Ixazomib (Ninlaro®)

Some cancer medications are only available through specialty pharmacies. Your provider or pharmacist will start this process. Your insurance plan may also affect where you can get your medication.  Call your prescription plan provider to find out which specialty pharmacies are in-network.

This medication may be covered by your prescription plan. If you qualify, you may be able to get financial help through patient assistance programs (PAP). Co-pay cards may also be available to lower your out-of-pocket cost if you have commercial (not Medicare/Medicaid/Tricare) insurance. Your pharmacist, social worker, or navigator can help find resources for financial support.

These are some of the most common or most serious side effects of this medication. Talk with your provider about the side effects you are having and how they can be managed.

Platelets are blood cells that help your blood clot. Thrombocytopenia is when your platelet count is lower than normal, and you are at a higher risk of bleeding. Tell your providers if you have any bruising or bleeding, including nose bleeds, bleeding gums, or blood in your urine or stool. If your count gets too low, you may receive platelets from a donor. 

• Do not use a razor (an electric razor is fine).
• Do not do activities that can cause injury or bleeding.
• Talk to your provider before taking any non-steroidal, anti-inflammatory medications (NSAIDs) like Motrin/Advil (ibuprofen), Aleve (naproxen), Celebrex (celecoxib), and others. These can raise the risk of bleeding. 
• Use a soft-bristle toothbrush to brush your teeth. Ask your provider about flossing or using toothpicks. 

White blood cells (WBC) help your body fight infection. While you are having treatment for cancer, your WBC count can drop, putting you at a higher risk of an infection. Tell your provider right away if you have a fever (temperature greater than 100.4°F or 38°C), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn't heal.

Tips for preventing infection:

• Hand washing: both yours and your visitors is the best way to prevent the spread of infection.
• Avoid large crowds and people who are sick (those who have a cold, fever, or cough, or live with someone with these symptoms).
• When working outside, wear clothes that protect you, like long pants and gloves.
• Do not handle pet waste.
• Keep all cuts and scratches clean.
• Shower or bathe daily. 
• Brush your teeth at least twice a day.
• Do not cut cuticles or ingrown nails. You may wear nail polish, but not fake nails.
• Ask your providers before scheduling dental appointments or procedures.
• Ask your providers before you or someone you live with has any vaccines. 

Diarrhea is when you pass three or more stools in a day. Your providers can suggest medications to relieve diarrhea. Do not take any medications to manage your diarrhea without talking to your provider first, as your stool may need to be tested. To manage it, try eating foods that are low in fiber and bland, like white rice and boiled or baked chicken. Try not to eat raw fruits, vegetables, whole grain breads, cereals, and seeds. Soluble fiber is a type of fiber found in some foods that helps absorb (soak up) fluid. Foods high in soluble fiber are applesauce, bananas (ripe), canned fruit, oranges, boiled potatoes, white rice, foods made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Stay hydrated by drinking 8 to 10 glasses of non-alcoholic, non-caffeinated fluid each day.

Constipation is when you have less bowel movements than usual or are having trouble passing stool. To relieve constipation, you can include fiber in your diet (fruits like prunes, apples, peaches, and pear nectars/juices), drink 8 to 10 glasses of non-alcoholic fluids a day, and stay active. Taking a stool softener once or twice a day can prevent constipation. If you do not have a bowel movement for 2 to 3 days, call your provider. 

Talk to your providers if you have nausea and/or vomiting. They can prescribe medications to help you. Making changes to your diet can also help. Avoid things that make your symptoms worse, like heavy or greasy/fatty foods and spicy or acidic foods, like tomatoes, lemons, and oranges. Try saltines or ginger ale to help your symptoms.  

Call your providers if you cannot keep fluids down for more than 12 hours or if you feel lightheaded or dizzy.

Peripheral neuropathy is when the nerves not in your brain or spinal cord are damaged. It causes numbness or a tingling feeling in the hands and/or feet, which can also cause pain and trouble with balance. The more you take this medication, the worse your neuropathy can get. The symptoms may slowly get better, or they may never fully go away. Tell your providers if you have symptoms of neuropathy, so that changes can be made to your treatment plan and to manage your symptoms.

Peripheral edema is swelling in your hands, arms, legs, ankles, and feet. It is caused by retention (buildup) of fluid. To help get rid of the fluid, you can elevate (lift up) the affected body part and rest it on a pillow. You may need medications to help your body get rid of the extra fluid, and you may be told to follow a low salt diet. Tell your providers if you have any new or worsening swelling.

Some people may get a rash, scaly skin, or red, itchy bumps from this medication. Tell your provider if you notice any of these changes in your skin, since it could be a reaction. Your provider may suggest:

• Using an alcohol-free moisturizer on your skin and lips, and do not use moisturizers with perfumes or scents. 
• Keep the area clean to avoid infection, especially if it cracks or bleeds.
• Using a topical medication (applied to the skin) if the itching bothers you.

Be sure to talk with your provider about how to care for your skin.

There is a higher risk of health problems for your baby if you are pregnant, become pregnant, or get someone pregnant while on this medication. To lower the risk of birth defects, you should use birth control (contraception) to avoid pregnancy. Talk with your provider about what kind of birth control is safest for you and your partner.

This medication can cause liver toxicity, or liver problems, which your provider may monitor for with blood tests called liver function tests. Symptoms may be:

• Yellowing of your skin or eyes.
• Dark or brown urine.
• Pain in your abdomen (belly).

Tell your provider if you have any of these symptoms.

This medication can cause a rare blood-clotting disorder called thrombotic thrombocytopenic purpura or hemolytic uremic syndrome (TTP or HUS). Symptoms may be:

• Bruising.
• Bleeding.
• Tiny red or purple spots on the skin.
• Pale skin, lips, or inner eyelids.
• Fatigue and weakness.
• Yellowing of the skin or eyes.

Your provider will monitor you for TTP and HUS during treatment. Tell your provider if you have any of these symptoms.