Patients on immunosuppressive therapy have an increased risk of infections. Since infections have a potential to trigger acute porphyric attacks vigilance is motivated regarding signs or symptoms of infection and/or possible symptoms of a porphyric attack. Side effects like nausea, vomiting, diarrhea and constipation may potentially be porphyrinogenic through reduction in carbohydrate intake.

Infections are common in patients using immunosuppressant drugs. Since infections might trigger an acute porphyric attack, vigilance regarding signs and symptoms of an infection and/ or a porphyric attack is recommended. Common adverse reactions of pomalidomide that can be confused with an acute porphyric attack are nausea, vomiting, diarrhea and constipation. These side effects may potentially be porphyrinogenic if leading to a decrease in carbohydrate intake.

Pomalidomide is a substrate of CYP1A2 and CYP3A4, and it is not an inducer or a mechanism-based inhibitor of CYP enzymes. No pharmacokinetic porphyrinogenic effects are suspected.

Isoindolones. Pomalidomide is an analogue of thalidomide.

Pomalidomide has immunomodulatory and antineoplastic effect and is used in combination with corticosteroid in the treatment of multiple myeloma. Pomalidomide is more potent than both thalidomide (100 times) and Lenalidomide (10 times) (SPC). It is administered orally.

In vitro studies show that pomalidomide is mainly metabolized by CYP1A2 and 3A4, with minor contributions from CYP2C19 and CYP2D6 (Hoffmann 2013, Scott 2014). It is excreted primarily as metabolites in the urine. In vitro studies indicate that pomalidomide is a substrate of P-glycoprotein, and that it is not an inducer or inhibitor of CYP-enzymes (Kassera 2015).