Abstract: OBJECTIVE To evaluate the clinical use and standardize rational drug use of thalidomide through evidence-based medicine. METHODS A retrospective survey of 122 prescriptions for thalidomide tablets in 2017 was conducted. The prescriptions in which thalidomide was used off-label were categorized, and evidence of Chinese or foreign databases, classics, and guidelines was provided. According to the quality of evidence, proposed recommended strengths and take interventions. RESULTS The main type of off-label use of thalidomide tablets was superindicated. The top three departments with the highest incidence were Hematology, Rheumatology and Immunology, and Stomatology. The top three clinical diagnoses were multiple myeloma, primary myelofibrosis, and recurrent aphthous ulcers. According to the off-label beyond-instructions classification management system, analyzing evidence-based medical evidence, one type was agreed to use, five types were limited used, five typies were specially used, and no type was not agreed to use.CONCLUSION There is a widespread phenomenon of the off-label use of thalidomide tablets. It must be strictly implement off-label management system to promote safe medication.