Pomalidomide

• In Aotearoa New Zealand, pomalidomide is available as capsules in different strengths (1 mg, 2 mg, 3 mg and 4 mg).
• The usual dose of pomalidomide is 4 mg once a day. 
• Your prescriber may adjust your dose depending on the result of blood tests and any side effects you may have.
• Always take your pomalidomide exactly as your doctor has told you. The pharmacy label on your medicine will tell you how much to take, how often to take it, and any special instructions.

• Take care when handling the capsules: Remove your capsules carefully from the packaging and wash your hands afterwards.
• Timing: Take pomalidomide once a day, at the same time each day.
• Swallow the capsules whole, preferably with water: Don't open, break or chew the capsules. If powder from a broken pomalidomide capsule touches your skin, wash the skin immediately and thoroughly with soap and water.
• Food: You can take your capsules with or without food. 
• Missed dose: If you forget to take your dose, take it as soon as you remember. But if it's less than 12 hours until your next dose, just take the next dose at the right time. Don't take double the dose.

Pregnancy Prevention Program

Pomalidomide is only available in Aotearoa New Zealand as part of a special programme.

• Women and men must be enrolled and agree to the conditions of the program before they can get pomalidomide.
• Only prescribers registered with the pregnancy prevention programme can prescribe this medicine.
• Only pharmacies/pharmacists registered with pregnancy prevention programme can dispense this medicine.

Females

It's very important to make sure you don't become pregnant.
Note: Even if you are not having regular periods or are near menopause, you may still be able to become pregnant.

• You must use effective contraception at least 1 month before, during, and for at least 1 month after treatment, including during pomalidomide dose interruptions.
• You must have a pregnancy test before starting treatment to check that you're not pregnant and be re-tested every month (before each dispensing) and 1 month after the end of treatment.
• Note: The pregnancy test must be organised by your doctor. You can't use the home pregnancy test kits available from a pharmacy or supermarket. This is to make sure that the test is done accurately and your doctor can give you immediate advice based on the results.
• You should start your pomalidomide treatment as soon as you've had a negative pregnancy test result.
• Make sure you get your pomalidomide within 7 days of it being prescribed, or you'll need a new pregnancy test to get a new prescription.

Contraception: Not all types of contraception are suitable during pomalidomide treatment. Only the options with a very low failure rate (less than 1%) are recommended. This means that with perfect use, fewer than 1 out of 100 women using the method will become pregnant in a year.

Recommended contraception:

• Hormone releasing intra-uterine device (IUD) eg, Jaydess and Mirena.
• Hormone implant (Jadelle).
• Depot hormone injection (Depot-Provera).
• Tubal ligation.
• Partner’s vasectomy (confirmed by 2 negative semen analyses).
• Progestogen-only oral contraceptive pill desogestrel (Cerazette).

Contraception that's not recommended:

• Copper IUD (increased risk of infections and bleeding).
• Combined oral contraceptive pill (because of increased risk of blood clots).
• Condoms (unreliable).
• Fertility awareness (unreliable).

You and your partner should talk to your doctor about suitable forms of contraception that you both find acceptable.

Males

Pomalidomide passes into human semen, so there's a risk that the medicine can be passed to partners who can get pregnant during sex. Therefore, it's important for men who are taking pomalidomide to use effective contraception to prevent pregnancy in their partners.

• If your partner is pregnant or able to become pregnant and doesn’t use effective contraception, you must use condoms during your treatment and dose interruptions and for 7 days after you stop pomalidomide.
• Note: Even if you've had a vasectomy, you must use a condom throughout your pomalidomide treatment.
• If your partner does become pregnant while you're taking pomalidomide, or within the 7 days after you've stopped taking it, let your prescriber know immediately. Your partner should also contact their doctor immediately.
• Don't donate semen or sperm during treatment or treatment interruption, or for at least 1 week after stopping treatment. 
• Don't donate blood – in Aotearoa New Zealand, people with myeloma are permanently excluded from donating blood.
• You must get your pomalidomide within 28 days of it being prescribed, or you'll need a new prescription.

Handling and storing pomalidomide

• Store pomalidomide in the original, labelled container in a safe place, out of reach of children and pets.
• This medicine shouldn't be stored in a pillbox.
• Pregnant or breastfeeding people shouldn't not handle the medicine for you.
• Healthcare providers, caregivers and family members should wear disposable gloves when handling the blister or capsule. Gloves should then be removed carefully to prevent contact with the skin, placed in a sealable plastic polyethylene bag and disposed of as advised by your healthcare team.
• Don't share your medicines with anyone else, even if they have similar symptoms to you. 
• Ask your healthcare team where to return any unused medication for disposal. Don't flush it down the toilet or throw it in the rubbish.

Vaccinations

• Since pomalidomide affects your immune system, you're at increased risk of infection. It's important that you're up to date with the annual flu vaccination and the COVID-19 vaccinations. These are non-live vaccines and they're safe to have while you're taking pomalidomide.
• You shouldn't be given any live vaccines, such as MMR (measles, mumps and rubella) and varicella (chickenpox vaccine), while you're receiving pomalidomide and for 6 months after treatment has stopped. Ask your healthcare team if you have questions.

Treatment delays

There may be times when your treatment is delayed. This can happen:

• if you get severe side effects
• if your blood counts are affected
• if you're finding it hard to cope with the treatment.

Your doctor will tell you if you need any delays to your treatment and the reason why.

Other medicines

Pomalidomide interacts with some other medicines, herbal supplements and rongoā Māori, so check with your doctor or pharmacist before starting pomalidomide and before starting any new products.

Like all medicines, pomalidomide can cause side effects, although not everyone gets them. Because pomalidomide affects your immune system, it may cause a variety of side effects. It may also make you more unwell with other illnesses.

• You may experience side effects at any time during your treatment. Some side effects go away within a few days or weeks and some may be longer lasting.
• To monitor your side effects, you'll need regular reviews and blood tests to check your liver, kidneys and blood before you start treatment and regularly while you are receiving treatment.