Lenalidomide

Symptoms of drug allergy including one or more of the following:

• Swollen face/eyes/lips/tongue
• Difficulty in breathing
• Itchy skin rashes over your whole body

Decrease in white blood cell count

• This may increase your chances of getting an infection.

• To reduce risk of infection:
• Maintain good hand hygiene. Wash your hands before handling food and after using the toilet.
• Avoid crowds and do not go near people who are sick. Wear a mask if necessary.
• Eat freshly cooked and well-cooked food. Avoid raw meats, vegetables and eggs, or half-cooked or uncooked food.
• Proceed to the A&E department immediately if you have any signs of infection, such as having
  • A fever of 38°C and above
  • Chills
  • Bad sore throat
  • Pain when you pass urine
  • Mouth sores or wounds that do not heal

You should avoid taking Paracetamol to relieve fever as this may mask your fever and delay the treatment of your infection

Decrease in platelet count

• Low platelet levels can increase your chance of bleeding. 

• To reduce risk of bleeding:
  • Be careful when using sharp objects such as scissors or knives.
  • Brush your teeth gently with a soft bristle toothbrush to prevent gum bleeding.
  • Try not to bruise, cut or knock yourself. Apply direct pressure to any cuts or wounds to help stop bleeding
• Proceed to the A&E department immediately if you have:
  • Blood in the urine
  • Black, sticky or bloody stools
  • Unexplained large bruises
  • Coughing out blood or coffee-ground like vomit
  • Bleeding which does not stop

Decrease in number of red blood cells (anaemia)

• This means there are less red blood cells in your body to carry oxygen to your organs and tissues.
• Symptoms may include worsening tiredness, pale skin or lips, feeling breathless more easily, or having a fast heartbeat while resting.

• Proceed to the A&E department immediately if you have:
  • Unusual giddiness or light-headedness that does not go away
  • Severe breathlessness or rapid breathing
  • An unusually fast heartbeat while resting

Nerve problems

You may experience numbness or tingling sensation in the hands or feet.

This side effect usually affects the fingertips and toes or soles of feet after a few cycles of treatment.

• Inform your doctor if this symptom troubles you or affects your daily activities such as buttoning up shirts or picking up objects.
• Take extra care when walking or getting up if the numbness affects your feet, and when handling hot or sharp objects.

• Consume more fibre by eating more fruits and vegetables, unless otherwise advised by your doctor to limit the amount of fibre you can take.
• Drink enough fluids every day (at least 2 litres or 8 glasses) unless otherwise advised by your doctor.
• Your doctor may prescribe medications to help relieve or prevent constipation. Take these as instructed.

• Drink plenty of clear fluids (at least 2 litres or 8 glasses every day) unless otherwise advised by your doctor.
• Eat food that is gentler on the stomach such as porridge or soup.
• Avoid milk, dairy products, high-fibre food and oily or spicy food.
• Your doctor may prescribe medications to help relieve diarrhoea. Take these as instructed.

• Do not drive or operate machinery if you are feeling tired.
• Eat well and get enough sleep. Prioritize tasks to ensure you make the best use of your energy.
• Simple exercise such as walking can help to boost your energy.
• Avoid alcohol as this may cause you to feel more tired and drowsy.

• Avoid hot showers. Use cool or lukewarm water to bathe.
• Apply a moisturiser to areas with dry skin.
• Avoid staying out under the sun. Use sunscreen with Sun Protection Factor (SPF) of at lease 30 and covered clothinh when you are out in the sun.
• Please see a doctor immediately if the rashes are painful, blistering, or affect a large area of the body.

Abnormal blood clot 

This may occur in the one of the legs or arms (deep vein thrombosis [DVT]) or lungs (pulmonary embolism [PE])

Symptoms of DVT may include swelling,redness, pain, warmth or redness of theaffected arm or leg

Symptoms of PE may include sudden chest pain, shortness of breath or coughing up blood.

• Proceed to the A&E department immediately.
• You may be given a medication which help reduce the risk or prevent the formation of blood clots.

Symptoms of a stroke, such as:

• Sudden onset of severe headache
• Eyesight changes
• Trouble talking or moving properly
• Drooping of the face, weakness or numbness in an arm or leg.

• If you experience any of these symptoms, call 995 for an ambulance and proceed to the A&E department immediately.
• Learn how to recognise symptoms of a stroke using the FAST acronym: https://www.healthhub.sg/a-z/diseases-and-conditions/stroke-emergency

Symptoms of a heart attack, such as:

• A discomfort in the middle of your chest that lasts for a few minutes or goes away and comes back;
• Shortness of breath with or without chest discomfort;
• Chest pain or chest discomfort that feels like an uncomfortable heavy pressure;
• Sensation of squeezing or fullness in the chest area, or
• Pain at the chest area.

• If you experience any of these symptoms, call 995 for an ambulance and proceed to the A&E department immediately. 

• Rarely, this medication can injure or damage the liver
  • A liver injury may recover on its own. However, in some cases, it can cause serious liver damage
• Stop this medication and proceed to the A&E department immediately if you experience any:
  • Dark coloured urine
  • Light-coloured stools
  • Yellowing of your skin or eyes
  • Nausea, vomiting that does not go away
  • Severe abdominal pain

This medication can cause Progressive Multifocal Leukoencephalopathy, which is a rare but serious viral infection of the brain. This can cause problems with brain function and symptoms can include: 

• Changes in your mood or usual behaviour
• Feeling confused or having difficulty thinking
• Memory loss
• Changes in your vision, speech, or walking
• Decreased strength or weakness on one side of the body

• Proceed to the A&E department immediately.

If you need to go to the hospital for any reason other than cancer, always inform the doctors and nurses that you are receiving anti-cancer treatment.

Talk to your cancer doctor if you think you need dental treatment. Always inform your dentist that you are receiving anti-cancer treatment.

It is normal to feel fearful or worried about your condition.

Do not be afraid to talk about your concerns with your healthcare team or loved ones.

There may be resources and support available to help you.