On March 7, 2022 Teva Pharmaceuticals, a U.S. affiliate of Teva Pharmaceutical Industries Ltd. (NYSE and TASE: TEVA), reported the launch of a first generic version of Revlimid1 (lenalidomide capsules), in 5mg, 10mg, 15mg, and 25mg strengths, in the United States (Press release, Teva, MAR 7, 2022, View Source [SID1234609612]).

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Teva’s Lenalidomide capsules are a prescription medicine used in adults for the treatment of (1) multiple myeloma in combination with the medicine dexamethasone, (2) certain myelodysplastic syndromes, and (3) mantle cell lymphoma following specific prior treatment. Please see the below "What are lenalidomide capsules?" section for more information.

"The launch of our first generic version of Revlimid in the U.S. provides patients with another important treatment option for these extremely challenging conditions, demonstrating Teva’s commitment to making complex generic drugs available to the patients who need them," said Christine Baeder, SVP, Chief Operating Officer US Generics, Teva USA. "This product adds to our broad generic portfolio of oncology treatments, which accounts for 73% of the essential medicines in this category, as defined by the World Health Organization."

With nearly 550 generic medicines available, Teva has the largest portfolio of FDA-approved generic products on the market, and holds the leading position in first-to-file opportunities, with approximately 100 pending first-to-files in the U.S. Currently, 1 in 12 generic prescriptions dispensed in the U.S. is filled with a Teva generic product.

Revlimid had annual sales of $2.3 billion as of December 2021, according to IQVIA data.

What are lenalidomide capsules? Lenalidomide capsules are a prescription medicine, used to treat adults with:

multiple myeloma (MM)
in combination with the medicine dexamethasone
a condition called myelodysplastic syndromes (MDS). Lenalidomide capsules are for the type of MDS with a chromosome problem where part of chromosome 5 is missing. This type of MDS is known as deletion 5q MDS. People with this type of MDS may have low red blood cell counts that require treatment with blood transfusions.
mantle cell lymphoma (MCL) when the disease comes back or becomes worse after treatment with 2 prior medicines, one of which included bortezomib. MCL is a cancer of a type of white blood cell called lymphocytes that are in the lymph nodes.
Lenalidomide capsules should not be used to treat people who have chronic lymphocytic leukemia (CLL) unless they are participants in a controlled clinical trial.

It is not known if lenalidomide capsules are safe and effective in children.

IMPORTANT SAFETY INFORMATION

What is the most important information I should know about lenalidomide capsules?

Before you begin taking lenalidomide capsules, you must read and agree to all of the instructions in the Lenalidomide REMS program. Before prescribing lenalidomide capsules, your healthcare provider will explain the Lenalidomide REMS program to you and have you sign the Patient-Physician Agreement Form.

Lenalidomide capsules may cause serious side effects including:

Possible birth defects (deformed babies) or death of an unborn baby. Females who are pregnant or who plan to become pregnant must not take lenalidomide capsules.

Lenalidomide is similar to the medicine thalidomide. We know thalidomide can cause severe life-threatening birth defects. Lenalidomide capsules have not been tested in pregnant females. Lenalidomide capsules have harmed unborn animals in animal testing.
Females must not get pregnant:

For at least 4 weeks before starting lenalidomide capsules
While taking lenalidomide capsules
During any breaks (interruptions) in your treatment with lenalidomide capsules
For at least 4 weeks after stopping lenalidomide capsules
Females who can become pregnant:

Will have pregnancy tests weekly for 4 weeks, then every 4 weeks if your menstrual cycle is regular, or every 2 weeks if your menstrual cycle is irregular.
If you miss your period or have unusual bleeding, you will need to have a pregnancy test and receive counseling.
Must agree to use two acceptable forms of birth control at the same time, for at least 4 weeks before, while taking, during any breaks (interruptions) in your treatment, and for at least 4 weeks after stopping lenalidomide capsules.
Talk with your healthcare provider to find out about options for acceptable forms of birth control that you may use to prevent pregnancy before, during, and after treatment with lenalidomide capsules.
If you had unprotected sex or if you think your birth control has failed, stop taking lenalidomide capsules immediately and call your healthcare provider right away.
If you become pregnant while taking lenalidomide capsules, stop taking it right away and call your healthcare provider. If your healthcare provider is not available, you can call Customer Care Center at 1‐888‐423‐5436. Healthcare providers and patients should report all cases of pregnancy to:

FDA MedWatch at 1-800-FDA-1088, and
The Lenalidomide REMS program at 1‐888‐423‐5436
There is a pregnancy exposure registry that monitors the outcomes of females who take lenalidomide capsules during pregnancy, or if their male partner takes lenalidomide capsules and they are exposed during pregnancy. You can enroll in this registry by calling the Lenalidomide REMS program at the phone number listed above.

