Ixazomib (Ninlaro) is an oral proteasome inhibitor, which is usually administered in combination with lenalidomide and dexamethasone for the treatment of patients with multiple myeloma who have received at least one prior therapy. It is crucial for the effective treatment of patients to understand its potential side effects, potential serious risks, and the precautions that must be followed.

Side Effects of Ixazomib (Ninlaro)

Hematological Toxicity

Thrombocytopenia: This is one of the most common side effects. The lowest point of platelet count decline usually occurs on days 14 to 21 of each 28-day treatment cycle and recovers before the start of the next cycle. In severe cases, it may lead to bleeding or easy bruising.

Neutropenia: Also relatively common, it may increase the risk of infection.

Gastrointestinal Reactions

Diarrhea, constipation, nausea, and vomiting: These symptoms are common during treatment, and most are mild in severity, but some patients may experience severe symptoms.

Patients should manage symptoms with antidiarrheal, antiemetic, and other supportive medications as prescribed by healthcare professionals.

Peripheral Neuropathy

Manifestations: Mainly manifested as paresthesia, such as numbness, tingling, pain, or a burning sensation in the hands and feet.

Severity: The vast majority of cases are grade 1 or 2, and the incidence of severe (grade 3) reactions is low.

Monitoring: Neurological symptoms should be regularly assessed during treatment.

Management: If new or worsening peripheral neuropathy occurs, especially accompanied by pain, ixazomib should be temporarily suspended based on the severity of symptoms, and the dose should be reduced after recovery.

Serious Side Effects of Ixazomib (Ninlaro)

Thrombotic Microangiopathy

Scope: Includes thrombotic thrombocytopenic purpura/hemolytic uremic syndrome (TTP/HUS), which is rare but potentially fatal.

Warning Signs: Patients need to be alert for symptoms such as fever, bruising, abnormal bleeding, fatigue, confusion, and decreased urine output.

Emergency Measures: If TTP/HUS is suspected, ixazomib should be discontinued immediately and emergency evaluation conducted.

Hepatotoxicity

Reported Events: Drug-induced liver injury, hepatocellular injury, and other conditions have been reported.

Monitoring: Liver enzyme indicators should be regularly monitored during treatment.

Reporting: Symptoms such as jaundice and right upper quadrant pain should be reported in a timely manner.

Precautions for Ixazomib (Ninlaro)

Dosage and Administration

Standard Dosage: The recommended starting dose is 4 mg, taken orally once on days 1, 8, and 15 of each 28-day treatment cycle.

Dose Reduction for Special Populations: Patients with moderate to severe hepatic insufficiency, severe renal insufficiency, or end-stage renal disease requiring dialysis should have their starting dose reduced to 3 mg.

Administration Timing: Must be taken on an empty stomach at least 1 hour before meals or 2 hours after meals to facilitate absorption.

Administration Method: Swallow the entire capsule with water; do not crush, chew, or open the capsule.

Missed Dose: If a dose is missed, it may only be taken if it is at least 72 hours before the next scheduled dose. Do not take a missed dose within 72 hours of the next dose, and do not take a double dose.

Monitoring and Follow-Up

Regular Monitoring: Perform regular complete blood counts (with a focus on platelets and neutrophils), liver function tests, and assessments of peripheral neuropathy symptoms.

Prophylaxis: It is recommended to consider the use of antiviral medications to prevent reactivation of herpes zoster.