Ixazomib
Pronunciation: (ik-SAZ-oh-mib).
- Generic name
- Ixazomib
- Brand names
- Ninlaro, Ixazomib, Ixamed
- Drug class
- Proteasome inhibitor (antineoplastic agent)
Availability and supply rules vary by country
Trade names by country: United States · Canada
Australia: · Full directory
What Ixazomib is and how it works
Uses, formulations, monitoring, and supply rules can differ by patient, product, and country. Follow the exact local product information and professional advice.
Mechanism of action: how Ixazomib works
Ixazomib is a reversible inhibitor of the 20S proteasome, a key component of the ubiquitin-proteasome pathway responsible for protein degradation in cells. By inhibiting proteasome activity, ixazomib disrupts multiple signaling cascades, leading to accumulation of misfolded proteins and apoptosis of malignant plasma cells in multiple myeloma.
What Ixazomib is used for
Multiple myeloma (in combination with lenalidomide and dexamethasone)
FDA-approved for patients who have received at least one prior therapy. Ixazomib is a proteasome inhibitor used in combination therapy, not as a stand-alone treatment. (2)
Before taking Ixazomib
Do not take / not appropriate for
- Contraindicated in patients with hypersensitivity to ixazomib or any component of the formulation. (Contraindication) (2)
- Not recommended during pregnancy or breastfeeding. (Contraindication) (2)
Tell your clinician about
(2)How to take Ixazomib
- General Instructions: Take ixazomib exactly as prescribed, usually once weekly on the same day each week, in combination with other medications.. Adult Dosing: The usual starting dose is 4 mg orally once weekly on days 1, 8, and 15 of a 28-day cycle, in combination with lenalidomide and dexamethasone. Dose adjustments may be required based on side effects or organ function.. Pediatric Dosing: Safety and efficacy in children have not been established; use in pediatric patients is not recommended.. Administration: Swallow the capsule whole with water, at least one hour before or two hours after food. Do not crush, chew, or open the capsules.. When To Stop: Do not stop taking ixazomib without consulting your doctor. If you experience severe side effects, seek medical advice promptly; let the treating oncologist decide whether to adjust the dose, pause, or stop treatment.. Storage: Store at room temperature, not exceeding 30C (86F). Do not freeze. Keep capsules in their original packaging until immediately before use.
- This page does not provide a dose calculator. Dosing must follow the prescriber, pharmacist, or product label.
Procedures and treatment changes
Tell the treating team before surgery, procedures, or any medicine change. Do not alter treatment without the responsible clinician. (2)
Missed dose
If you miss a dose and it is more than 72 hours until your next scheduled dose, take it as soon as you remember. If less than 72 hours remain, skip the missed dose and take your next dose at the regular time. Do not take two doses at once.
Overdose
In case of overdose, seek emergency medical attention immediately. Symptoms may include severe nausea, vomiting, diarrhea, low blood counts, or other serious effects. Supportive care and monitoring are recommended. (2)
Side effects
Side effects and their urgency vary; report severe, persistent, or concerning symptoms to a healthcare professional.
Thrombocytopenia (low platelet count)
Incidence: Common (occurs in 20% or more of patients per the FDA label)
Neutropenia (low white blood cell count)
Incidence: Common (occurs in 20% or more of patients per the FDA label)
Diarrhea
Incidence: Common (occurs in 20% or more of patients per the FDA label)
Constipation
Incidence: Common (occurs in 20% or more of patients per the FDA label)
Peripheral neuropathy
Incidence: Common (occurs in 20% or more of patients per the FDA label)
Nausea
Incidence: Common (occurs in 20% or more of patients per the FDA label)
Peripheral edema (swelling)
Incidence: Common (occurs in 20% or more of patients per the FDA label)
Rash
Incidence: Common (occurs in 20% or more of patients per the FDA label)
Vomiting
Incidence: Common (occurs in 20% or more of patients per the FDA label)
Bronchitis
Incidence: Common (occurs in 20% or more of patients per the FDA label)
Serious warnings
May cause low blood cell counts (thrombocytopenia, neutropenia) — serious
Symptoms: May cause low blood cell counts (thrombocytopenia, neutropenia). Risk of peripheral neuropathy (nerve damage). May increase risk of infections. Can cause liver toxicity. Use effective contraception; may harm an unborn baby.
