Ixazomib: Drug information

(For additional information see "Ixazomib: Patient drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)

Brand Names: US

Ninlaro

Brand Names: Canada

Ninlaro

Pharmacologic Category

Antineoplastic Agent, Proteasome Inhibitor

Dosing: Adult

Note: ANC should be ≥1,000/mm³, platelets should be ≥75,000/mm³, and nonhematologic toxicities should be at baseline or ≤ grade 1 (per prescriber discretion) prior to initiating a new cycle of therapy. Consider antiviral prophylaxis to decrease the risk of herpes zoster reactivation.

Multiple myeloma

Multiple myeloma (in patients who have received at least 1 prior therapy): IRd regimen: Oral: 4 mg once weekly on days 1, 8, and 15 of a 28-day treatment cycle (in combination with lenalidomide and dexamethasone); continue until disease progression or unacceptable toxicity (Ref).

Off-label dosing/combinations:

ICd regimen: Oral: 4 mg once weekly on days 1, 8, and 15 of a 28-day cycle (in combination with oral cyclophosphamide and dexamethasone) until disease progression or unacceptable toxicity (Ref).

Id regimen (in patients not refractory to bortezomib): Oral: 4 mg once weekly on days 1, 8, and 15 of a 28-day cycle (in combination with dexamethasone) until disease progression or unacceptable toxicity (Ref).

IPd regimen (in patients refractory to lenalidomide): Oral: 4 mg once weekly on days 1, 8, and 15 of a 28-day cycle (in combination with pomalidomide and dexamethasone) until disease progression or unacceptable toxicity (Ref).

Newly diagnosed multiple myeloma in patients not eligible for transplant (off label): IRd regimen: Oral: 4 mg once weekly on days 1, 8, and 15 of a 28-day cycle (in combination with lenalidomide and dexamethasone) for 18 cycles. After 18 cycles, ixazomib was continued at 3 mg once weekly on days 1, 8, and 15 of a 28-day cycle (in combination with lenalidomide) until disease progression or unacceptable toxicity (Ref). Note: According to the manufacturer’s labeling, ixazomib (in combination with lenalidomide and dexamethasone) is not recommended in patients with newly diagnosed multiple myeloma outside of controlled clinical trials. This regimen may be considered only in select clinical scenarios (eg, if an all-oral regimen is necessary/desired).

Missed doses: If a dose is delayed or missed, administer only if the next scheduled dose is ≥72 hours away. Do not take a missed dose within 3 days of the next scheduled dose; do not double up on doses to make up for the missed dose. If vomiting occurs, do not repeat the dose; resume dosing at the next scheduled dose.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

The International Myeloma Working Group (IMWG) recommends the use of the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation (preferred) or the Modification of Diet in Renal Disease (MDRD) formula to evaluate renal function estimation in multiple myeloma patients with a stable serum creatinine (Ref).

Preexisting renal impairment:

CrCl ≥30 mL/minute: The IMWG suggest that ixazomib (in combination with lenalidomide and dexamethasone) may be safely administered to patients with a CrCl ≥30 mL/minute (Ref).

CrCl <30 mL/minute: Reduce initial dose to 3 mg once weekly on days 1, 8, and 15 of a 28-day treatment cycle

ESRD requiring dialysis: Reduce initial dose to 3 mg once weekly on days 1, 8, and 15 of a 28-day treatment cycle; ixazomib is not dialyzable and may be administered without regarding to dialysis timing.

Renal toxicity during treatment: Grade 3 or 4 toxicity: Withhold ixazomib until recovery to baseline or improvement to ≤ grade 1 (at prescriber's discretion). If attributable to ixazomib, resume ixazomib at the next lower dose.

Dosing: Hepatic Impairment: Adult

Preexisting hepatic impairment:

Mild impairment (total bilirubin ≤ ULN and AST > ULN or total bilirubin >1 to 1.5 times ULN and any AST): No dosage adjustment is necessary.

Moderate (total bilirubin >1.5 to 3 times ULN) or severe (total bilirubin >3 times ULN) impairment: Reduce initial dose to 3 mg once weekly on days 1, 8, and 15 of a 28-day treatment cycle

Hepatotoxicity during treatment: Grade 3 or 4 toxicity: Withhold ixazomib until recovery to baseline or improvement to ≤ grade 1 (at prescriber's discretion). If attributable to ixazomib, resume ixazomib at the next lower dose.

