Thalidomide Dosing for Gastrointestinal Bleeding from Angiodysplasia

Patient Selection and Treatment

For patients with recurrent GI bleeding from angiodysplasia who have failed endoscopic and medical therapies, thalidomide should be initiated at 50-100 mg orally daily and continued for 4-6 months, with the understanding that this is reserved only for refractory cases due to significant adverse effects including peripheral neuropathy, constipation, and bowel perforation, as recommended by the American Gastroenterological Association 1
Thalidomide should only be considered after failure of multiple endoscopic ablation attempts, iron supplementation, somatostatin analogues, and patients requiring recurrent transfusions or hospitalizations despite these interventions, according to the American Gastroenterological Association 1
Reduction in transfusion requirements is a secondary endpoint, as noted by the American Gastroenterological Association 1
Reduction in hospitalizations for bleeding is a secondary endpoint, as noted by the American Gastroenterological Association 1

Constipation is a common side effect, as reported by the American Gastroenterological Association 1
Peripheral neuropathy is a common side effect, as reported by the American Gastroenterological Association 1
Bowel perforation is a serious complication, as noted by the American Gastroenterological Association 1
Recent thrombosis is a relative contraindication, as reported by the American Society of Hematology 2
Atrial fibrillation is a relative contraindication, as reported by the American Society of Hematology 2
Known thrombophilia is a relative contraindication, as reported by the American Society of Hematology 2

For patients with hereditary hemorrhagic telangiectasia and chronic GI bleeding, thalidomide may be considered, but the American Society of Hematology recommends screening for thrombosis contraindications before initiating 2
The American Society of Hematology recommends reserving thalidomide for mild GI bleeding that has failed topical therapies in patients with hereditary hemorrhagic telangiectasia 2