Lenalidomide can pass into human semen:

Males, including those who have had a vasectomy, must always use a latex or synthetic condom during any sexual contact with a pregnant female or a female that can become pregnant while taking lenalidomide capsules, during any breaks (interruptions) in your treatment with lenalidomide capsules, and for up to 4 weeks after stopping lenalidomide capsules.
Do not have unprotected sexual contact with a female who is or could become pregnant. Tell your healthcare provider if you do have unprotected sexual contact with a female who is or could become pregnant.
Do not donate sperm while taking lenalidomide capsules, during any breaks (interruptions) in your treatment, and for 4 weeks after stopping lenalidomide capsules. If a female becomes pregnant with your sperm, the baby may be exposed to lenalidomide and may be born with birth defects.
Men, if your female partner becomes pregnant, you should call your healthcare provider right away.

Low white blood cells (neutropenia) and low platelets (thrombocytopenia). Lenalidomide capsules cause low white blood cells and low platelets in most people. You may need a blood transfusion or certain medicines if your blood counts drop too low. Your healthcare provider should check your blood counts often especially during the first several months of treatment with lenalidomide capsules, and then at least monthly. Tell your healthcare provider if you develop any bleeding or bruising, during treatment with lenalidomide capsules.
Blood clots. Blood clots in the arteries, veins, and lungs happen more often in people who take lenalidomide capsules. This risk is even higher for people with multiple myeloma who take the medicine dexamethasone with lenalidomide capsules. Heart attacks and strokes also happen more often in people who take lenalidomide capsules with dexamethasone. To reduce this increased risk, most people who take lenalidomide capsules will also take a blood thinner medicine.
Before taking lenalidomide capsules, tell your healthcare provider:

If you have had a blood clot in the past
If you have high blood pressure, smoke, or if you have been told you have a high level of fat in your blood (hyperlipidemia)
About all the medicines you take. Certain other medicines can also increase your risk for blood clots. Call your healthcare provider or get medical help right away if you get any of the following during treatment with lenalidomide capsules:
Signs or symptoms of a blood clot in the lung, arm, or leg may include: shortness of breath, chest pain, or arm or leg swelling
Signs or symptoms of a heart attack may include: chest pain that may spread to the arms, neck, jaw, back, or stomach area (abdomen), feeling sweaty, shortness of breath, feeling sick or vomiting
Signs or symptoms of stroke may include: sudden numbness or weakness, especially on one side of the body, severe headache or confusion, or problems with vision, speech, or balance
Who should not take lenalidomide capsules?

Do not take lenalidomide capsules if you:

are pregnant, plan to become pregnant, or become pregnant during treatment with lenalidomide capsules. See "What is the most important information I should know about lenalidomide capsules?"
are allergic to lenalidomide or any of the ingredients in lenalidomide capsules. See the end of the Medication Guide for a complete list of ingredients in lenalidomide capsules.
What should I tell my healthcare provider before taking lenalidomide capsules?

Before you take lenalidomide capsules, tell your healthcare provider about all of your medical conditions, including if you:

have liver problems
have kidney problems or receive kidney dialysis treatment
have thyroid problems
have had a serious skin rash with thalidomide treatment. You should not take lenalidomide capsules.
are lactose intolerant. Lenalidomide capsules contain lactose.
are breastfeeding. Do not breastfeed during treatment with lenalidomide capsules. It is not known if lenalidomide passes into your breast milk and can harm your baby.
Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Lenalidomide capsules and other medicines may affect each other, causing serious side effects. Talk with your healthcare provider before taking any new medicines.

Know the medicines you take. Keep a list of them to show your healthcare provider and pharmacist.

What should I avoid while taking lenalidomide capsules?

