Ixazomib (Oral)

Along with lenalidomide and dexamethasone, ixazomib is used in the treatment of bone marrow cancer, as it inhibits the growth of cancer cells, so they can then be destroyed in the body.

Overview

Ixazomib is most frequently used in combination with two other cancer drugs, dexamethasone and lenalidomide, in the treatment of bone marrow cancer. By inhibiting the growth and spread of cancer cells, it allows the body's natural immune system to eventually kill off those cells, and slow down or halt the spread of the disease.

Generally speaking, patients will not be administered this triple combination drug unless other medications have been tried first, and found to be less than successful. When this drug is administered to a patient, it will be in a cycle lasting 28 days. During the first three weeks of this cycle, the patient will be given ixazomib once each week, while any accompanying medications will be administered either daily, or also once per week.

Since there are a number of side effects which can attend usage of ixazomib, and these have the potential to be severe in nature, it is possible that your doctor will need to administer other medicines to counteract these effects. For a full description of potential side effects, read further along in this document.

This medication comes in capsule form and is intended to be taken orally, either one hour before a meal, or two hours afterward. When taking dexamethasone, it should not be at the same time as your ixazomib, since dexamethasone needs to be taken along with a meal, whereas ixazomib must be taken on an empty stomach. The exact period that you should take these medications will be determined by your doctor.

Condition Treated

  • Some types of cancer

Type Of Medicine

  • Antineoplastic agent, Proteasome inhibitor

Side Effects

Along with the very important medical benefit it provides as a cancer treatment, ixazomib also may induce some unwanted side effects in patients who are treated with it. Some of these are relatively minor and will subside on their own without any kind of medical treatment, and some may be more severe for patients, and may even need treatment of their own. One of the most important side effects to be aware of is an allergic reaction to the medication, and although this kind of side effect is rare in patients who are treated with this drug, it has been reported as a legitimate consequence of taking the medication. The symptoms to look for in an allergic reaction are the following:

  • Extreme itchiness at various locations around the body
  • Hives and/or rashes appearing on skin surfaces
  • Tightness of the chest, often in conjunction with difficulty breathing
  • Dizziness or lightheadedness with the sensation that you are about to faint
  • Swelling or puffiness of the eyelids, or around the lips, mouth, and in the throat.

Some of the more common side effects which accompany usage of this medication are those listed below:

  • Rapid weight gain
  • Painful urination or difficulty urinating
  • Nausea and/or vomiting
  • Sore throat
  • Redness or other discoloration of skin
  • Abdominal pain or cramps
  • Stomach pain or cramps
  • Swelling of the arms, legs, feet, face, or hands
  • Chills and/or fever
  • Itching or rashes
  • Headaches
  • Pale colored stools
  • Loss of appetite
  • Side pain or lower back pain
  • Tingling or numbness in the feet or in the hands
  • Lesions appearing on the skin
  • Diarrhea
  • Dark-colored urine
  • Persistent coughing
  • Stools which are black or tarry
  • Yellowish tinge to the skin or around the eyes
  • Vomiting up blood
  • Unusual weakness or tiredness
  • Unexplained bruising or bleeding
  • Bad breath
  • Sores, white spots, or ulcers which become present in the mouth
  • Bleeding gums
  • Blood in the stools or in urine
  • Red irritated eyes
  • Muscle or joint pain
  • Unusually heavy menstrual cycles
  • Peeling, blistering, or flabbiness of the skin
  • Reddish colored lesions on the skin, sometimes having a purple center.

There are some other side effects which may appear and fade away within the course of a day or two, as your body adapts itself to the new medication. For the most part, these do not require medical attention as they work themselves out. However, if any the side effects listed above reach the uncomfortable stage for you, it is advisable that you contact your doctor at the earliest opportunity and relate to him/her all side effects which you are experiencing, as well as your estimate of their severity.

Dosage

It should be noted that this medication will be administered as a treatment for multiple myeloma, in conjunction with dexamethasone and lenalidomide for patients who have already been treated with other cancer medications unsuccessfully. Since these three medications are always administered together, although not at the same exact time, dosages are provided for the other two medications as well as ixazomib.

Although your doctor may recommend a somewhat different dosage, the dosage recommended by the manufacturer of lenalidomide is 25 mg, to be taken orally on the first 21 days of a 28-day treatment cycle. The dosage for dexamethasone should be 40 mg, to be taken on days 1, 8, 15, and 22 of that same treatment cycle consisting of 28 days. For ixazombi itself, the recommended dosage is 4 mg, to be taken orally once a week on days 1, 8, and 15 of the same 28-day cycle as with the other two medications.

Ixazomib should be administered once weekly on the same day and at the same time for the first three weeks of a typical 28-day cycle of treatment. Make sure the drug is taken on an empty stomach at least an hour before meal time, or at least two hours after having taken a meal. The capsule of medication should not be opened, chewed, or crushed, but should instead be swallowed whole, with as much water as the patient is comfortable with.

Whenever a regularly scheduled dosage is missed, that missed dosage should only be taken in a situation where the next scheduled dose is at least 72 hours in the future. Whenever the dosage is missed, it should not be taken within three days of the next dosage which has been scheduled, and at no time should a patient ever double up on dosages in an attempt to get back on schedule.

If the patient experiences vomiting after having a dosage of this drug administered, the dosage should not be re-administered, and instead just wait until the next regularly scheduled dosage. In order to decrease the risk of herpes zoster reactivation, antiviral prophylaxis should be considered as part of the routine during this treatment cycle.

