Drug General Information (ID: DDIBI38QN9)
Drug Name			Mechlorethamine		Drug Info		Thalidomide		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antineoplastics				Immunosuppressive Agents
Structure

Mechanism of Mechlorethamine-Thalidomide Interaction (Severity Level: Major)
Additive thrombogenic effects Click to Show/Hide Mechanism Graph
Drug Name		Mechlorethamine				Thalidomide
Mechanism		Thrombogenic effects				Thrombogenic effects
Key Mechanism Factor 1
		Factor Name		Thrombogenic effects
		Factor Description		Drug-induced thrombosis disrupts the balance between thrombogenic factors and protective mechanisms and tends to produce thrombosis. Drug-induced thrombosis usually causes venous thrombotic events, and arterial thrombotic events are also noted as a result of drug administration
Mechanism Description		Additive thrombogenic effects by the combination of Mechlorethamine and Thalidomide

Recommended Action
Management		Close monitoring for DVT or pulmonary embolism is recommended in patients who require thalidomide therapy in combination with glucocorticoids and/or cytotoxic agents. Patients should be advised to seek medical attention if they develop potential signs and symptoms of thromboembolism such as chest pain, shortness of breath, and pain or swelling in the arms or legs. Prophylaxis with anticoagulants such as low-molecular weight heparins or warfarin may be appropriate, but the decision to take thromboprophylactic measures should be made after careful assessment of underlying risk factors. If a thromboembolic event occurs during therapy with thalidomide, treatment must be discontinued and standard anticoagulation therapy started. Once anticoagulation is stabilized and complications of the thromboembolic event under control, thalidomide may be restarted at the original dose if benefit is deemed to outweigh the risks.

References
1	Figg WD, Arlen P, Gulley J, et al. "A randomized phase II trial of docetaxel (taxotere) plus thalidomide in androgen-independent prostate cancer." Semin Oncol 28(4 Suppl 15) (2001): 62-6. [PMID: 11685731]
2	Fine HA, Wen PY, Maher EA, et al. "Phase II Trial of Thalidomide and Carmustine for Patients With Recurrent High-Grade Gliomas." J Clin Oncol 21 (2003): 2299-304. [PMID: 12805330]
3	Zangari M, Siegel E, Barlogie B, et al "Thrombogenic activity of doxorubicin in myeloma patients receiving thalidomide: implications for therapy." Blood 100 (2002): 1168-71. [PMID: 12149193]