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Proteasome inhibitor

Ixazomib (Specialist drug)

Brand names: Ninlaro

Ixazomib is an oral proteasome inhibitor used as a specialist treatment for multiple myeloma, usually in combination with lenalidomide and dexamethasone. It is taken once weekly under haemato-oncology supervision.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

It reversibly inhibits the chymotrypsin-like activity of the 20S proteasome, disrupting protein degradation and triggering apoptosis in myeloma cells.

Prescribing in practice

  • Thrombocytopenia is common and follows a cyclical pattern, so platelet counts must be monitored and dosing adjusted accordingly.
  • Peripheral neuropathy, gastrointestinal effects and rash can occur and may require dose modification.
  • Take on an empty stomach; food reduces absorption, and the once-weekly schedule should not be doubled if a dose is missed.

Monitoring

Monitor full blood count, particularly platelets, and assess for neuropathy, gastrointestinal effects and liver function during treatment.

Counselling the patient

  • Take the capsule whole on an empty stomach, away from food, and never take a double dose to make up a missed one.
  • Report new tingling, numbness or weakness in the hands or feet.
  • Report unusual bruising, bleeding or signs of infection.

Evidence & guidelines

The TOURMALINE-MM1 trial showed improved progression-free survival when ixazomib was added to lenalidomide and dexamethasone.

Reference: NICE TA1005; SmPC; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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