Lindoshil contains Lenalidomide as an active substance which belongs to thalidomide analogue. Lindoshil contains some pharmacological activities like immuno modulatory, anti-neoplastic, & anti-angiogenesis.
Lindoshil is a prescription medicine; used under the supervision of medical oncologist. Lindoshil is used by combining with dexamethasone.
The most common indications of Lindoshil are; Multiple myeloma: Lindoshil should be used in combination with dexamethasone. Myelodysplastic syndrome: Lindoshil is used to treat this condition Mantle cell lymphoma: Lindoshil is used for this condition, if patients are not responding to the Bortezomib treatment.
MECHANISM OF ACTION
Tumor cells asserted epidermal growth factor receptors on their cell surface, present in both active and cancer infected cells. These receptors complicated in advancement of cell growth and production. Some epidermal growth factor receptors have exciting mutations (changes) within non small cell lung cancer cells which are supposing to encourage cancer cell growth, restrict the apoptosis, which may raise angiogenic factors and develop metastasis process. Geffyenclose Gefitinib causes erratic prohibition of tyrosine kinase and provoke abnormality of EGFR, block the autophosphorylation of tyrosine debris similar with receptor, via inhibition of following signaling and blockade EGFR dependent multiplication.
The usual prescribed dose of Lindoshil in myelodysplastic syndromes is 10mg should be given as once a day. For renal damaged patients; In Patients with CrCl >60ml/min should not require dosage adjustment of Lindoshil . In Patients with CrCl 30 to 60ml/min, 5mg of Lindoshil should be given orally as once a day. In Patient with CrCl < 30ml/min, 2.5mg of Lindoshil should be administered orally as a once a day. Dosage variation;
Drops to <50000/mcL, therapy should be interrupted. Back to > or equal to 50000/mcL, continue the Lindoshil of 5mg/day.
Drops to <500/mcL, therapy should be postponed. Back to > or equal to 500/mcL, treatment should be continue to 5mg/day.
In this condition, Lindoshil is concomitant with dexamethasone. The usual dose of Lindoshil is 25mg should be administered as once daily on day 1 to 21. The dose of dexamethasone; 40mg of dexamethasone should be followed on day 1 to 4, 9 to 12 & 17 to 20 of each 28 day cycles. Patient with >75 years, 20mg of dexamethasone should be recommended on day 1, 8, 15, & 22.
MANTLE CELL LYMPHOMA
The advised dose of Lindoshil for this condition is 25mg should be administered orally as once daily. For renal damaged patients; Patient with CrCl 30 to 60ml/min, 10mg of Lindoshil should be administered as once daily. Patient with CrCl < 30ml/min, 15mg of Lindoshil should be used for q48hr. Pediatrics; The potency & effectiveness of Lenalidomide has not been evaluated in pediatric patients with age of <18 years.
Second primary malignancies Liver toxicity Hypersensitivity reactions Tumor lysis syndrome Tumor flare reactions Thyroid disorders Fetal toxicity Hematological toxicity Elevation of mortality rate
COMMON SIDE EFFECTS
Fatigue Asthenia Pyrexia Diabetes mellitus Rash Insomnia Depression Deep vein thrombosis Myocardial infraction Renal failure Squamous cell carcinoma Basal cell carcinoma Pain Diarrhea Dyspepsia Bone pain Neck pain Muscle weakness, pain Respiratory infections UTI Influenza Sepsis Headache Anemia Loss of appetite Hypokalemia Hyperglycemia Hypocalcaemia Dehydration Gout
Lindoshil + digoxin, causes increased concentration of digoxin causes increased risk of adverse effects related to digoxin. Lindoshil + Erythropoietic agents, leads to produced increased risk of thrombosis. Counsel the patients before starting this combination treatment. Lindoshil + warfarin, causes increased exposure of bleeding disorders. Monitor the INR value & prothrombin time.
Lindoshil should be contraindicated to pregnancy period. Hypersensitivity reactions are produced due to patients are contraindicated to the Lindoshil component.
The most common life threatening condition like Embryo fetal damage Hypersensitivity reactions Venous & arterial thromboembolism Blood clotting effects Hematological disorders For all these conditions, some supportive measures should be used and provide safety measures.
PREGNANCY & LACTATION
Pregnancy category X Lindoshil causes fetal damage leads to death Breast feeding should not be allowed
Lindoshil capsules should be stored at 20°C to 25°C Protect the container from light Keep away from moisture & heat.
Over dosage of Lindoshil leads to neutropenia & thrombocytopenia as most common adverse effects. Provide general supportive therapy. Monitor the blood cells counts frequently during the treatment.
The missed dose of Lindoshil should be avoided. If missed dose occurs, then patients should be consulting with medical oncologist Maintain the regular dosing schedule.