Jul 27, 2022

Generic name:  ixazomib  [ ix-AZ-oh-mib ]
Drug class:  Proteasome inhibitors

What is Ninlaro?

Ninlaro is a  cancer medicine  that interferes with the growth and spread of cancer cells in the body.

Ninlaro is used in adults to treat  multiple myeloma  (bone marrow cancer), in combination  chemotherapy  with  lenalidomide  and  dexamethasone .

This combination is usually given after treatment with at least one other cancer medicine has failed.

Ninlaro should not be used to treat people who are receiving maintenance treatment, or who have been newly diagnosed with multiple myeloma, except if they are participants in a controlled clinical trial.


Do not use Ninlaro with lenalidomide if you are pregnant, or if you are a man and your sexual partner is pregnant. Lenalidomide is known to cause severe, life-threatening birth defects or death of a baby if the mother or the father is taking this medicine at the time of conception or during pregnancy.

Follow all directions on your medicine label and package. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use.

Before taking this medicine

You should not use Ninlaro if you are allergic to ixazomib.

To make sure Ninlaro is safe for you, tell your doctor if you have ever had:

  • liver disease ; or
  • kidney disease (or if you are on dialysis).

Ixazomib may harm an unborn baby. Both men and women should use effective  birth control  to prevent pregnancy while taking Ninlaro, and for at least 90 days after the last dose.

If you are a woman also taking dexamethasone: If you use  birth control pills  or other hormonal contraception (injections, implants, skin patches, vaginal rings), also use a barrier form of birth control such as a condom,  diaphragm , cervical cap, or contraceptive sponge.

Ninlaro is used together with lenalidomide. Do not use Ninlaro with lenalidomide if you are pregnant, or if you are a man and your sex partner is pregnant. Lenalidomide is known to cause severe, life-threatening birth defects or death of a baby if the mother or the father is taking this medicine at the time of conception or during pregnancy.

Carefully follow all instructions about the use of birth control while using Ninlaro with lenalidomide, whether you are a man or a woman. Tell your doctor right away if a pregnancy occurs while either the mother or the father is using these medicines.

Do not breastfeed while using Ninlaro, and for at least 90 days after your last dose.

How should I take Ninlaro?

Take Ninlaro exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose.

Your combination chemotherapy will be given in a 28-day treatment cycle. You will take Ninlaro once per week on the same day of the week during the first 3 weeks of each cycle. Your other medicines may be taken daily or only once per week throughout the cycle.

If you’ve ever had chickenpox or  shingles , taking Ninlaro can cause this virus to become active again. You may be given antiviral medication to prevent shingles.

Carefully follow your doctor’s dosing instructions for taking all your medications.

Take Ninlaro at the same time each day on an empty stomach, at least 1 hour before or 2 hours after a meal.

Do not take your dexamethasone dose at the same time you take Ninlaro. Dexamethasone should be taken with food and Ninlaro should be taken without food.

Swallow the Ninlaro capsule whole and do not crush, chew, break, or open it. Take with a full glass of water.

If you vomit shortly after taking Ninlaro, do not take another dose. Wait until your next scheduled dose time to take the medicine again.

Do not use a broken capsule. The medicine inside the capsule can be dangerous if it gets in your eyes or on your skin. If this happens, wash your skin with soap and water or rinse your eyes with water. Ask your pharmacist how to safely dispose of a broken pill.

You may need frequent medical tests to be sure this medicine is not causing harmful effects. Your cancer treatments may be delayed based on the results of these tests.

Store at room temperature away from moisture and heat. Do not freeze. Keep each capsule in the blister pack until you are ready to take a dose.

Dosing information

Usual Adult Dose for Multiple Myeloma:

4 mg orally once a week on Days 1, 8, and 15 of a 28-day cycle

-This drug should be taken once a week on the same day and at approximately the same time for the first 3 weeks of a 4-week cycle.
-This drug should be taken at least 1 hour before or 2 hours after food.
-The whole capsule should be swallowed with water (not crushed, chewed, or opened).
-If a dose is delayed or missed, the dose should be taken only if the next scheduled dose is 72 or more hours away. A missed dose should not be taken within 72 hours of the next scheduled dose. A double dose should not be taken to make up for the missed dose.
-If vomiting occurs after taking a dose, the patient should not repeat the dose. The patient should resume dosing at the time of the next scheduled dose.
-Antiviral prophylaxis should be considered to decrease the risk of  herpes zoster  reactivation.
-Treatment should be continued until disease progression or unacceptable toxicity.
-Prior to initiating a new cycle of therapy:
1) Absolute neutrophil count should be at least 1000/mm3
2) Platelet count should be at least 75,000/mm3
3) Nonhematologic toxicities should, at physician discretion, generally be recovered to patient baseline condition or Grade 1 or lower
-This drug is only given in combination with lenalidomide and dexamethasone; the manufacturer recommended dose of lenalidomide is 25 mg orally on Days 1 through 21 of a 28-day treatment cycle and dexamethasone is 40 mg orally on Days 1, 8, 15, and 22 of a 28-day treatment cycle. For additional information regarding lenalidomide and dexamethasone, refer to their prescribing information.

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

Detailed Ninlaro dosage information

What happens if I miss a dose?

Take the medicine as soon as you can, but skip the missed dose if your next dose is due in less than 72 hours (3 days). Do not take two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What to avoid

Follow your doctor’s instructions about any restrictions on food, beverages, or activity.

Ninlaro side effects

Get emergency medical help if you have signs of an allergic reaction to Ninlaro ( hives , difficult breathing, swelling in your face or throat) or a severe skin reaction (fever,  sore throat , mouth sores, burning eyes, skin pain, red or purple  skin rash  with blistering and peeling).

Ixazomib can cause life-threatening blood clots in the small blood vessels inside your organs, such as your brain or kidneys. Seek medical help right away if you have symptoms of this condition, such as a fever, tiredness, decreased urination, bruising, or  nosebleeds .

Call your doctor at once if you have:

  • severe ongoing  nausea ,  vomiting ,  diarrhea , or  constipation ;
  • a new or worsening skin rash;
  • blurred vision, dry or red eyes;
  • back pain ;
  • fluid retention – swelling in your hands or feet, rapid weight gain;
  • liver problems – upper stomach pain,  jaundice  (yellowing of the skin or eyes);
  • low levels of platelets in your blood – easy bruising, unusual bleeding, purple or red spots under your skin;
  • low white blood cell counts – fever, cold or flu symptoms, cough, sore throat, swollen gums, mouth sores, skin sores;
  • nerve problems –  numbness , tingling, pain, burning feeling in your hands or feet, weakness in your arms or legs; or
  • signs of shingles – flu-like symptoms, tingly or painful blistering rash on one side of your body.

Common Ninlaro side effects may include:

  • nerve problems or swelling in your hands or feet;
  • low blood platelets;
  • diarrhea, constipation;
  • nausea, vomiting; or
  • back pain.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Ninlaro side effects  (more detail)

What other drugs will affect Ninlaro?

Other drugs may interact with ixazomib, including prescription and over-the-counter medicines,  vitamins , and  herbal products . Tell your doctor about all your current medicines and any medicine you start or stop using.

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