Thalidomide was withdrawn from the market in the early 1960's because it caused devastating fetal malformations. It has had a recent resurgence in use, so it is necessary to be aware of its impact on the developing fetus.


Use in pregnant women prior to recall: as an anti-emetic and sedative


About 20% of fetuses from mothers taking thalidomide during pregnancy were affected. Teratogenic if fetus exposed in the first trimester (27 to 42 gestational day, 34 to 50 gestational day).


Features of thalidomide embryopathy:

(1) limb shortening due to phocomelia (intercalary and transverse, with absence of long bones, especially femur and radius) or amelia

(2) congenital heart disease

(3) renal malformations

(4) cryptorchidism

(5) abducens nerve (6th cranial nerve) paralysis

(6) facial paralysis

(7) deafness

(8) microtia or anotia (hypoplasia or absence of pinna, absence of external auditory meatus)

(9) polydactyly or syndactyly

(10) gastrointestinal malformations (affecting musculature)


Current uses:

(1) graft vs host reactions

(2) erythema nodosum leprosum (reactional lepromatous leprosy)

(3) Langerhans cell histiocytosis

(4) Behcet's syndrome

(5) aphthous ulcers in AIDS patients

(6) erythema multiforme

(7) rheumatoid arthritis

(8) discoid lupus

(9) multiple myeloma


The basis for its benefits is uncertain. It is associated with reduction in serum tumor necrosis factor alpha in some patients. It also may affect angiogenesis.


Current precautions:

(1) Available only through specially licensed physicians.

(2) Women of child bearing age must take effective contraceptives and must not be pregnant (at least not during the first trimester).


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