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Thalidomide side effects: what 36,495 FDA adverse event reports show

Thalidomide · Thalomid · 1,173 reaction terms · 107,133 drug–reaction co-reports · data 2026-09-14
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Drug class

Not stated in label

Brand names

Thalomid

openFDA label

Who reports

36,495 reports · 89% serious · 12,161 with death outcome · 44% female

openFDA FAERS counts, all years, deduplication not applied

Used for

• THALOMID in combination with dexamethasone is indicated for the treatment of patients with newly diagnosed multiple myeloma (MM). ( 1.1 ) • THALOMID is indicated for the acute treatment of the cutaneous manifestations of moderate to severe erythema nodosum leprosum (ENL). THALOMID is not indicated as monotherapy for such ENL treatment in the presence of moderate to severe neuritis.

FDA label, Indications and Usage

What it is

THALOMID, α-(N-phthalimido) glutarimide, is an immunomodulatory agent.

FDA label, Description section

Boxed warning

EMBRYO-FETAL TOXICITY AND VENOUS THROMBOEMBOLISM WARNING: EMBRYO-FETAL TOXICITY AND VENOUS THROMBOEMBOLISM See full prescribing information for complete boxed warning. EMBRYO -FETAL TOXICITY • If THALOMID is taken during pregnancy, it can cause severe birth defects or embryo-fetal death.

FDA label
How to read this page. FAERS is a spontaneous-reporting system: counts are not incidence rates and a signal is not proof of causation. Each reaction below is run through an automated screen — is the term in the FDA label (known), in the indications (the disease being treated), an administrative/coding term, or none of these (unlabeled)? That screen is mechanical text matching, not a causality assessment. The 30 hand-written Bradford Hill assessments are on the causality assessment page. Not medical advice.

Causality screen of the 40 strongest signals

Labeled — boxed warning 1Labeled adverse reaction 2Labeled (related wording) 4Likely indication confounding 3Reporting / coding artifact 1Lab value / disease marker 2Not in label — unassessed 27
What the badges mean

Strongest disproportionality signals

Flagged terms (PRR ≥ 2, χ² ≥ 4, n ≥ 10), ranked by PRR; infinite PRRs (no comparator reports) excluded. The EBGM column is a second, shrinkage-based estimate (MGPS) with its 5th percentile EB05 and the BCPNN IC025; a pair flagged by PRR alone is marked PRR-only and should be read as fragile. The strata column recomputes the PRR on serious reports only (and, for the 300 most-reported drugs, adjusted for age band), and flags pairs whose reports are unusually skewed by sex or come mostly from consumers. Each row also shows the PRR against the other drugs of the same FDA class, which removes most confounding by the condition being treated, and a calibrated p-value: on validation, known non-causes average an ROR of about 2, so significance is judged against that empirical null (✓ = p < 0.05 after calibration). 1,133 further terms are in the interactive explorer. Reaction links open the term's cross-drug page.