Dosing: Adjustment for Toxicity: Adult

Concomitant medications may also require dosage modifications.

**Ixazomib Dose Reductions Due to Adverse Reactions**
^a Recommended starting dose of 3 mg in patients with moderate or severe hepatic impairment, severe renal impairment, or end-stage renal disease requiring dialysis.
Recommended starting dose^a	First reduction to	Second reduction to	Discontinue
4 mg	3 mg	2.3 mg	Discontinue

**Ixazomib Dose Modifications (in Combination with Lenalidomide and Dexamethasone)**
Toxicity	Toxicity management
^a G-CSF = growth-colony stimulating factor
^b TTP/HUS = thrombocytopenic thrombotic purpura/hemolytic uremic syndrome
Neutropenia
ANC <500/mm³	Withhold ixazomib and lenalidomide until ANC is ≥500/mm³. Consider adding G-CSF^a. Upon recovery, resume lenalidomide at the next lower dose and resume ixazomib at the dose used prior to therapy interruption. If ANC falls to <500/mm³ again, interrupt ixazomib and lenalidomide until ANC is ≥500/mm³. Following recovery, resume ixazomib at the next lower dose and resume lenalidomide at the dose used prior to therapy interruption. For additional occurrences, alternate dose modification of lenalidomide and ixazomib.
Thrombocytopenia
Platelet count <30,000/mm³	Withhold ixazomib and lenalidomide until platelet count is ≥30,000/mm³. Upon recovery, resume lenalidomide at the next lower dose and resume ixazomib at the dose used prior to therapy interruption. If platelets fall to <30,000/mm³ again, withhold ixazomib and lenalidomide until platelets are ≥30,000/mm³. Following recovery, resume ixazomib at the next lower dose and resume lenalidomide at the dose used prior to therapy interruption. For additional occurrences, alternate dose modification of lenalidomide and ixazomib.
Thrombotic microangiopathy	Interrupt ixazomib if TTP/HUS^b diagnosis is suspected; manage appropriately. If TTP/HUS diagnosis is excluded, may consider reinitiating ixazomib. The safety of restarting ixazomib after a TTP/HUS diagnosis is unknown.
Dermatologic toxicity
Grade 2 or 3 rash	Withhold lenalidomide until rash recovers to ≤ grade 1. Upon recovery, resume lenalidomide at the next lower dose and resume ixazomib at the dose used prior to therapy interruption. If grade 2 or 3 rash recurs, interrupt ixazomib and lenalidomide until rash recovers to ≤ grade 1. Following recovery, resume ixazomib at the next lower dose and resume lenalidomide at the dose used prior to therapy interruption. For additional occurrences, alternate dose modification of lenalidomide and ixazomib.
Grade 4 rash	Discontinue treatment regimen.
Stevens Johnson syndrome	Discontinue ixazomib (and manage as clinically indicated).
GI toxicity	Antidiarrheals, antiemetics, and supportive care may be required to manage toxicity. Dosage adjustment is recommended for grade 3 or 4 symptoms.
Peripheral edema	Evaluate for potential underlying causes and provide supportive care. If necessary, grade 3 or 4 symptoms may require dosage adjustment.
Peripheral neuropathy
Grade 1 (with pain) or grade 2	Withhold ixazomib until peripheral neuropathy recovers to ≤ grade 1 without pain or to baseline. Upon recovery, resume ixazomib at the dose used prior to therapy interruption.
Grade 2 (with pain) or grade 3	Withhold ixazomib until recovery to baseline or improvement to ≤ grade 1 (at prescriber's discretion). Following recovery, resume ixazomib at the next lower dose.
Grade 4	Discontinue treatment regimen.
Other toxicities (nonhematologic)	Toxicity management
Grade 3 or 4 toxicity	Withhold ixazomib until recovery to baseline or improvement to ≤ grade 1 (at prescriber's discretion). If attributable to ixazomib, resume ixazomib at the next lower dose.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Adverse reaction percentages reported in adults as part of a combination regimen with lenalidomide and dexamethasone.

