thalidomide thalidomide thalidomide, sold under the brand names contergan and thalomid among others, is an oral medication used to treat a number of cancers (e.g. multiple myeloma), graft-versus-host disease, and many skin disorders (e.g. complications of leprosy such as skin lesions). while thalidomide has been used in a number of hiv-associated conditions, such use is associated with increased levels of the virus. this article is about the drug. for the thalidomide scandal and birth defect crisis, see thalidomide scandal. thalidomideclinical datapronunciation/θəˈlɪdəmaɪd/ trade namescontergan, thalomid, othersother namesα-phthalimidoglutarimideahfs/drugs.commonographmedlineplusa699032license data eu ema: by inn us dailymed: thalidomide us fda: thalidomide pregnancycategory au: x (high risk) routes ofadministrationby mouthatc codel04ax02 (who) legal statuslegal status au: s4 (prescription only) br: class c3 (immunosuppressive drugs) ca: ℞-only uk: pom (prescription only) us: ℞-only eu: rx-only pharmacokinetic databioavailability90%protein binding55% and 66% for the (r)-(+)- and (s)-(−)-enantiomers, respectivelymetabolismliver (minimally via cyp2c19-mediated 5-hydroxylation; mostly via non-enzymatic hydrolysis at the four amide sites)elimination half-life5–7.5 hours (dose-dependent)excretionurine, feces and semenidentifierscas number50-35-1 ypubchem cid5426iuphar/bps7327drugbankdb01041 ychemspider5233 yunii4z8r6ors6lkeggd00754 ychebichebi:9513 nchemblchembl468 ycomptox dashboard (epa)dtxsid9022524 echa infocard100.000.029 chemical and physical dataformulac13h10n2o4molar mass258.233 g·mol−13d model (jsmol)interactive imagechiralityracemic mixture smiles o=c1c2ccccc2c(=o)n1c3ccc(=o)nc3=o inchi inchi=1s/c13h10n2o4/c16-10-6-5-9(11(17)14-10)15-12(18)7-3-1-2-4-8(7)13(15)19/h1-4,9h,5-6h2,(h,14,16,17) ykey:uejjhqnacjxskw-uhfffaoysa-n y ny (what is this?) (verify) common side effects include sleepiness, rash, and dizziness. severe side effects include tumor lysis syndrome, blood clots, and peripheral neuropathy. use of thalidomide in pregnancy can cause fetal abnormalities such as phocomelia (malformation of the limbs). in males who are taking the medication, contraception is essential if a partner could become pregnant. it is an immunomodulatory medication and works by a number of mechanisms, including stimulating t cells and decreasing tnf-α production. thalidomide was first marketed in 1957 in west germany, where it was available over the counter. when first released, thalidomide was promoted for anxiety, trouble sleeping, "tension", and morning sickness. while it was initially thought to be safe in pregnancy, concerns regarding birth defects arose, resulting in its removal from the market in europe in 1961. the total number of infants affected by thalidomide use during pregnancy is estimated at 10,000, of whom about 40% died around the time of birth. those who survived had limb, eye, urinary tract, and heart problems. its initial entry into the us market was prevented by frances kelsey, a reviewer at the fda. the birth defects caused by thalidomide led to the development of greater drug regulation and monitoring in many countries. it was approved in the united states in 1998 for use as a treatment for cancer. it is on the world health organization's list of essential medicines. it is available as a generic medication. medical uses pack of thalidomide capsules thalidomide is used as a first-line treatment for multiple myeloma in combination with dexamethasone or with melphalan and prednisone to treat acute episodes of erythema nodosum leprosum, as well as for maintenance therapy. the bacterium that causes tuberculosis (tb) is related to leprosy. thalidomide may be helpful in some cases where standard tb drugs and corticosteroids are not sufficient to resolve severe inflammation in the brain. it is used as a second-line treatment to manage graft versus host disease and aphthous stomatitis in children and has been prescribed for other conditions in children, including actinic prurigo and epidermolysis bullosa; the evidence for these uses is weak. it is recommended only as a third line treatment in graft-versus-host-disease in adults because of lack of efficacy and side effects observed in clinical trials. contraindications thalidomide should not be used by men or women who are trying to father or conceive a child, those who cannot or will not follow the risk management program to prevent pregnancies, or by women who are breastfeeding or pregnant. the prescribing doctor is required to ensure that contraception is being used, and that regular pregnancy tests are taken. those allergic to thalidomide should not take it. it should be used with caution in people with chronic infections like hiv or hepatitis b. adverse effects