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Does Ninlaro cause shingles (herpes zoster)?

Medically reviewed by Melisa Puckey, BPharm. Last updated on April 6, 2023.

Official answer


Ninlaro (ixazomib) does not cause shingles, but while having Ninlaro treatment there is an increased risk of shingles in patients who have previously had chickenpox (varicella-zoster virus), as the virus that is dormant can be reactivated when the immune system is suppressed.

In the clinical trial the overall shingles rate in the Ninlaro group was 4% and the placebo group was 2%, meaning the Ninlaro rate of shingles was 2% higher than the placebo group.

By taking antiviral medication, the shingles rate in the Ninlaro group decreased to below 1%.

Shingles rate Ninlaro treatment group Placebo treatment group
Overall rate 4% 2%
With antiviral prophylaxis <1% information not available
Without antiviral prophylaxis 6% information not available

What are shingles?

  • Shingles (herpes zoster) is a painful rash that usually only develops on one side of the face, body or head.
  • Shingles is an infection caused by the varicella-zoster virus.
  • When first infected with varicella-zoster virus it causes chickenpox, which most people have when they are younger.
  • Once the chickenpox infection has cleared up, small amounts of varicella-virus can remain inactive within the nerves.
  • If the immune system becomes suppressed, like when taking anticancer drugs, the virus can become reactivated causing shingles.
  • Once reactivated, the virus will travel along a nerve to the skin and cause a rash.
  • The pain or irritation from shingles can last 3 to 5 weeks, but if the virus damages a nerve, you may have pain, numbness or tingling for months or even years after the rash is healed.

Why do some Ninlaro patients have an increased rate of shingles?

  • In the clinical trials there was an increase in the rate of shingles in patients in both treatment groups, but for the Ninlaro group it was higher.
  • This may be because Ninlaro treatment reduces the immune system, which in a small percentage of patients can cause the reactivation of the varicella-zoster virus.
  • Ninlaro group patients, who did not have any antiviral prevention medicine, had a higher rate of shingles than the placebo group.
  • Ninlaro group patients, who had antiviral prevention medicine, had a lower shingles rate.

How can I prevent shingles while having Ninlaro treatment?

  • Taking an antiviral medication while having Ninlaro treatment will lower the shingles rate to below the shingles rate of the placebo treatment group.
  • It is important to discuss this with your health care provider.

Bottom line:

  • Anticancer medications combinations can suppress a patient's natural immunity
  • While the immune system is suppressed there is an increased risk of the varicella-zoster virus being reactivated causing shingles.
  • While on Nilaro you can reduce the risk of shingles by taking an antiviral medication.
  • It is important to discuss your risk of shingles with your health care provider.

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