Adults

Dosage varies significantly based on indication and patient's renal function. For Multiple Myeloma: Typically 25 mg orally once daily on days 1-21 of a 28-day cycle, in combination with dexamethasone. For MDS: 10 mg orally once daily. For MCL: 25 mg orally once daily on days 1-21 of a 28-day cycle. Always consult prescribing information.

Elderly

No specific dose adjustment based solely on age, but renal function should be assessed, and dose adjusted accordingly.

Renal_impairment

Significant dose reduction required based on creatinine clearance. For CrCl 30-60 mL/min, initial dose may be 10 mg daily; for CrCl <30 mL/min (not requiring dialysis), 5 mg daily; for dialysis-dependent, 5 mg daily on dialysis days.

Onset

Onset of therapeutic effect varies depending on the indication, typically weeks to months.

Excretion

Primarily excreted by the kidneys, with approximately 80-90% of the dose recovered in urine as unchanged drug within 24 hours.

Half life

Mean elimination half-life is approximately 3-9 hours, prolonged in patients with renal impairment.

Absorption

Rapidly absorbed after oral administration, peak plasma concentrations reached within 0.5 to 6 hours. Bioavailability is approximately 60%.

Metabolism

Minimally metabolized; primarily excreted as unchanged drug. No significant metabolism by cytochrome P450 enzymes.

Digoxin

Increased digoxin exposure; monitor digoxin levels.

Warfarin

Increased risk of bleeding or thrombosis; monitor INR closely.

Oral Contraceptives

Lenalidomide's primary concern is teratogenicity, not direct interaction affecting contraceptive efficacy. Strict contraception is mandatory via REMS.

Erythropoietic Stimulating Agents (ESAs), other myelosuppressive drugs

Increased risk of myelosuppression (neutropenia, thrombocytopenia).