Treatment cycles should be repeated unless the disease progresses significantly, or the patient experiences a level of toxicity which is unacceptable. Before starting a new 28-day treatment cycle, it is advisable to make sure that absolute neutrophil count is at least 1000/mm3, and that platelet count is at least 75,000/mm3. Although a doctor's recommendation should be the final one in each patient case, it is advisable that non-hematologic disease toxicities should be restored to the patient's original baseline levels.

Interactions

There are a number of interactions which are possible for patients being treated with ixazomib, with regard to other medications you may be taking, or with regard to the presence of medical conditions which you have in addition to the bone marrow cancer for which you are being treated. Of these other medical conditions, the ones which are most likely to be impacted by taking ixazomib are the following:

By taking alcohol or tobacco while you are also in the midst of a 28-day cycle of izazomib, you may cause side effects to be worsened, or increased in frequency. It is therefore advisable that you either reduce your intake of alcohol and tobacco, or exclude them entirely during your treatment cycle for this medication.

With regard to other medications that you may be taking, there's a possibility that some of your other medications may interact with ixazomib, and cause an increase in the side effects which you are experiencing. It's also possible that interactions between your other medications and ixazomib will cause the effectiveness of either or both of the medications to be diminished significantly.

It is therefore advisable to prepare a list of all your other medications, including over-the-counter drugs, other prescription medications, herbal supplements, and vitamins, as well as all the dosage levels of each. Once you doctor has had a chance to review this medication list, he/she can make a determination whether or not drugs on your list have the potential of interacting with ixazomib.

You can also use this medication list to go to another health clinic if necessary, where your primary care doctor may not be in residence, or if you ever have to make an unscheduled trip to the emergency room. Any doctor at either of these two facilities can review your medication list and safely prescribe treatment for your medical condition, without causing interactions with your other drugs.

The drugs which are most commonly checked for potential interaction with ixazomib are those on the following list:

  • Zoledronic acid
  • Cholecalciferol
  • Cyanocobalamin
  • Olmesartan
  • Carfilzomib
  • Ubiquinone
  • Mirabegron
  • Lenalidomide
  • Rituximab
  • Dexamethasone
  • Imatinib
  • Filgrastim
  • Dilitiazem
  • Dexamethasone
  • Glucosamine and chondroitin
  • Warfarin
  • Pregabalin, omega-3 polyunsaturated fatty acids
  • Bortezomib
  • Daratumumab
  • Pomalidomide
  • Dasatinib
  • Rituximab.

Warnings

When taking ixazomib, there are some important precautions that you should adhere to in order to avoid complications with other medical conditions, or to avoid triggering a new one. In this regard, it will be very important that you keep all appointments with your doctor so that progress of the medication can be checked, and that any blood tests necessary can be carried out.

It is known that taking this medication can cause serious problems to an unborn fetus, so you should be very careful to make sure and not become pregnant while taking this drug. You should make sure that an effective form of birth control is used throughout the period of a treatment cycle, and for at least three months afterward. If you suspect that you may have become pregnant while taking this drug, you should immediately contact your doctor for consultation. By the same token, breast-feeding any time around your treatment cycle of ixazomib is strongly discouraged, because it is known that this medication can be passed on through breast milk, and that can cause serious harm to a nursing infant.

This medication can reduce the number of your blood platelets, which are essential for proper clotting. You should be very careful about any bruises which cause bleeding when you are being treated with this medication, because it may be difficult to stop the bleeding.

Almost all cancer medications, including this one, can trigger diarrhea, constipation, nausea, and vomiting in patients, even if you are taking other medications to prevent that. However, there may be alternative forms of treatment which can prevent the side effects from happening more effectively.

If you should notice any sensation of numbness or tingling in your hands, legs, arms, or feet, these may be symptomatic of a medical condition known as peripheral neuropathy, and you should alert your doctor to this fact.

There is a potential for this medication to cause patients to retain fluid, and that could lead to a buildup of fluid in the legs, feet, hands, arms, or face. This in turn can also lead to a rapid weight gain, so you should notify your doctor if any of these symptoms appear.

If you should notice any symptoms such as pain or tenderness in your stomach, dark-colored urine, or a yellowish tinge to the skin or around the eyes, you should discuss these with your doctor immediately, as they may be signs of a potentially dangerous liver problem. Do not begin taking any new medications, including over-the-counter drugs, while you are being treated with ixazomib, unless you have discussed it thoroughly with your doctor beforehand.

Storage

This medication should be stored at room temperature, away from extremes of heat, moisture, cold, and direct lighting. It should also be kept in a location which children cannot access, since it can become toxic for youngsters if ingested in any quantity. When you have expired medication, it should be disposed of rather than used, and should be discarded according to recognized safe procedures for this type of medicine. Your doctor or pharmacist can advise you about proper disposal methods.

Summary

Ixazomib is a medication used in conjunction with two other medications, dexamethasone and lenalidomide, in the treatment of bone marrow cancer. Together, these three medicines are administered in a 28-day cycle of treatment, but only after other medications have been tried first and found to be unsuccessful in managing a patient's cancer. The medication is administered in capsule form, and this capsule must be swallowed whole, without chewing or crushing, and on an empty stomach. Some patients do experience nausea and or vomiting after taking ixazomib, but if the drug is being effective in killing cancer cells, the benefits do outweigh any discomfort from the side effects.