Show:
ReactionReportsPRR 95% CI · ROR · χ²/pEBGM EB05 · IC025Label screenSerious-only & strataTrial cross-check
Actinomycotic sepsis171,202.6
519.0–2,786.4ROR 1,203.1 · calibrated p 6e-14 ✓
269.0 EB05 177.9 · IC025 +4.2
3/3 methods agree
Not in label — unassessedserious n=17not reported in cached trials
Blood human chorionic gonadotropin increased113633.2
484.2–827.9ROR 635.1 · calibrated p 1e-14 ✓
284.9 EB05 243.5 · IC025 +6.7
3/3 methods agree
Lab value / disease markerserious n=113 · ♀ 100% (drug 44%) · 100% cliniciannot reported in cached trials
Blood human chorionic gonadotropin abnormal16503.0
256.5–986.4ROR 503.3 · calibrated p 1e-11 ✓
202.6 EB05 132.2 · IC025 +4.0
3/3 methods agree
Lab value / disease markerserious n=16not reported in cached trials
Leukaemia plasmacytic45217.7
154.4–306.9ROR 217.9 · calibrated p 6e-10 ✓
147.7 EB05 114.9 · IC025 +5.4
3/3 methods agree
Not in label — unassessedserious n=44 · 100% clinicianNCT00689936: 1/541 (0.2%) on Thalidomide (serious AE)
Myeloma recurrence24178.7
113.0–282.8ROR 178.8 · calibrated p 6e-9 ✓
123.0 EB05 87.0 · IC025 +4.5
3/3 methods agree
Likely indication confounding
term in indications
serious n=24not reported in cached trials
Type 2 lepra reaction43170.2
121.0–239.3ROR 170.4 · calibrated p 4e-9 ✓
124.0 EB05 95.9 · IC025 +5.2
3/3 methods agree
Not in label — unassessedserious n=40 · ♀ 0% (drug 44%) · 100% cliniciannot reported in cached trials
Multiple myeloma856127.0
118.1–136.7ROR 130.1 · calibrated p 2e-8 ✓
103.7 EB05 98.0 · IC025 +6.5
3/3 methods agree
Labeled — boxed warning
exact term
serious n=850 · 94% clinicianNCT00689936: 1/541 (0.2%) on Thalidomide (serious AE)
Pseudomyopia18107.2
64.8–177.5ROR 107.3 · calibrated p 3e-7 ✓
82.6 EB05 55.3 · IC025 +3.9
3/3 methods agree
Not in label — unassessedserious n=18not reported in cached trials
Ivth nerve paralysis34101.3
70.3–145.9ROR 101.4 · calibrated p 2e-7 ✓
82.2 EB05 61.5 · IC025 +4.7
3/3 methods agree
Not in label — unassessedserious n=34 · ♀ 0% (drug 44%) · 100% cliniciannot reported in cached trials
Medulloblastoma2088.4
55.2–141.6ROR 88.5 · calibrated p 1e-6 ✓
71.6 EB05 48.9 · IC025 +4.0
3/3 methods agree
Not in label — unassessedserious n=19not reported in cached trials
Hepatosplenic t-cell lymphoma4476.9
56.1–105.3ROR 76.9 · calibrated p 1e-6 ✓
65.9 EB05 51.1 · IC025 +4.8
3/3 methods agree
Not in label — unassessedserious n=44 · ♀ 100% (drug 44%) · 91% cliniciannot reported in cached trials
Plasmacytoma21273.1
63.4–84.3ROR 73.5 · calibrated p 1e-6 ✓
64.5 EB05 57.5 · IC025 +5.6
3/3 methods agree
Not in label — unassessedserious n=211NCT00689936: 3/541 (0.6%) on Thalidomide (serious AE)
Plasmacytosis1962.9
39.1–101.0ROR 62.9 · calibrated p 9e-6 ✓
53.8 EB05 36.4 · IC025 +3.8
3/3 methods agree
Not in label — unassessedserious n=19not reported in cached trials
Wound debridement3958.5
42.1–81.4ROR 58.6 · calibrated p 8e-6 ✓
51.9 EB05 39.6 · IC025 +4.5
3/3 methods agree
Not in label — unassessedserious n=40 · 100% cliniciannot reported in cached trials
Plasma cell myeloma refractory11958.1
48.1–70.1ROR 58.2 · calibrated p 6e-6 ✓
52.3 EB05 44.9 · IC025 +5.1
3/3 methods agree
Likely indication confounding
shares a disease stem with the indications wording
serious n=119 · 100% cliniciannot reported in cached trials
Plasma cell myeloma recurrent29757.4
50.9–64.6ROR 57.8 · calibrated p 6e-6 ✓
52.0 EB05 47.2 · IC025 +5.4
3/3 methods agree
Likely indication confounding
shares a disease stem with the indications wording
serious n=288not reported in cached trials
Neuropathy15155.1
46.6–65.1ROR 55.3 · calibrated p 8e-6 ✓
50.0 EB05 43.6 · IC025 +5.2
3/3 methods agree
Labeled adverse reaction
exact term
serious n=146 · 92% clinicianNCT00689936: 1/541 (0.2%) on Thalidomide (serious AE)
