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Ixazomib Dosage

Medically reviewed by Drugs.com. Last updated on May 22, 2020.

Applies to the following strengths: 2.3 mg; 3 mg; 4 mg

Usual Adult Dose for Multiple Myeloma

4 mg orally once a week on Days 1, 8, and 15 of a 28-day cycle

Comments:
-This drug is only given in combination with lenalidomide and dexamethasone.
-For additional information regarding lenalidomide and dexamethasone, refer to their prescribing information.
-Antiviral prophylaxis should be considered to decrease the risk of herpes zoster reactivation.
-Prior to initiating a new cycle of therapy:
1) Absolute neutrophil count should be at least 1,000/mm3
2) Platelet count should be at least 75,000/mm3
3) Nonhematologic toxicities should, at physician discretion, generally be recovered to patient baseline condition or Grade 1 or lower
-Treatment should be continued until disease progression or unacceptable toxicity.

Use: In combination with lenalidomide and dexamethasone for the treatment of patients with multiple myeloma who have received at least one prior therapy

Renal Dose Adjustments

Severe renal impairment (CrCl less than 30 mL/min) or end-stage renal disease (ESRD) requiring dialysis: Reduce the starting dose to 3 mg

Liver Dose Adjustments

Moderate (total bilirubin greater than 1.5 to 3 x ULN) or severe (total bilirubin greater than 3 x ULN) hepatic impairment: Reduce the starting dose to 3 mg

Dose Adjustments

DOSE REDUCTIONS DUE TO ADVERSE REACTIONS:
-Recommended starting dose: 4 mg
-First reduction recommendation: 3 mg
-Second reduction recommendation: 2.3 mg
-Discontinue therapy

DOSE MODIFICATION GUIDELINES FOR THIS DRUG IN COMBINATION WITH LENALIDOMIDE AND DEXAMETHASONE:
THROMBOCYTOPENIA:
Platelet count less than 30,000/mm3:
-Withhold this drug and lenalidomide until platelet count is at least 30,000/mm3.
-Following recovery, resume lenalidomide at the next lower dose according to its prescribing information and resume this drug at its most recent dose.
-If platelet count falls to less than 30,000/mm3 again, withhold this drug and lenalidomide until platelet count is at least 30,000/mm3.
-Following recovery, resume this drug at the next lower dose and resume lenalidomide at its most recent dose.

NEUTROPENIA:
Absolute neutrophil count less than 500/mm3:
-Withhold this drug and lenalidomide until absolute neutrophil count is at least 500/mm3. Consider adding granulocyte colony-stimulating factor (G-CSF) as per clinical guidelines.
-Following recovery, resume lenalidomide at the next lower dose according to its prescribing information and resume this drug at its most recent dose.
-If absolute neutrophil count falls to less than 500/mm3 again, withhold this drug and lenalidomide until absolute neutrophil count is at least 500/mm3.
-Following recovery, resume this drug at the next lower dose and resume lenalidomide at its most recent dose.

NONHEMATOLOGIC TOXICITIES RECOMMENDED DOSE MODIFICATIONS:
Grade 2 or 3 rash:
-Withhold lenalidomide until rash recovers to Grade 1 or lower.
- Following recovery, resume lenalidomide at the next lower dose according to its prescribing information.
-If Grade 2 or 3 rash occurs again, withhold this drug and lenalidomide until rash recovers to Grade 1 or lower.
-Following recovery, resume this drug at the next lower dose and resume lenalidomide at its most recent dose.
Grade 4 rash:
-Discontinue therapy.

PERIPHERAL NEUROPATHY RECOMMENDED DOSE MODIFICATIONS:
Grade 1 peripheral neuropathy with pain or Grade 2 peripheral neuropathy:
-Withhold this drug until peripheral neuropathy recovers to Grade 1 or lower without pain or patient's baseline.
-Following recovery, resume this drug at its most recent dose.
Grade 2 peripheral neuropathy with pain or Grade 3 peripheral neuropathy:
-Withhold this drug. Toxicities should, at the physician's discretion, generally recover to patient's baseline condition or Grade 1 or lower prior to resuming this drug.
-Following recovery, resume this drug at the next lower dose.
Grade 4 peripheral neuropathy:
-Discontinue therapy.

OTHER NONHEMATOLOGIC TOXICITIES RECOMMENDED DOSE MODIFICATIONS:
Other Grade 3 or 4 nonhematological toxicities:
-Withhold this drug. Toxicities should, at the physician's discretion, generally recover to patient's baseline condition or Grade 1 or lower prior to resuming this drug.
-If attributable to this drug, resume this drug at the next lower dose following recovery.

Precautions

CONTRAINDICATIONS: None

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

This drug is not dialyzable and can be administered without regard to the timing of dialysis.

Other Comments

Administration advice:
-Capsules should not be opened or crushed.
-This drug is cytotoxic and direct contact with the capsule contents should be avoided.
-If contact occurs with the skin, wash thoroughly with soap and water.
-If contact occurs with the eyes, flush thoroughly with water.
-Any unused medicinal product or waste material should be disposed in accordance with local requirements.

Storage Requirements:
-This drug may be stored at room temperature.
-Do not store above 30°C (86°F); do not freeze.
-Store capsules in original packaging until immediately prior to use.

Patient advice:
-The patient should be advised to read the approved patient labeling.
-If a dose is delayed or missed, the dose should be taken only if the next scheduled dose is 72 hours away or more.
-A missed dose should not be taken within 72 hours of the next scheduled dose.
-A double dose should not be taken to make up for the missed dose.
-If vomiting occurs after taking a dose, the patient should not repeat the dose. The patient should resume dosing at the time of the next scheduled dose.
-Patients should be advised to take this drug exactly as prescribed.
-Patients should be advised to take this drug at least 1 hour before or at least 2 hours after food.
-Patients should be advised that this drug and dexamethasone should not be taken at the same time, because dexamethasone should be taken with food.
-Patients should swallow the capsule whole with water. The capsule should not be crushed, chewed or opened.
-Patients should be advised that direct contact with the capsule contents should be avoided.
-Patients should be advised to wash thoroughly with soap and water If contact occurs with the skin and to flush thoroughly with water If contact occurs with the eyes.

Frequently asked questions

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.