[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Other antineoplastics (differentiating agents, asparaginases, proteasome inhibitors)](https://durgical.com/en/pharmacology/classes/other-antineoplastics/) › Ixazomib

# 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.

Updated Nov 1, 2026

## Quick facts

**Group**
[Other antineoplastics (differentiating agents, asparaginases, proteasome inhibitors)](https://durgical.com/en/pharmacology/classes/other-antineoplastics/)

**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.

On this page

- The basics Mechanism of action
- Indications
- Adverse effects
- Pharmacokinetics
- Memory aid

- Clinical What the labels mean

- Safety Contraindications
- Key interactions
- What is monitored
- Administration and safety
- Pregnancy and breastfeeding
- Nursing care

- Study Test yourself

- Connections Connections

## Mechanism of action

✂**26S proteasome, β5 subunit (PSMB5) of the 20S core**Ixazomib

ⓘ The crystal shows ixazomib in the active sites of the human 20S proteasome core.

**Target in 3D:** 26S proteasome, β5 subunit (PSMB5) of the 20S core. PDB structure 5LF7 (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/5LF7) · Drag to rotate · pinch to zoom

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 →](https://durgical.com/en/conditions/multiple-myeloma/)

## Adverse effects

### Common

- Diarrhoea, constipation, nausea, vomiting
- Rash
- Swelling of the arms or legs; back pain
- Blurred vision, dry eyes, conjunctivitis

### Serious (rare, important)

- Thrombocytopenia with bleeding
- Peripheral neuropathy
- Liver toxicity: yellow skin or eyes, upper-right abdominal pain
- Severe diarrhoea or vomiting with dehydration

## 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.

## Memory aid

IXAzomib = the proteasome inhibitor in a capsule: once a week, empty stomach, never with the dexamethasone meal.

## 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.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/ixazomib/)

[More Pharmacology questions →](https://durgical.com/en/practice/?f=pharmacology)

## What the labels mean

**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…

## Connections

## Related drugs 3

- [Bortezomib](https://durgical.com/en/pharmacology/bortezomib/)
- [Carfilzomib](https://durgical.com/en/pharmacology/carfilzomib/)
- [Lenalidomide](https://durgical.com/en/pharmacology/lenalidomide/)

## Related conditions 1

- [Multiple myeloma](https://durgical.com/en/conditions/multiple-myeloma/)

[← Back to the class: Other antineoplastics (differentiating agents, asparaginases, proteasome inhibitors)](https://durgical.com/en/pharmacology/classes/other-antineoplastics/)

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](https://medlineplus.gov/druginfo/meds/a616008.html) (MedlinePlus (U.S. National Library of Medicine), 2016); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=L01XG03) (WHO Collaborating Centre for Drug Statistics Methodology, 2026); [Human 20S proteasome complex with Ixazomib at 2.0 Angstrom](https://www.rcsb.org/structure/5LF7) (RCSB Protein Data Bank, 2016).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/pharmacology/ixazomib/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/ixazomib/