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Thalidomide, a drug initially developed as a sedative agent and later notorious as a teratogen, has recently been shown to be a potent immunomodulator, mediated by inhibition of tumor necrosis factor.1,2,3 As such, it is being reevaluated for possible use in HIV disease, among other conditions.4 A recent report by Jacobson demonstrated the effectiveness of thalidomide in treating idiopathic oral aphthous ulcers in HIV-infected patients.5 Thalidomide is also being investigated for potential use in treating HIV wasting syndrome.6 Knowledge of several issues related to the clinical pharmacology of this drug will help guide its proper use.
Like many drugs, thalidomide is given as a racemic mixture, meaning that half of the drug is given as the R…