>10%:

Cardiovascular: Peripheral edema (27%)

Dermatologic: Skin rash (27%; including maculopapular rash)

Gastrointestinal: Constipation (35%), diarrhea (52%; grade 3: 10%), nausea (32%; grade 3: 2%), vomiting (26%; grade 3: 1%)

Hematologic & oncologic: Neutropenia (74%; grades 3/4: 34%), thrombocytopenia (85%; grades 3/4: 13% to 30%)

Nervous system: Peripheral neuropathy (32%; grade 3: 2%), peripheral sensory neuropathy (24%)

Neuromuscular & skeletal: Back pain (27%)

Ophthalmic: Eye disease (38%; including blurred vision [7%], cataract [15%], conjunctivitis [9%], and dry eye syndrome [6%])

Respiratory: Bronchitis (22%), upper respiratory tract infection (27%)

1% to 10%:

Hepatic: Hepatotoxicity

Infection: Herpes zoster infection (6%; 1% with antiviral prophylaxis; 10% without antiviral prophylaxis)

<1%:

Dermatologic: Stevens-Johnson syndrome, Sweet syndrome

Hematologic & oncologic: Thrombotic thrombocytopenic purpura, tumor lysis syndrome

Hepatic: Cholestatic hepatitis, hepatic injury, liver steatosis

Nervous system: Peripheral motor neuropathy, reversible posterior leukoencephalopathy syndrome, transverse myelitis

Postmarketing: Hematologic & oncologic: Hemolytic-uremic syndrome, thrombotic microangiopathy

Contraindications

There are no contraindications listed in the manufacturer's US labeling.

Canadian labeling: Additional contraindications (not in the US labeling): Hypersensitivity to ixazomib or any component of the formulation

Warnings/Precautions

Concerns related to adverse effects:

• Bone marrow suppression: Thrombocytopenia was reported commonly in clinical trials; grade 3 or 4 toxicity was also observed. Platelet nadirs generally occurred between days 14 to 21 of each cycle with a recovery to baseline by the start of the subsequent cycle.

• Dermatologic toxicity: Rash was reported with ixazomib use; the majority of cases were grade 1 or 2 (grade 3 rash was observed in a small number of patients). Maculopapular and macular rashes were the most commonly reported cutaneous reactions. Stevens-Johnson syndrome, including a fatality, has also been reported.

• Gastrointestinal toxicity: Diarrhea, constipation, nausea, and vomiting have been reported with ixazomib.

• Hepatotoxicity: Drug-induced liver injury, hepatocellular injury, hepatic steatosis, hepatitis cholestatic and hepatotoxicity were reported rarely in clinical trials.

• Peripheral edema: Peripheral edema was reported in one-quarter of patients receiving ixazomib (generally grade 1 or 2 reactions).

• Peripheral neuropathy: Peripheral neuropathy (mostly grade 1 or 2) was observed. Peripheral sensory neuropathy was the most commonly reported symptom, while peripheral motor neuropathy was rarely seen.

• Thrombotic microangiopathy: Thrombotic microangiopathy, including cases of thrombocytopenic thrombotic purpura/hemolytic uremic syndrome (TTP/HUS) has been reported (some fatal).

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Capsule, Oral:

Ninlaro: 2.3 mg, 3 mg, 4 mg

Generic Equivalent Available: US

Pricing: US

Capsules (Ninlaro Oral)

2.3 mg (per each): $5,189.60

3 mg (per each): $5,189.60

4 mg (per each): $5,189.60

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Capsule, Oral:

Ninlaro: 2.3 mg, 3 mg, 4 mg

Prescribing and Access Restrictions

Available through specialty pharmacies and distributors. Further information may be obtained from the manufacturer, Takeda Oncology, at 1-800-390-5663 or at http://www.ninlarohcp.com.

Administration: Adult

Oral: Administer on the same day of the week and at approximately the same time on that day. Administer at least 1 hour before or at least 2 hours after eating. Swallow capsule whole with water; do not crush, chew, or open the capsule. Avoid skin or eye exposure to capsule contents. If skin contact occurs, wash thoroughly with soap and water; if eye contact occurs, flush thoroughly with water.

Hazardous Drugs Handling Considerations

Hazardous agent (NIOSH 2016 [group 1]).

Use appropriate precautions for receiving, handling, storage, preparation, dispensing, transporting, administration, and disposal. Follow NIOSH and USP 800 recommendations and institution-specific policies/procedures for appropriate containment strategy (NIOSH 2016; USP-NF 2020).

Use: Labeled Indications

Multiple myeloma: Treatment of multiple myeloma (in combination with lenalidomide and dexamethasone) in patients who have received at least one prior therapy.

