Thalidomide enhances sedative activity of barbiturates, alcohol, chlopromazine, and reserpine Avoid use of otherv drugs that have the potential tocause peripheral neuropathy Increased risks of thrombolic events with darbepoetin- alfa, doxorubicin Increased risks of bonevmarrow suppression with peg interferon-alpha

Multiple myeloma

Severe and irreversible peripheral neuropathy, Constipation, dizziness, orthostatic hypotension,drowsiness, somlonence, bradycardia, Increased of viral load on HIV - infected patients, Hypersensitivity reactions Stevens- Johnson syndrome Toxic epidermal necrolysis and blood dyscrasias

Pregnancy Lactation

Special precautions-

All females of child bearing age should use 2 reliable forms of contraception simutaneously 4 weeks before starting therapy, during and 4 weeks after therapy is discontinued Therapy to be stopped immediately if pregnancy occurs

Male- use of barrier methods of contraception if partner is of child bearing potential Do not donate blood or sperm during therapy Patient should not drive or opperate machinery Discontinune therapy if any skin rash develops

Do not resume therapy if rash is exfoliative, purpuric or bullous or if Stevens- Johnson syndrome or toxic epidermal necrolysis is suspected

Multiple myeloma

Dosage-

Initial dose - 200mg once daily , increased by 100mg at weekly intervals according to patient tolerance Max 800mg daily

Use contraindicated. Observe extreme caution