Thalidomide

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Thalidomide is synthetic glutamic acid derivative that was originally used to treat morning sickness in pregnancy. It was made infamous owing to its teratogenic effects in pregnancy.

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Thalidomide Babies

The drug was introduced in 1957 in Germany and April 1958 in the UK. Several doctors in Germany (Lenz), UK (Speirs) and Australia (McBride) began noticing limb deformities and began to suspect thalidomide might be responsible.[1][2] It was withdrawn from use in the UK in November 1961.

Thalidomide left a legacy of thousands of 'thalidomide babies' who were born with severe birth defects, particularly involving abnormal limb development. This was observed in several countries around the world with the exception of the USA, where the US Food and Drug Administration (FDA) refused approval because of the neuropathy associated with its use.

The lessons from thalidomide led to a much more cautious approach to prescribing in pregnancy. Several medications appear to have a safe profile in pregnancy and are routinely used in obstetrics (e.g. opioids and certain antibiotics). However, most other drugs are generally avoided if at all possible, even in the absence of adverse teratogenic effects in experimental conditions.

Current Uses

Thalidomide has anti-angiogenic properties probably mediated by its function as an inhibitor of basic fibroblast growth factor-2 (bFGF) and immuno-modulatory effects as it is a tumour necrosis factor alpha (TNF-α) inhibitor . Thalidomide and chemical derivatives of thalidomide now have a role in treatment of multiple myeloma.[3][4][5]

  • It should no longer be used in leprosy as both steroids and more importantly clofazimine are more effective without the potential for misuse in women of childbearing age(WHO recommendation)
  • In 2008 The European Medicines Agency (EMEA) has recommended that it can be relicensed for multiple myeloma. The precautions recommended include particular information leaflets for both male and female users, and might be thus seen medicolegally as the minimum standard of information that should be given to patients.
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The MHRA has indicated on 8th December 2008 that it does not believe a case can be made by clinicians in the UK under the relevant medicines legislation for the (continued) patient specific use of 50mg and 100mg thalidomide tablets from unlicensed sources for any indication[6]

Pharmacology

It is pointless using pure R-thalidomide as a safe drug as enzymatic transformation in humans produces some S-thalidomide from R-thalidomide.

See Also

References