Thalidomide

Thalidomide is a drug that is now used for multiple myeloma and erythema nodosum leprosum, as well as some other skin conditions.

The key side effect is that use in pregnancy may harm the fetus, most commonly resulting in a malformation of the limbs. When the drug was first marketed in 1957 as a wonder drug for morning sickness in pregnancy, it had not been tested in pregnancy. This lead to probably the most controversial and shameful episode in the history of the pharmaceutical industry.

As the birth defects that were associated with thalidomide are thought to have occurred because of the drug’s inhibition of angiogenesis it is tried in multiple myeloma to interfere with the neovascularisation that occurs in the bone marrow. It is usually used in combination with dexamethasone for multiple myeloma.

The mechanism of action of thalidomide in skin conditions is not clear, but it may prevent the immune system from overreacting to an inflammatory disease by reducing the levels of cytokine tumor necrosis factor-alpha (TNF-alpha).

The common side effects of thalidomide are drowsiness, rash, constipation and dizziness. The severe side effects include blood clots and peripheral neuropathy.

Brand name: Thalomid
Chemical formula: C13H10N2O4

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