Bone debridement4152.6
38.2–72.4ROR 52.7 · calibrated p 2e-5 ✓
47.2 EB05 36.3 · IC025 +4.4
3/3 methods agree
Not in label — unassessedserious n=41 · 100% cliniciannot reported in cached trials
Refractory cancer1852.0
32.1–84.2ROR 52.0 · calibrated p 3e-5 ✓
45.5 EB05 30.5 · IC025 +3.6
3/3 methods agree
Not in label — unassessedserious n=18not reported in cached trials
Carcinoma2147.9
30.7–74.8ROR 47.9 · calibrated p 4e-5 ✓
42.7 EB05 29.4 · IC025 +3.7
3/3 methods agree
Not in label — unassessedserious n=21NCT00689936: 1/541 (0.2%) on Thalidomide (serious AE)
Primary sequestrum6543.7
34.0–56.3ROR 43.8 · calibrated p 4e-5 ✓
40.2 EB05 32.7 · IC025 +4.6
3/3 methods agree
Not in label — unassessedserious n=64not reported in cached trials
Aseptic necrosis bone5643.7
33.3–57.3ROR 43.7 · calibrated p 4e-5 ✓
40.1 EB05 32.0 · IC025 +4.5
3/3 methods agree
Not in label — unassessedserious n=56 · 100% cliniciannot reported in cached trials
Pregnancy of partner5043.1
32.3–57.4ROR 43.1 · calibrated p 5e-5 ✓
39.5 EB05 31.2 · IC025 +4.4
3/3 methods agree
Not in label — unassessedserious n=48 · ♀ 0% (drug 44%)not reported in cached trials
Tuberculosis of central nervous system1739.1
23.9–63.9ROR 39.1 · calibrated p 1e-4 ✓
35.3 EB05 23.4 · IC025 +3.4
3/3 methods agree
Not in label — unassessedserious n=17not reported in cached trials
Morganella infection1837.5
23.2–60.3ROR 37.5 · calibrated p 2e-4 ✓
34.0 EB05 22.8 · IC025 +3.4
3/3 methods agree
Not in label — unassessedserious n=18not reported in cached trials
Paraproteinaemia1835.0
21.7–56.3ROR 35.0 · calibrated p 2e-4 ✓
32.0 EB05 21.4 · IC025 +3.4
3/3 methods agree
Not in label — unassessed–not reported in cached trials
Congenital aplasia1633.5
20.3–55.5ROR 33.6 · calibrated p 3e-4 ✓
30.7 EB05 20.0 · IC025 +3.2
3/3 methods agree
Not in label — unassessedserious n=16not reported in cached trials
Actinomycosis5333.3
25.3–44.0ROR 33.4 · calibrated p 2e-4 ✓
31.2 EB05 24.8 · IC025 +4.2
3/3 methods agree
Not in label — unassessedserious n=52not reported in cached trials
Human chorionic gonadotropin increased4832.6
24.4–43.6ROR 32.6 · calibrated p 2e-4 ✓
30.5 EB05 23.9 · IC025 +4.1
3/3 methods agree
Not in label — unassessedserious n=42 · ♀ 100% (drug 44%) · 100% cliniciannot reported in cached trials
Sequestrectomy3632.4
23.2–45.4ROR 32.5 · calibrated p 3e-4 ✓
30.3 EB05 22.9 · IC025 +3.9
3/3 methods agree
Not in label — unassessedserious n=35not reported in cached trials
Oral soft tissue disorder1832.2
20.1–51.8ROR 32.3 · calibrated p 4e-4 ✓
29.7 EB05 19.9 · IC025 +3.3
3/3 methods agree
Not in label — unassessedserious n=17not reported in cached trials
Exposure via body fluid4232.1
23.5–43.8ROR 32.2 · calibrated p 3e-4 ✓
30.1 EB05 23.2 · IC025 +4.0
3/3 methods agree
Reporting / coding artifactserious n=42 · ♀ 100% (drug 44%)not reported in cached trials
B-cell type acute leukaemia3731.2
22.4–43.4ROR 31.2 · calibrated p 3e-4 ✓
29.2 EB05 22.1 · IC025 +3.9
3/3 methods agree
Not in label — unassessedserious n=37 · 100% cliniciannot reported in cached trials
Renal cell carcinoma stage unspecified2829.3
20.1–42.9ROR 29.4 · calibrated p 5e-4 ✓
27.5 EB05 20.0 · IC025 +3.6
3/3 methods agree
Not in label — unassessedserious n=28 · 100% cliniciannot reported in cached trials
Amyloidosis8429.3
23.6–36.5ROR 29.4 · calibrated p 3e-4 ✓
27.8 EB05 23.1 · IC025 +4.2
3/3 methods agree
Labeled adverse reaction
exact term
serious n=82NCT00689936: 1/541 (0.2%) on Thalidomide (serious AE)
Cellulitis staphylococcal3027.6
19.1–39.8ROR 27.6 · calibrated p 6e-4 ✓
26.0 EB05 19.1 · IC025 +3.6
3/3 methods agree
Not in label — unassessedserious n=28 · ♀ 65% (drug 44%) · 100% cliniciannot reported in cached trials

