Ixazomib is used to treat multiple myeloma along with drugs lenalidomide and dexamethasone in adult patients who have already been treated with one therapy of cancer-treating medications.
Multiple myeloma is a type of cancer that occurs in the plasma cells of the bone marrow which results in low blood cell counts, infections due to low immunity, bone disorders, and kidney damage.
Ixazomib works by selectively inhibiting the actions of a specific protein thus arresting the growth of cancer cells.
Ixazomib should not be used in patients-
If there is an allergy to ixazomib
Pregnant and breastfeeding women
Children below 18 years of age
Caution is required while using ixazomib in patients with-
History of severe liver disease
End-stage kidney disease
The recommended adult dose of ixazomib is 4 mg taken once a week on days 1, 8, and 15 in a 28-day cycle.
Ixazomib capsules should be taken on the same day in a week and approximately at the same time in a four-week treatment cycle.
If vomiting occurs after taking ixazomib, do not take another dose of ixazomib, and take the following dose as per the next prescribed schedule.
Lenalidomide 25 mg should be taken once daily from day 1 to day 21 in a 28-day treatment cycle.
The recommended adult dose of dexamethasone is 40 mg that should be taken once a day on days 1,8,15 and 22 in a full 28-day cycle.
The dose of ixazomib can be reduced to 3 mg if it is given to patients with moderate to severe liver disease and severe kidney disease, mainly those who are undergoing dialysis.
If serious side effects occur during ixazomib treatment, the dose can be further reduced to 2.3 mg and the treatment with ixazomib can be permanently discontinued if further dose reduction is required.
Ixazomib treatment can be continued until the progression of the cancer disease or until the treatment with ixazomib does not result in intolerable toxicity.
If a dose of ixazomib is missed, the missed dose can be taken if the next scheduled dose is more than three full days away (72 hours).
If the next scheduled dose is to be taken within 72 hours, ignore the missed dose and take the next dose as prescribed.
Never take a double dose of ixazomib to make up for the missed dose as it can result in harm.
Ixazomib is available in a capsule form that should be taken by mouth at least 1 hour before or 2 hours after food.
Ixazomib capsule should not be crushed, chewed, or opened but swallowed as a whole with sufficient quantity of water.
Patients should be checked for platelet counts, absolute neutrophil counts, and for the presence of any other toxicity such as peripheral neuropathy or rashes before an ixazomib therapy is initiated.
Treatment with ixazomib can be temporarily stopped if the platelet count reaches 30,000/mm3 and neutrophil count reaches 500/mm3.
The ixazomib treatment can be permanently discontinued if the platelet levels go below 30,000/mm3 and the neutrophil count is below 500/mm3.
Following the recovery of platelet and neutrophil counts, the treatment with lenalidomide can be resumed with its most recent dose and ixazomib with its next lower dose.
Patients should be monitored for the platelet and the neutrophil counts every month during the treatment with ixazomib. In low platelet counts frequent monitoring is necessary and in severe cases, platelet transfusions can be considered.
Monitor patients for symptoms and signs of peripheral neuropathy, rashes, liver damage, and stomach upset such as loose stools, nausea, and vomiting. The dose of ixazomib can be modified according to the severity of the side effects.
The dose of dexamethasone (steroid) can be reduced if patients experience any symptoms or signs of peripheral edema or swelling of the legs or the feet.
Monitor the levels of liver enzymes regularly to detect any symptoms or signs of liver damage much earlier. In such cases, the dose of ixazomib can be reduced and patients should be treated appropriately.
Male and female patients of reproductive potential should be advised to use effective contraceptive measures during the treatment with ixazomib and for at least three months (90 days) after the last dose of ixazomib.
Women of childbearing age must be tested for their pregnancy status before starting ixazomib therapy. Treatment should be initiated only if the pregnancy status is negative.
Gastrointestinal: Diarrhea, nausea, vomiting, constipation
Musculoskeletal: Back pain
Nervous system: Peripheral neuropathy
Blood: Low levels of platelets and neutrophils
Eye: Blurred vision, dry eye, cataract, conjunctivitis
Others: Rashes, swelling of the ankles or feet, infections of the upper respiratory tract and herpes zoster
Ixazomib is toxic to living cells and avoid direct contact of the capsule contents with the eyes or the skin.
If the ixazomib capsules come in contact with the skin or the eyes, wash or flush thoroughly with clean water.
Patients should be advised not to carry out skilled tasks such as driving and operating heavy machinery as ixazomib capsules may affect mental alertness.
Women using hormonal contraceptives must additionally use a barrier method of contraception as dexamethasone (taken along with ixazomib) can reduce the effectiveness of oral contraceptives.
The following drugs should be avoided during ixazomib treatment as they may reduce the effectiveness of ixazomib and can result in treatment failure.
St. Johns Wort
If the above-mentioned medications cannot be avoided, patients must be closely watched for disease control under the supervision of a cancer specialist or oncologist.
Store ixazomib capsules at room temperature between 15°C to 25°C.
Protect ixazomib capsules from excess heat and moisture.
Keep the ixazomib capsules in their original packaging and use immediately once removed from the packaging.
Keep the ixazomib capsules away from the reach of children.
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