Limitations of use: Not recommended for use in the maintenance setting or in patients newly diagnosed with multiple myeloma in combination with lenalidomide and dexamethasone outside of controlled clinical trials.

Medication Safety Issues

Sound-alike/look-alike issues:

Ixazomib may be confused with bortezomib, carfilzomib, idelalisib, infliximab, isatuximab, ivosidenib.

High alert medication:

This medication is in a class the Institute for Safe Medication Practices (ISMP) includes among its lists of drug classes which have a heightened risk of causing significant patient harm when used in error.

Metabolism/Transport Effects

Substrate of CYP3A4 (major), P-glycoprotein/ABCB1 (minor); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

5-Aminosalicylic Acid Derivatives: May enhance the myelosuppressive effect of Myelosuppressive Agents. Risk C: Monitor therapy

BCG (Intravesical): Myelosuppressive Agents may diminish the therapeutic effect of BCG (Intravesical). Risk X: Avoid combination

Chloramphenicol (Ophthalmic): May enhance the adverse/toxic effect of Myelosuppressive Agents. Risk C: Monitor therapy

Chloramphenicol (Systemic): Myelosuppressive Agents may enhance the myelosuppressive effect of Chloramphenicol (Systemic). Risk X: Avoid combination

Cladribine: May enhance the myelosuppressive effect of Myelosuppressive Agents. Risk X: Avoid combination

CloZAPine: Myelosuppressive Agents may enhance the adverse/toxic effect of CloZAPine. Specifically, the risk for neutropenia may be increased. Risk C: Monitor therapy

CYP3A4 Inducers (Moderate): May decrease the serum concentration of Ixazomib. Risk C: Monitor therapy

CYP3A4 Inducers (Strong): May decrease the serum concentration of Ixazomib. Risk X: Avoid combination

Deferiprone: Myelosuppressive Agents may enhance the neutropenic effect of Deferiprone. Management: Avoid the concomitant use of deferiprone and myelosuppressive agents whenever possible. If this combination cannot be avoided, monitor the absolute neutrophil count more closely. Risk D: Consider therapy modification

Dipyrone: May enhance the adverse/toxic effect of Myelosuppressive Agents. Specifically, the risk for agranulocytosis and pancytopenia may be increased Risk X: Avoid combination

Fexinidazole: Myelosuppressive Agents may enhance the myelosuppressive effect of Fexinidazole. Risk X: Avoid combination

Hormonal Contraceptives: Ixazomib may decrease the serum concentration of Hormonal Contraceptives. More specifically, use of ixazomib with dexamethasone may decrease the serum concentrations of hormonal contraceptives. Management: Patients of reproductive potential should use a non-hormonal contraceptive method during treatment with ixazomib and for at least 90 days after the last ixazomib dose. Risk D: Consider therapy modification

Olaparib: Myelosuppressive Agents may enhance the myelosuppressive effect of Olaparib. Risk C: Monitor therapy

Promazine: May enhance the myelosuppressive effect of Myelosuppressive Agents. Risk C: Monitor therapy

Ropeginterferon Alfa-2b: Myelosuppressive Agents may enhance the myelosuppressive effect of Ropeginterferon Alfa-2b. Management: Avoid coadministration of ropeginterferon alfa-2b and other myelosuppressive agents. If this combination cannot be avoided, monitor patients for excessive myelosuppressive effects. Risk D: Consider therapy modification

St John's Wort: May decrease the serum concentration of Ixazomib. Risk X: Avoid combination

Reproductive Considerations

Verify pregnancy status prior to use. Patients who could become pregnant should use effective contraception during therapy and for at least 90 days after the last ixazomib dose; a barrier method should be used with hormonal contraception. Patients with partners who could become pregnant should also use effective contraception during therapy and for at least 90 days after the last dose of ixazomib.

Pregnancy Considerations

Based on the mechanism of action and data from animal reproduction studies, in utero exposure to ixazomib may cause fetal harm.

When used for the treatment of multiple myeloma, ixazomib is indicated to be used with lenalidomide and dexamethasone. Lenalidomide is contraindicated for use during pregnancy (refer to Lenalidomide monograph for details).

Breastfeeding Considerations

It is not known if ixazomib is present in breast milk.

Due to the potential for serious adverse events in a breastfeeding infant, the manufacturer recommends that breastfeeding be discontinued during therapy and for 90 days after the last ixazomib dose.

