Risk Minimisation Materials

Thalidomide Women of Childbearing Potential Treatment Initiation Form

This Treatment Initiation Form must be completed for each woman of childbearing potential prior to the initiation of their thalidomide treatment. It is mandatory that women of childbearing potential receive counselling and education to be made aware of the risks of thalidomide. Thalidomide is contraindicated in women of childbearing potential unless all terms of counselling are met. The aim of the Treatment Initiation Form is to protect patients and any possible foetuses by ensuring that patients are fully informed of and understand the risk of teratogenicity and other adverse effects associated with thalidomide.

For Healthcare Professionals