Immunomodulatory drug (IMiD)
ATC code: L04AX06 (Pomalidomide)
Brand names
Pomalidomida Sandoz, Pomalidomida Accord, Imnovid, Pomalyst
Pomalidomide binds cereblon – a component of the E3 ubiquitin ligase – redirecting it to degrade the transcription factors IKZF1 and IKZF3 in myeloma plasma cells. This blocks tumor proliferation, increases T- and NK-cell activity against myeloma, and inhibits angiogenesis. Third IMiD after thalidomide and lenalidomide, active in patients refractory to both.
Third line
Relapsed or refractory multiple myeloma in adults previously treated with at least two lines including lenalidomide and bortezomib, with progression on the last line. Per IMWG 2024 and SEHH 2023 – third-line and beyond, combined with dexamethasone plus one of: daratumumab, isatuximab, elotuzumab, bortezomib, cyclophosphamide. Dose: 4 mg orally once daily on days 1-21 of a 28-day cycle. Adjust for neutropenia and thrombocytopenia.
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Boxed warning
FDA Black Box: severe birth defects due to teratogenicity (pomalidomide is a thalidomide analog). Use only under the Pregnancy Prevention Programme with mandatory dual contraception in women and male partners.
Categorically contraindicated. Severe teratogenicity (see Black Box). Contraception starting 4 weeks before, during therapy, and for 4 weeks after stopping in women; barrier contraception during therapy and 7 days after in men.
Contraindicated. Likely milk transfer.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Pomalidomide is evaluated for the following indications with varying evidence strength: Multiple myeloma (evidence tier A). See the full indication matrix with dosing and citations above on this page.
Common side effects of Pomalidomide (≥ 1 in 100): Neutropenia, thrombocytopenia, anemia, Fatigue, Constipation and diarrhea, Nausea, Rash, Peripheral neuropathy. See the Safety section for uncommon and serious reactions.
FDA category X. Categorically contraindicated. Severe teratogenicity (see Black Box). Contraception starting 4 weeks before, during therapy, and for 4 weeks after stopping in women; barrier contraception during therapy and 7 days after in men.
Contraindicated. Likely milk transfer.
Pomalidomide is contraindicated in: Pregnancy; Women and men of reproductive age not enrolled in the Pregnancy Prevention Programme; Hypersensitivity; Breastfeeding. Full list in the Safety section.
FDA Black Box: severe birth defects due to teratogenicity (pomalidomide is a thalidomide analog). Use only under the Pregnancy Prevention Programme with mandatory dual contraception in women and male partners.