oncology pharmacy specialist currently practicing in Seattle. She has been practicing as a pharmacist since 2015 and is licensed to practice in Washington state and North Carolina.

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