Ixazomib (Ninlaro) is an oral proteasome inhibitor used in combination with lenalidomide and dexamethasone for the treatment of multiple myeloma patients who have received at least one prior therapy.

Precautions for Taking Ixazomib (Ninlaro)

Administration Method and Timing

(1) Patients must strictly follow the prescribed cycle and dosage, typically a 28-day treatment course, with oral intake once on days 1, 8, and 15.

(2) It should be taken at least 1 hour before or 2 hours after a meal. The capsule must be swallowed whole and should not be crushed, chewed, or opened.

(3) Avoid direct contact of the capsule contents with the skin or eyes. If accidental contact occurs, wash the skin thoroughly with soap and water, and rinse the eyes with plenty of water.

(4) Ixazomib and dexamethasone should not be taken at the same time, as dexamethasone should be taken with food, while ixazomib should be taken on an empty stomach.

Missed Dose or Vomiting

(1) If a dose is missed, it can be taken only if there are more than 72 hours until the next scheduled dose.

(2) If there are less than 72 hours until the next dose, do not take the missed dose, and do not take a double dose to make up for it.

(3) If vomiting occurs after taking the medication, do not repeat the dose. Simply resume the medication at the next scheduled time.

Interactions with Other Medications

(1) Avoid using ixazomib with strong CYP3A inducers (such as rifampin, phenytoin, carbamazepine, St. John's wort), as these drugs can significantly reduce the blood concentration of ixazomib and affect its efficacy.

(2) Since dexamethasone, included in the treatment regimen, may affect the activity of certain enzymes and transporters, female patients using hormonal contraceptives should be aware that their effectiveness may be reduced. Additional barrier contraceptive methods are recommended.

Monitoring During Ixazomib (Ninlaro) Treatment

Hematological Monitoring

(1) The nadir in platelet counts typically occurs between days 14 and 21 of each 28-day cycle and recovers to baseline before the start of the next cycle.

(2) Platelet counts should be monitored at least monthly during treatment, and more frequent monitoring may be considered during the initial three cycles.

(3) When the platelet count falls below 30,000/mm³, ixazomib and lenalidomide should be withheld until it recovers to above 30,000/mm³. Upon recovery, the drug dose should be reduced.

(4) Neutropenia is also common. When the absolute neutrophil count falls below 500/mm³, treatment should be paused, and granulocyte colony-stimulating factor support may be considered. The dose should also be adjusted upon recovery.

(5) The start of any new cycle requires a neutrophil count of ≥1,000/mm³ and a platelet count of ≥75,000/mm³.

Neurological Monitoring

(1) Peripheral neuropathy is a common adverse reaction in this treatment regimen, primarily manifesting as sensory neuropathy.

(2) Patients should be closely monitored for new or worsening symptoms, such as tingling, numbness, pain, burning sensations, or limb weakness.

(3) For Grade 1 neuropathy with pain or Grade 2 neuropathy without pain, ixazomib may be paused until symptoms resolve, after which treatment can be resumed at the original dose.

(4) For Grade 2 neuropathy with pain or Grade 3 neuropathy, the dose of ixazomib should be reduced upon recovery.

(5) Once Grade 4 neuropathy occurs, the entire treatment regimen should be discontinued.