Ixazomib (Ninlaro®)

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About This Drug

Ixazomib is used to treat cancer. It is given orally (by mouth).

Possible Side Effects

  • Decrease in the number of white blood cells. This may raise your risk of infection.
  • Decrease in the number of platelets. This may raise your risk of bleeding.
  • Nausea and vomiting (throwing up)
  • Constipation (not able to move bowels)
  • Diarrhea (loose bowel movements)
  • Swelling of your legs, ankles and/or feet
  • Back pain
  • Effects on the nerves are called peripheral neuropathy. You may feel numbness, tingling, or pain in your hands and feet. It may be hard for you to button your clothes, open jars, or walk as usual. The effect on the nerves may get worse with more doses of the drug. These effects get better in some people after the drug is stopped but it does not get better in all people.

Note: Each of the side effects above was reported in 20% or greater of patients treated with Ixazomib. Not all possible side effects are included above.

Warnings and Precautions

  • Severe decrease in the number of platelets
  • Severe diarrhea, constipation, nausea and vomiting
  • Changes in liver function
  • Rash

How to Take Your Medication

  • Swallow the medicine whole with a full glass of water (8 ounces). Do not crush, chew or open the capsules.
  • Take this drug by mouth without food, at least 1 hour before you eat or 2 hours after you eat, at approximately the same time each time it is scheduled.
  • Do not take your dexamethasone at the same time you take ixazomib. (Take dexamethasone with food, take ixazomib without food.)
  • Missed dose: If you miss a dose, and it is less than 72 hours until your next dose, then skip the missed dose and go back to your normal schedule. If you miss a dose, and it is more than 72 hours until your next dose, take it as soon as you think about it. Do not take 2 doses at the same time or extra doses. Do not replace a vomited dose. If you vomit a dose or miss a dose, contact your physician.
  • Handling: Wash your hands after handling your medicine, your caretakers should not handle your medicine with bare hands and should wear latex gloves.
  • If you get any of the content of a broken capsules on your skin or in your eyes, you should wash the area of the skin well with soap and water right away. Wash your eyes with flowing water for at least 15 minutes and call your doctor. Call your doctor if you get a skin reaction.
  • This drug may be present in the saliva, tears, sweat, urine, stool, vomit, semen, and vaginal secretions. Talk to your doctor and/or your nurse about the necessary precautions to take during this time.
  • Storage: Store this medicine in the original container at room temperature. Do not store above 30°C (86°F). Do not freeze.
  • Disposal of unused medicine: Do not flush any expired and/or unused medicine down the toilet or drain unless you are specifically instructed to do so on the medication label. Some facilities have take-back programs and/or other options. If you do not have a take-back program in your area, then please discuss with your nurse or your doctor how to dispose of unused medicine.

Treating Side Effects

  • To decrease the risk of infection, wash your hands regularly.
  • Avoid close contact with people who have a cold, the flu, or other infections.
  • Take your temperature as your doctor or nurse tells you, and whenever you feel like you may have a fever.
  • To help decrease bleeding, use a soft toothbrush. Check with your nurse before using dental floss. 
  • Be very careful when using knives or tools.
  • Use an electric shaver instead of a razor.
  • Drink plenty of fluids (a minimum of eight glasses per day is recommended).
  • If you throw up or have loose bowel movements, you should drink more fluids so that you do not become dehydrated (lack of water in the body from losing too much fluid).
  • Ask your doctor or nurse about medicines that are available to help stop or lessen constipation, diarrhea and/or nausea.
  • If you are not able to move your bowels, check with your doctor or nurse before you use enemas, laxatives, or suppositories.
  • To help with nausea and vomiting, eat small, frequent meals instead of three large meals a day. Choose foods and drinks that are at room temperature. Ask your nurse or doctor about other  helpful tips and medicine that is available to help or stop lessen these symptoms.
  • If you get diarrhea, eat low-fiber foods that are high in protein and calories and avoid foods that can irritate your digestive tracts or lead to cramping.
  • If you have numbness and tingling in your hands and feet, be careful when cooking, walking, and handling sharp objects and hot liquids.
  • Keeping your pain under control is important to your well-being. Please tell your doctor or nurse if you are experiencing pain.

Food and Drug Interactions

  • There are no known interactions of ixazomib with food, however this medication should be taken on an empty stomach.
  • Check with your doctor or pharmacist about all other prescription medicines and over-the-counter medicines and dietary supplements (vitamins, minerals, herbs and others) you are taking before starting this medicine as there are known drug interactions with ixazomib. Also, check with your doctor or pharmacist before starting any new prescription or over-the-counter medicines, or dietary supplements to make sure that there are no interactions.
  • Avoid the use of St. John’s Wort while taking ixazomib as this may lower the levels of the drug in your body, which can make it less effective.

When to Call the Doctor

Call your doctor or nurse if you have any of these symptoms and/or any new or unusual symptoms:

  • Fever of 100.5 F (38 C) or higher
  • Chills
  • Easy bleeding or bruising
  • Nausea that stops you from eating or drinking, and/or that is not relieved by prescribed medicines
  • Throwing up more than 3 times a day
  • Diarrhea, 4 times in one day or diarrhea with weakness or a feeling of being dizzy
  • No bowel movement for 3 days or you feel uncomfortable
  • Numbness, tingling, or pain your hands and feet
  • Weight gain of 5 pounds in one week (fluid retention)
  • Swelling of your legs, ankles and/or feet
  • Signs of liver problems: dark urine, pale bowel movements, bad stomach pain, feeling very tired and weak, unusual itching, or yellowing of the eyes or skin
  • Heavy menstrual period that lasts longer than normal
  • A new rash or a rash that is not relieved by prescribed medicines
  • Itching that is bothersome
  • If you think you are pregnant or may have impregnated your partner

Reproduction Warnings

  • Pregnancy warning: This drug can have harmful effects on the unborn baby. Women of childbearing potential should use effective methods of birth control during your cancer treatment and for 90 days after treatment. Men with female partners of childbearing potential should use effective methods of birth control during your cancer treatment and for 90 days after your cancer treatment. Let your doctor know right away if you think you may be pregnant or may have impregnated your partner.
  • Women using hormonal methods of birth control (i.e., birth control pills, skin patches, shots, vaginal rings, intrauterine devices (IUDs)) should also use a barrier methods of birth control such as a condom, sponge, diaphragm, spermicide and/or cervical cap.
  • Breastfeeding warning: Women should not breastfeed during treatment and for 90 days after treatment because this drug could enter the breast milk and cause harm to a breastfeeding baby.
  • Fertility warning: Human fertility studies have not been done with this drug. Talk with your doctor or nurse if you plan to have children. Ask for information on sperm or egg banking. 

Revised October 2018

This patient information was developed by Via Oncology, LLC © 2018. This information is not intended to be used as a substitute for professional medical advice, diagnosis, or treatment. You should not rely entirely on this information for your health care needs. Ask your own doctor or health care provider any specific medical questions that you have.

CLIENT acknowledges that the Via Pathways and Via Portal are information management tools only, and that Via Oncology, LLC has not represented the Via Pathways or Via Portal as having the ability to diagnose disease, prescribe treatment, or perform any other tasks that constitute the practice of medicine. The clinical information contained in the Via Pathways and Via Portal are intended as a supplement to, and not a substitute for, the knowledge, expertise, skill, and judgment of physicians, pharmacists and other healthcare professionals involved with patient care at CLIENT facilities.