Action: Follow the urgency stated and seek prompt or emergency care when indicated. (2)
Contraindications recorded in the clinician database — serious
Symptoms: Contraindications recorded in the clinician database: Contraindicated in patients with hypersensitivity to ixazomib or any component of the formulation. Use with caution in patients with hepatic or severe renal impairment, as exposure may be increased. Monitor for thrombocytopenia, neutropenia, and peripheral neuropathy. Not recommended during pregnancy or breastfeeding.
Action: Follow the urgency stated and seek prompt or emergency care when indicated. (2)
The FDA label's own formal Contraindications section lists none (hypersensitivity to the drug remains a standard clinical reason not to use it, even though it is not separately called out as a formal FDA contraindication) — serious
Symptoms: The FDA label's own formal Contraindications section lists none (hypersensitivity to the drug remains a standard clinical reason not to use it, even though it is not separately called out as a formal FDA contraindication). Monitoring requirements: platelet counts are checked at least monthly during treatment, with dose adjustment as needed; patients are also monitored for peripheral neuropathy and gastrointestinal side effects (diarrhea, constipation, nausea, vomiting), with dose adjustment as needed.
Action: Follow the urgency stated and seek prompt or emergency care when indicated. (2)
Interactions
| Medicine or test | Effect | Action |
|---|---|---|
| Recorded interactions | Ixazomib may interact with strong CYP3A inducers (such as rifampin, carbamazepine, phenytoin, and St. John’s wort), which can decrease its effectiveness. Caution is also advised with other medications that affect blood counts or immune function. Always inform your healthcare provider about all medicines and supplements you are taking. |
Pregnancy, breastfeeding, kidney/liver function, age
Pregnancy
Ixazomib can cause fetal harm; animal studies showed embryo-fetal toxicity at doses slightly exceeding the recommended human exposure. Females of reproductive potential are advised to use effective non-hormonal contraception during treatment and for 90 days after the last dose; males are advised to use effective contraception for the same period. (2)
Breastfeeding
Breastfeeding is not recommended during treatment and for 90 days after the final dose, due to the potential for serious harm to a nursing infant. (2)
Children
Frequency: Not applicable. Weight Based: Not recommended for pediatric use. Max Daily Dose: Not applicable. Max Single Dose: Not applicable. Age Restrictions: Safety not established in children (2)
Renal_impairment
Renal impairment: the starting dose is reduced to 3 mg in patients with severe renal impairment (creatinine clearance under 30 mL/min) or end-stage renal disease requiring dialysis, as directed by the treating oncologist. Hepatic impairment: the starting dose is reduced to 3 mg in patients with moderate (bilirubin 1.5-3 times the upper limit of normal) or severe (bilirubin over 3 times the upper limit of normal) hepatic impairment. (2)
Hepatic_impairment
Renal impairment: the starting dose is reduced to 3 mg in patients with severe renal impairment (creatinine clearance under 30 mL/min) or end-stage renal disease requiring dialysis, as directed by the treating oncologist. Hepatic impairment: the starting dose is reduced to 3 mg in patients with moderate (bilirubin 1.5-3 times the upper limit of normal) or severe (bilirubin over 3 times the upper limit of normal) hepatic impairment. (2)
Monitoring
(2)Storage
Store at room temperature, not exceeding 30C (86F). Do not freeze. Keep capsules in their original packaging until immediately before use.
Professional information
Clinician-facing context only. This section does not replace current product labeling.
General
Indication: Multiple myeloma (with lenalidomide and dexamethasone)
Dose summary: 4 mg orally once weekly on days 1, 8, and 15 of a 28-day cycle.
Renal context: Reduce starting dose to 3 mg for severe renal impairment (CrCl <30 mL/min) or ESRD requiring dialysis. Reduce starting dose to 3 mg for moderate (bilirubin 1.5-3x ULN) or severe (bilirubin >3x ULN) hepatic impairment. (2)
Frequently asked questions
What is ixazomib used for?
Ixazomib is used to treat adults with multiple myeloma, a type of blood cancer, usually in combination with other medications after at least one prior therapy.
