Ixazomib
Other antineoplastics (differentiating agents, asparaginases, proteasome inhibitors)
Other antineoplastics (differentiating agents, asparaginases, proteasome inhibitors)High alert
An error with this medicine can cause serious harm: double checks and protocols are used.Pregnancy: avoid
Avoid in pregnancy. Can harm the fetus; effective contraception is used by women and by men with partners who could become pregnant, during treatment and for some months after…
Oral proteasome inhibitor, a capsule taken once a week with lenalidomide and dexamethasone for relapsed multiple myeloma.
Quick facts
- Group
- Other antineoplastics (differentiating agents, asparaginases, proteasome inhibitors)
- Target
- 26S proteasome, β5 subunit (PSMB5) of the 20S core
- Key effects
- Diarrhoea · Rash · Swelling of the arms or legs
- Monitor
- Platelet count before each dose · Signs of neuropathy
- ATC
- L01XG03
No doses: the clinician sets them by the current guideline.
Mechanism of action
The crystal shows ixazomib in the active sites of the human 20S proteasome core.
Ixazomib is an oral peptide-analogue proteasome inhibitor that binds the β5 subunit (PSMB5) of the 20S proteasome. With the proteasome blocked, ubiquitin-tagged proteins, including cell-cycle and apoptosis regulators, are not broken down; misfolded protein builds up and myeloma cells die.
- Ixazomib binds the β5 subunit of the proteasome
- Ubiquitin-tagged proteins are not broken down
- Protein stress kills the myeloma cell
Indications
- Multiple myeloma after at least one earlier therapy, with lenalidomide and dexamethasone. Multiple myeloma →
Adverse effects
Common
- Diarrhoea, constipation, nausea, vomiting
- Rash
- Swelling of the arms or legs; back pain
- Blurred vision, dry eyes, conjunctivitis
Contraindications
- No absolute contraindications in the label apart from hypersensitivity; see the warnings
Key interactions
- St John's wort
- Interacts with ixazomib and is not started during treatment without medical advice.
- Dexamethasone in the same regimen
- Not taken at the same moment: dexamethasone is taken with food and ixazomib on an empty stomach.
What is monitored
- Platelet count before each dose
- Signs of neuropathy
- Liver tests
- Bowel habit, rash and swelling
Administration and safety
- Oral capsule once a week on set days of each cycle, with water, on an empty stomach.
- Swallowed whole: not opened, chewed or crushed.
- Hazardous drug: if a capsule breaks, contact with skin, eyes, mouth or nose is avoided and the skin or eyes are washed.
- If vomited, the dose is not repeated; the next dose is taken on the next scheduled day.
Pregnancy and breastfeeding
Avoid in pregnancy. Can harm the fetus; effective contraception is used by women and by men with partners who could become pregnant, during treatment and for some months after, and breastfeeding is avoided.
Nursing care
- Teach the weekly schedule clearly, separate from the lenalidomide and dexamethasone days and timings.
- Check platelets and ask about bruising or bleeding.
- Ask about numbness, tingling or burning in the hands and feet.
- Ask about St John's wort and liver or kidney disease.
Pharmacokinetics
- Absorption
- Oral capsule taken on an empty stomach, at least an hour before or two hours after food.
- Half-life
- Very long, about 9.5 days, which allows weekly dosing.
Test yourself
Think of the answer, then tap the question to see it.
What makes ixazomib different from bortezomib and carfilzomib?
It is taken by mouth, once a week.
With which two drugs is ixazomib combined?
Lenalidomide and dexamethasone.
Which blood count is checked before each ixazomib dose?
Platelets, because thrombocytopenia is a key toxicity.
Connections
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Ixazomib: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2016); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026); Human 20S proteasome complex with Ixazomib at 2.0 Angstrom (RCSB Protein Data Bank, 2016).
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Representative model, for educational purposes only.