Trial evidence (ClinicalTrials.gov)

✓ Trial adverse-event data found on ClinicalTrials.gov

Largest completed trials with posted results that list Thalidomide as a study intervention. The right-hand column of the signal table shows whether each FAERS term was also recorded in these trials, with a real denominator (6 of 40 signal terms matched).

Caveats: trial populations, doses and follow-up differ from the reporting population; AE terms are sponsor-coded and matched here by wording; absence from a trial list means the term was not reported above the sponsor's frequency threshold, not that it cannot occur.

Most frequently reported reactions

By raw co-report count, regardless of disproportionality. Common terms here are often the illness itself or generic outcomes.

ReactionReportsPRR 95% CI · ROR · χ²/pEBGM EB05 · IC025Label screenSerious-only & strataTrial cross-check
Death6,4124.3
4.2–4.4ROR 5.0 · calibrated p 0.234
4.3 EB05 4.2 · IC025 +2.1
3/3 methods agree
Outcome field, not a reaction
boxed warning mentions mortality
serious PRR 2.8NCT00689936: 1/541 (0.2%) on Thalidomide (serious AE)
Disease progression2,49512.4
11.9–12.9ROR 13.2 · calibrated p 0.012 ✓
12.2 EB05 11.8 · IC025 +3.5
3/3 methods agree
Reporting / coding artifactserious PRR 9.1 · 96% cliniciannot reported in cached trials
Off label use (used outside approved label)1,7851.2
1.1–1.2ROR 1.2 · calibrated p 0.434
1.2 EB05 1.1 · IC025 +0.2Reporting / coding artifactserious PRR 1.1not reported in cached trials
Pneumonia (lung infection)1,7133.1
2.9–3.2ROR 3.2 · calibrated p 0.578
3.0 EB05 2.9 · IC025 +1.5
3/3 methods agree
Labeled adverse reaction
exact term
serious PRR 2.0NCT00689936: 1/540 (0.2%) on Thalidomide (serious AE)
Fatigue (tiredness)1,4101.0
1.0–1.1ROR 1.0 · calibrated p 0.336
1.0 EB05 1.0 · IC025 -0.0
PRR-only: not supported by EBGM or IC
Labeled adverse reaction
exact term
serious PRR 1.0NCT00689936: 3/541 (0.6%) on Thalidomide (serious AE)
Drug ineffective (drug did not work)1,1480.5
0.5–0.5ROR 0.5 · calibrated p 0.044 ✓
0.5 EB05 0.5 · IC025 -1.1
PRR-only: not supported by EBGM or IC
Reporting / coding artifactserious PRR 0.8not reported in cached trials
Anaemia (low red blood cells)1,0233.1
2.9–3.3ROR 3.2 · calibrated p 0.579
3.1 EB05 2.9 · IC025 +1.5
3/3 methods agree
Labeled adverse reaction
exact term
serious PRR 2.2NCT00689936: 23/541 (4.3%) on Thalidomide (serious AE)
Asthenia (weakness)1,0211.6
1.5–1.7ROR 1.6 · calibrated p 0.692
1.6 EB05 1.5 · IC025 +0.5Labeled adverse reaction
exact term
serious PRR 1.3NCT00689936: 5/541 (0.9%) on Thalidomide (serious AE)
Constipation9962.7
2.5–2.8ROR 2.7 · calibrated p 0.733
2.6 EB05 2.5 · IC025 +1.3
3/3 methods agree
Labeled adverse reaction
exact term
serious PRR 2.5NCT00689936: 5/541 (0.9%) on Thalidomide (serious AE)
Dyspnoea (shortness of breath)9911.0
0.9–1.1ROR 1.0 · calibrated p 0.311
1.0 EB05 1.0 · IC025 -0.1
PRR-only: not supported by EBGM or IC
Labeled — boxed warning
synonym match
serious PRR 0.8NCT00689936: 8/541 (1.5%) on Thalidomide (serious AE)
Thrombocytopenia (low platelets)8794.6
4.3–4.9ROR 4.6 · calibrated p 0.277
4.5 EB05 4.3 · IC025 +2.1
3/3 methods agree
Labeled adverse reaction
exact term
serious PRR 3.0 · 91% clinicianNCT00689936: 10/541 (1.8%) on Thalidomide (serious AE)
Nausea8650.6
0.6–0.7ROR 0.6 · calibrated p 0.094
0.6 EB05 0.6 · IC025 -0.8
PRR-only: not supported by EBGM or IC
Labeled adverse reaction
exact term
serious PRR 0.7NCT00689936: 7/541 (1.3%) on Thalidomide (serious AE)