How should I take ixazomib?
Take ixazomib exactly as prescribed, usually once weekly on an empty stomach, at least one hour before or two hours after food. Swallow the capsule whole with water.
What are the most common side effects?
Common side effects include nausea, vomiting, diarrhea, constipation, swelling, back pain, rash, and fatigue.
Can I take ixazomib if I am pregnant or breastfeeding?
Ixazomib may harm an unborn baby and is not recommended during pregnancy or breastfeeding. Use effective contraception during treatment and for at least 90 days after the last dose.
What should I do if I miss a dose?
If more than 72 hours remain before your next dose, take the missed dose as soon as possible. If less than 72 hours remain, skip the missed dose and take your next dose at the regular time. Do not double up doses.
Are there any foods or medicines I should avoid?
Avoid grapefruit products and strong CYP3A inducers (like rifampin or St. John’s wort). Also, avoid live vaccines during treatment.
How will my doctor monitor my treatment?
Your doctor will regularly check your blood counts, liver function, and monitor for side effects or signs of infection during treatment.
What happens if I take too much Ixazomib?
Taking too much Ixazomib can lead to severe side effects, potentially exacerbating adverse reactions such as thrombocytopenia, gastrointestinal issues, or peripheral neuropathy. If an overdose is suspected, it is crucial to seek immediate emergency medical attention. Do not attempt to self-treat or wait for symptoms to worsen, as prompt intervention is vital for managing potential complications.
Can I drink alcohol while taking Ixazomib?
It is generally advisable to limit or avoid alcohol consumption while taking Ixazomib. As a proteasome inhibitor, Ixazomib can cause side effects like nausea, vomiting, and liver enzyme elevations, which may be exacerbated by alcohol. Alcohol can also increase the risk of peripheral neuropathy, a known side effect of this drug class. Always consult your healthcare provider for personalized advice regarding alcohol intake.
Is Ixazomib safe during pregnancy?
Ixazomib's pregnancy category requires careful consideration. It is not recommended for use during pregnancy due to potential risks to the fetus. Women of childbearing potential should use effective contraception during treatment and for a period after the last dose. Always consult your healthcare provider to discuss the risks and benefits, and to explore alternative treatment options if you are pregnant or planning to become pregnant.
What is the mechanism of action of Ixazomib?
Ixazomib is a reversible inhibitor of the 20S proteasome, a key component of the ubiquitin-proteasome pathway responsible for protein degradation in cells. By inhibiting proteasome activity, ixazomib disrupts multiple signaling cascades, leading to accumulation of misfolded proteins and apoptosis of malignant plasma cells in multiple myeloma.
What is the generic name of Ixazomib?
The generic name is Ixazomib. It is sold under brand names including Ninlaro, Ixazomib, Ixamed.
What class of drug is Ixazomib?
Ixazomib is classed as: Proteasome inhibitor (antineoplastic agent).
References
- Ixazomib — MedGuideGlobal Medicine RecordMedGuideGlobal clinician-authored medicine record (internal database) · Global (clinician-authored, not country-validated) · accessed 2026-08-06 · source 1
- NINLARO (ixazomib) capsules, full prescribing informationU.S. Food and Drug Administration · United States · accessed 2026-08-06 · source 2
- NINLARO (IXAZOMIB) CAPSULE [TAKEDA PHARMACEUTICALS AMERICA, INC.] — US prescribing information (DailyMed SPL)U.S. National Library of Medicine (DailyMed) · US · accessed 2026-08-14 · source 3
- NINLARO — FDA approval record (Drugs@FDA NDA208462)U.S. Food and Drug Administration · US · accessed 2026-08-14 · source 4
- Ixazomib — RxNorm normalized drug concept (RXCUI 1723734)U.S. National Library of Medicine (RxNorm) · US · accessed 2026-08-14 · source 5
Brand names by country
Single-ingredient Ixazomib names are shown separately by country. Product availability, strengths, and supply rules can change; combination products are not included here.
Priority countries
United States
- NINLARO4 mg, 2.3 mg, 3 mg · takeda pharmaceuticals america, inc.
Canada
- NINLARO