See "What is the most important information I should know about lenalidomide capsules?"
Females: Do not get pregnant and do not breastfeed while taking lenalidomide capsules.
Males: Do not donate sperm.
Do not share lenalidomide capsules with other people. It may cause birth defects and other serious problems.
Do not donate blood while you take lenalidomide capsules, during any breaks (interruptions) in your treatment, and for 4 weeks after stopping lenalidomide capsules. If someone who is pregnant gets your donated blood, her baby may be exposed to lenalidomide and may be born with birth defects.
What are the possible side effects of lenalidomide capsules?

Lenalidomide capsules can cause serious side effects, including:

See "What is the most important information I should know about lenalidomide capsules?"
Increased risk of death in people who have chronic lymphocytic leukemia (CLL). People with CLL who take lenalidomide capsules have an increased risk of death compared with people who take the medicine chlorambucil. Lenalidomide capsules may cause you to have serious heart problems that can lead to death, including atrial fibrillation, heart attack, or heart failure. You should not take lenalidomide capsules if you have CLL unless you are participating in a controlled clinical trial.
Risk of new cancers (malignancies). An increase in new (second) cancers has happened in patients who received lenalidomide capsules and melphalan, or a blood stem cell transplant, including certain blood cancers, such as acute myelogenous leukemia (AML), and myelodysplastic syndrome (MDS) and certain other types of cancers of the skin and other organs. Talk with your healthcare provider about your risk of developing new cancers if you take lenalidomide capsules. Your healthcare provider will check you for new cancers during your treatment with lenalidomide capsules.
Severe liver problems, including liver failure and death. Your healthcare provider should do blood tests to check your liver function during your treatment with lenalidomide capsules. Tell your healthcare provider right away if you develop any of the following symptoms of liver problems:
yellowing of your skin or the white part of your eyes (jaundice
dark or brown (tea-colored) urine
pain on the upper right side of your stomach area (abdomen)
bleeding or bruising more easily than normal
feeling very tired
Severe skin reactions and severe allergic reactions can happen with lenalidomide capsules and may cause death.
Call your healthcare provider right away if you develop any of the following signs or symptoms during treatment with lenalidomide capsules:
a red, itchy, skin rash
peeling of your skin or blisters
severe itching
fever
Get emergency medical help right away if you develop any of the following signs or symptoms during treatment with lenalidomide capsules:

swelling of your lips, mouth, tongue, or throat
trouble breathing or swallowing
raised red areas on your skin (hives)
a very fast heartbeat
you feel dizzy or faint
Tumor lysis syndrome (TLS). TLS is caused by the fast breakdown of cancer cells. TLS can cause kidney failure and the need for dialysis treatment, abnormal heart rhythm, seizure and sometimes death. Your healthcare provider may do blood tests to check you for TLS.
Worsening of your tumor (tumor flare reaction). Tell your healthcare provider if you get any of these symptoms of tumor flare reaction while taking lenalidomide capsules: tender swollen lymph nodes, low grade fever, pain, or rash.
Your healthcare provider may tell you to decrease your dose, temporarily stop or permanently stop taking lenalidomide capsules if you develop certain serious side effects during treatment with lenalidomide capsules.

Thyroid problems. Your healthcare provider may check your thyroid function before you start taking lenalidomide capsules and during treatment with lenalidomide capsules.
Risk of Early Death in MCL. In people who have Mantle Cell Lymphoma (MCL), there may be a risk of dying sooner (early death) when taking lenalidomide capsules. Talk with your healthcare provider about any concerns and possible risk factors.
The most common side effects of lenalidomide capsules include:

diarrhea
rash
nausea
constipation
tiredness or weakness
fever
itching
swelling of your arms, hands, legs, feet and skin
sleep problems (insomnia)
headache
muscle cramps or spasms
shortness of breath
cough, sore throat, and other symptoms of a cold
upper respiratory tract infection or bronchitis
inflammation of the stomach and intestine ("stomach flu")
nose bleed
shaking or trembling (tremor)
joint aches
pain in your back or stomach-area (abdomen)
These are not all the possible side effects of lenalidomide capsules. Call your doctor for medical advice about side effects. You are encouraged to report side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Please read the Medication Guide in the full Prescribing Information including Boxed Warning.