Patients on immunosuppressive therapy have an increased risk of infections. Since infections have a potential to trigger acute porphyric attacks vigilance is motivated regarding signs or symptoms of infection and/or possible symptoms of a porphyric attack. Side effects like nausea and vomiting may potentially be porphyrinogenic through reduction in carbohydrate intake.

Infections are common in patients using immunosuppressants and since infections might trigger an acute porphyric attack, vigilance regarding signs and symptoms of an infection and/ or a porphyric attack is recommended. Common adverse reactions of lenalidomide that can be confused with an acute porphyric attack are nausea and vomiting. These side effects may potentially be porphyrinogenic if leading to a decrease in carbohydrate intake.

Lenalidomide is not metabolised by CYP, and has no capacity for induction or inhibition of CYP.

Lenalidomide is a synthetic derivative of glutamic acid. It is structurally close to thalidomide but one oxygen is removed from the phthalyl ring and one amine group is added.

Lenalidomide in combination with corticosteroids is used in the treatment of multiple myeloma. It is administered orally.

Lenalidomide is eliminated mainly via the kidneys as unchanged drug. In vitro studies conclude that lenalidomide is not a substrate, inhibitor nor an inducer of cytochrome P450 enzymes (Kumar 2008).

Uneventful use reported in 1 patient with acute porphyria.