Monitoring Parameters

Platelet counts at least monthly during treatment (consider more frequent monitoring during the first 3 cycles), CBC (with differential) as clinically necessary, renal function tests, and LFTs (regularly). Verify pregnancy status prior to use in patients who could become pregnant. Monitor for signs/symptoms of GI toxicity, dermatologic toxicity, peripheral neuropathy, peripheral edema, and thrombotic microangiopathy. Monitor adherence.

The American Society of Clinical Oncology hepatitis B virus (HBV) screening and management provisional clinical opinion (ASCO [Hwang 2020]) recommends HBV screening with hepatitis B surface antigen, hepatitis B core antibody, total Ig or IgG, and antibody to hepatitis B surface antigen prior to beginning (or at the beginning of) systemic anticancer therapy; do not delay treatment for screening/results. Detection of chronic or past HBV infection requires a risk assessment to determine antiviral prophylaxis requirements, monitoring, and follow-up.

Cardiovascular monitoring: Comprehensive assessment prior to treatment including a history and physical examination, screening for cardiovascular disease risk factors such as hypertension, diabetes, dyslipidemia, obesity, and smoking (ASCO [Armenian 2017], (ESC [Lyon 2022]). Assess BP at baseline and each clinical visit (also consider weekly home monitoring for initial 3 months, then monthly thereafter); assess natriuretic peptide at baseline for high and very high-risk patients; consider checking natriuretic peptide at baseline for low- and moderate-risk patients; obtain a baseline echocardiography in all patients (ESC [Lyon 2022]).

Mechanism of Action

Ixazomib reversibly inhibits proteasomes, enzyme complexes which regulate protein homeostasis within the cell. Specifically, it reversibly inhibits chymotrypsin-like activity of the beta 5 subunit of the 20S proteasome, leading to activation of signaling cascades, cell-cycle arrest, and apoptosis.

Pharmacokinetics (Adult Data Unless Noted)

Absorption: High-fat meals decreased AUC by 28% and C_max by 69%

Distribution: 543 L

Protein binding: 99% to plasma proteins

Metabolism: Likely hepatic via multiple CYP enzymes and non-CYP proteins. At clinically relevant concentrations, no specific CYP isoform contributes predominantly to metabolism; possible CYP isoforms involved in metabolism include CYP3A4, 1A2, 2B6, 2C8, 2D6, 2C19, and 2C9.

Bioavailability: 58%

Half-life elimination: Terminal: 9.5 days

Time to peak: Median: 1 hour

Excretion: Urine (62%; <3.5% as unchanged drug); Feces (22%)

Pharmacokinetics: Additional Considerations (Adult Data Unless Noted)

Altered kidney function: Pharmacokinetics of ixazomib (at a dose of 3 mg) were evaluated in patients with normal renal function (CrCl ≥90 mL/minute), severe impairment (CrCl <30 mL/minute) or ESRD requiring dialysis. The mean AUC was 39% higher in patients with severe renal impairment and in ESRD requiring dialysis (as compared with patients with normal renal function).

Hepatic function impairment: Pharmacokinetics of ixazomib were evaluated in patients with normal hepatic function (at a dose of 4 mg), moderate impairment (total bilirubin >1.5 to 3 times ULN) at a dose of 2.3 mg, or severe impairment (total bilirubin <3 times ULN) at a dose of 1.5 mg. Dose-normalized mean AUC was 20% higher in patients with moderate or severe hepatic impairment, as compared to patients with normal hepatic function.

Brand Names: International

International Brand Names by Country

For country code abbreviations (show table)