Unlabeled candidate signals

These flagged terms were not found in the FDA label text and do not match an artifact pattern. They are the pairs that would merit a structured assessment (temporality, dose-response, biological plausibility, consistency across databases, trial or cohort evidence). The screen has not done that; string-matching misses label wording, and a strong PRR can still be stimulated reporting, co-medication, or the disease itself.

✓ A hand-written Bradford Hill causality assessment exists for this drug: Thalidomide ↔ Abnormal/increased blood hCG.

Want to assess one of these properly? The runbook describes the Bradford Hill / trial-evidence workflow used on the assessment page, and handoff_top1000_signals.csv lists the strongest unassessed pairs across all drugs.

Common questions

What are the most reported side effects of Thalidomide?

In FDA FAERS, the most frequently co-reported reaction terms for Thalidomide are plasma cell myeloma, neuropathy peripheral, pneumonia, fatigue, anaemia, asthenia. These are report counts, not rates: FAERS has no denominator, reporting is voluntary and uneven, and a term can be reported because of the illness being treated rather than the drug.

Does Thalidomide have an FDA boxed warning?

Yes. The current FDA label carries a boxed warning: EMBRYO-FETAL TOXICITY AND VENOUS THROMBOEMBOLISM WARNING: EMBRYO-FETAL TOXICITY AND VENOUS THROMBOEMBOLISM See full prescribing information for complete boxed warning. EMBRYO -FETAL TOXICITY • If THALOMID is taken during pregnancy, it can cause severe birth defects or embryo-fetal death.

Do FAERS signals prove that Thalidomide causes these side effects?

No. A disproportionality signal (PRR, ROR) means a reaction is reported more often with this drug than with others in the database. That can reflect a real effect, but also the disease being treated, stimulated reporting after news or litigation, co-medications, or how reports are coded. Causality needs temporality, dose-response, biological plausibility, consistency across data sources and, ideally, trial or cohort evidence. This page screens each term against the FDA label and ClinicalTrials.gov results; it does not establish causation.

Sources & methods

Page generated 2026-10-14. Label and PubChem text are retrieved automatically and may lag the current label; always check the current prescribing information. OpenPV is a beta research tool of the Open Source Medicine Foundation.