Names and pronunciation
(ix-az′-oh-mib) Ninlaro
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Drug reference
(ix-az′-oh-mib) Ninlaro
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Func. class.: Antineoplastic agent
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Chem. class.: Proteasome inhibitor
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ACTION: Reversibly inhibits protea- somes, enzyme complexes that regulate protein homeostasis within the cell; reversibly inhibits chymotrypsin-like activity of the beta 5 subunit of the 20S I proteasome, leading to activation of sig- naling cascades, cell-cycle arrest, and apoptosis
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USES: Multiple myeloma
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CONTRAINDICATIONS Hypersensitivity Precautions: • Bone marrow suppression, dermato- logic toxicity, gastrointestinal toxicity, hepatic disease, herpes zoster infection, peripheral edema, peripheral neuropa- thy, thrombotic microangiopathy, renal disease
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SIDE EFFECTS CV: Peripheral edema INTEG: Rash GI: Constipation, diarrhea, nausea, vomiting HEMA: Thrombocytopenia, neutropenia CNS: Peripheral neuropathy, peripheral sensory neuropathy MS: Back pain EENT: Eye disease RESP: URI
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INTERACTIONS Decrease: ixazomib effect—CYP3A4 inducers (carbamazepine, phenytoins, rifamycins), avoid using together Drug/Herb Decrease: ixazomib effect—St. John’s wort, avoid using together
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DOSAGE AND ROUTES Multiple myeloma Adult: PO 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
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Available forms: Capsules 2.3, 3, 4 mg
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Administer: • Use cytotoxic handling procedure, do not touch capsules, use gloves • Give 1 hr before or 2 hr after food, capsules should be swallowed whole • If a dose is missed, give only if the next scheduled dose is ≥72 hr, do not take a missed dose within 3 days of the next scheduled dose; do not double doses to make up for the missed dose. If vomiting occurs, do not repeat the dose; resume dosing at the next scheduled dose • Store at room temperature, do not freeze NURSING CONSIDERATIONS
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Assess: • Bone marrow suppression: Platelet nadirs (14 to 21 days) of each cycle with a recovery to baseline by the start of the next cycle. Monitor platelet counts at least monthly, more frequent monitoring during the initial 3 cycles. May require therapy interruption, dosage reduction, and/or platelet transfusions. Monitor CBC (with differential) for neutropenia; therapy interruption or dosage modifica- tion may be needed; monitor for bleed- ing, bruising • Dermatologic toxicity: Monitor for dermatologic toxicity and use supportive care or dosage modification of ixazomib and/or lenalidomide (for grade 2 or higher toxicity); SJS may occur (rare) • Gastrointestinal toxicity: Monitor diarrhea, constipation, nausea, and vomiting have been reported, antidiar- rheals, antiemetics, and supportive care, dosage change for grade 3 or 4 symptoms • Hepatotoxicity: Monitor LFTs base- line and regularly; may require dosage adjustment for grade 3 or 4 toxicity • Herpes zoster infection: May use an antiviral prophylaxis to decrease the risk of herpes zoster reactivation • Peripheral edema: Assess for poten- tial underlying causes and provide sup- portive care • Peripheral neuropathy: Monitor for neuropathy; may require dosage adjust- ment (of ixazomib and/or lenalidomide) or treatment discontinuation • Thrombotic microangiopathy: Monitor for signs/symptoms. Interrupt therapy if TTP/HUS is suspected • Renal disease: Reduced initial doses for 30 mL/min or end-stage renal disease requiring dialysis • Pregnancy/breastfeeding: Males and females of reproductive potential should use effective contraception during and for 90 days after last dose. Women using hormonal contraception should also use a barrier method
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Evaluate: • Therapeutic response: Delayed pro- gression of multiple myeloma with mini- mum toxicity
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Patient and caregiver information: • To take at the same time of day on the same day of the week for 3 wk out of 4 wk, do not double or skip doses, take whole • Not to touch capsule, use gloves • To notify provider of adverse reactions: bleeding, bruising, severe diarrhea, con- stipation, burning/tingling of feet or hands, weight gain, rash, yellow skin, eyes, clay-colored stools, pain in right upper area of abdomen • Pregnancy/breastfeeding: To report if pregnancy is planned or suspected or if breastfeeding; not to use during preg- nancy, both males and females should use contraception during and for 90 days after last dose, women taking hormonal contraceptive should also use barrier method, not to breastfeed
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PHARMACOKINETICS Onset unknown, peak 1 hr, duration unknown, half-life 9.5 days
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