(AE) United Arab Emirates: Ninlaro;
(AR) Argentina: Myvitla | Ninlaro;
(AT) Austria: Ninlaro;
(BE) Belgium: Ninlaro;
(BG) Bulgaria: Ninlaro;
(BR) Brazil: Ninlaro;
(CH) Switzerland: Ninlaro;
(CO) Colombia: Ninlaro;
(CZ) Czech Republic: Ninlaro;
(DE) Germany: Ninlaro;
(EE) Estonia: Ninlaro;
(FI) Finland: Ninlaro;
(FR) France: Ninlaro;
(GB) United Kingdom: Ninlaro;
(GR) Greece: Ninlaro;
(HK) Hong Kong: Ninlaro;
(HR) Croatia: Ninlaro;
(HU) Hungary: Ninlaro;
(IE) Ireland: Ninlaro;
(IT) Italy: Ninlaro;
(JP) Japan: Ninlaro;
(KE) Kenya: Ninlaro;
(KR) Korea, Republic of: Ninlaro;
(KW) Kuwait: Ninlaro;
(LB) Lebanon: Ninlaro;
(MX) Mexico: Ninlaro;
(MY) Malaysia: Ninlaro;
(NL) Netherlands: Ninlaro;
(NO) Norway: Ninlaro;
(PE) Peru: Ninlaro;
(PH) Philippines: Ninlaro;
(PL) Poland: Ninlaro;
(PR) Puerto Rico: Ninlaro;
(PT) Portugal: Ninlaro;
(QA) Qatar: Ninlaro;
(RO) Romania: Ninlaro;
(RU) Russian Federation: Ninlaro;
(SA) Saudi Arabia: Ninlaro;
(SE) Sweden: Ninlaro;
(SG) Singapore: Ninlaro;
(SI) Slovenia: Ninlaro;
(SK) Slovakia: Ninlaro;
(TH) Thailand: Ninlaro;
(TR) Turkey: Ninlaro;
(TW) Taiwan: Ninlaro;
(ZA) South Africa: Ninlaro

<800> Hazardous Drugs—Handling in Healthcare Settings. United States Pharmacopeia and National Formulary (USP 43-NF 38). Rockville, MD: United States Pharmacopeia Convention; 2020:74-92.
Armenian SH, Lacchetti C, Barac A, et al. Prevention and monitoring of cardiac dysfunction in survivors of adult cancers: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. 2017;35(8):893-911. [PubMed 27918725]
Dimopoulos MA, Sonneveld P, Leung N, et al. International Myeloma Working Group recommendations for the diagnosis and management of myeloma-related renal impairment. J Clin Oncol. 2016;34(13):1544-1557. [PubMed 26976420]
Facon T, Venner CP, Bahlis NJ, et al. Oral ixazomib, lenalidomide, and dexamethasone for newly diagnosed transplant-ineligible multiple myeloma patients. Blood. 2021;blood.2020008787. doi:10.1182/blood.2020008787 [PubMed 33763699]
Hwang JP, Feld JJ, Hammond SP, et al. Hepatitis B virus screening and management for patients with cancer prior to therapy: ASCO provisional clinical opinion update. J Clin Oncol. 2020;38(31):3698-3715. doi:10.1200/JCO.20.01757 [PubMed 32716741]
Krishnan A, Kapoor P, Palmer JM, et al. Phase I/II trial of the oral regimen ixazomib, pomalidomide, and dexamethasone in relapsed/refractory multiple myeloma. Leukemia. 2018;32(7):1567-1574. doi:10.1038/s41375-018-0038-8 [PubMed 32082000]
Kumar SK, Grzasko N, Delimpasi S, et al. Phase 2 study of all-oral ixazomib, cyclophosphamide and low-dose dexamethasone for relapsed/refractory multiple myeloma. Br J Haematol. 2019;184(4):536-546. doi:10.1111/bjh.15679 [PubMed 30460684]
Kumar SK, LaPlant BR, Reeder CB, et al. Randomized phase 2 trial of ixazomib and dexamethasone in relapsed multiple myeloma not refractory to bortezomib. Blood. 2016;128(20):2415-2422. doi:10.1182/blood-2016-05-717769 [PubMed 27702799]
Lyon AR, López-Fernández T, Couch LS, et al. 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart J. 2022;43(41):4229-4361. doi:10.1093/eurheartj/ehac244 [PubMed 36017568]
Moreau P, Masszi T, Grzasko N, et al. Oral ixazomib, lenalidomide, and dexamethasone for multiple myeloma. N Engl J Med. 2016;374(17):1621-1634. [PubMed 27119237]
Ninlaro (ixazomib) [prescribing information]. Lexington, MA: Takeda Pharmaceuticals America Inc; November 2022.
Ninlaro (ixazomib) [product monograph]. Toronto, Ontario, Canada: Takeda Canada Inc; October 2022.
US Department of Health and Human Services; Centers for Disease Control and Prevention; National Institute for Occupational Safety and Health. NIOSH list of antineoplastic and other hazardous drugs in healthcare settings 2016. https://www.cdc.gov/niosh/docs/2016-161/default.html. Updated September 2016. Accessed October 5, 2016.

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Ixazomib: Drug information