Ninlaro (Ixazomib) for Multiple Myeloma

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Ninlaro (ixazomib) is a prescription medication approved by the U.S. Food and Drug Administration (FDA) for treating adults with multiple myeloma.

What Members Say

MHT logo These insights are based on 1,139 comments about Ninlaro from MyMyelomaTeam members. These are the experiences of a small number of people and are not meant to be medical advice.

Benefits:

Taking it at home once a week can feel simpler than ongoing injections or infusions.
Some lab numbers can stay stable or improve during treatment.
Dose changes can help manage side effects when needed.

Considerations:

Diarrhea, nausea, constipation, and vomiting can disrupt the week.
Peripheral neuropathy, including burning feeling in the feet or hands, can worsen.
Swelling in the legs or feet can be hard to manage.

How Ninlaro Works and How It’s Taken

Ninlaro is a type of drug called a proteasome inhibitor. It blocks a part of the cell called the proteasome, which helps break down proteins. Blocking this system can lead to the death of cancerous myeloma cells.

Ninlaro is used to treat people with multiple myeloma who have had at least one prior treatment.

Typical Dosing for Multiple Myeloma

Ninlaro is a capsule taken by mouth once a week on the same day during the first three weeks of a 28-day cycle. The capsule should be swallowed whole with water.

This information is based on prescribing information, but your healthcare provider may tailor your treatment plan. Always follow their guidance.

Top Advice From Members on Ninlaro

These insights are based on 1,139 comments about Ninlaro from MyMyelomaTeam members.

Members who use Ninlaro often say it helps to pay close attention to patterns, especially side effects, lab results, and how they feel after each weekly dose. Many also mention that staying in touch with their oncology team about changes in symptoms, dosing, cost, or convenience can make treatment easier to manage.

1

Keep track of side effects after each dose.

“I feel tired and spaced out the day after I take it, but the nausea and constipation has resolved itself.”
2

Tell your doctor if side effects are getting worse.

“I have been having more intestinal issues since starting Ninlaro 3 milligrams. At 2.5 milligrams I was OK. I am having other issues with it also. I see my oncologist in 11 days. I will discuss it with her.”
3

Get regular labs and watch how your numbers change.

“The plan is to monitor M Spike monthly and consider treatment change when it reaches 0.5.”
4

Ask about timing and food if stomach issues are a problem.

“He had to adjust the timing of his Ninlaro with eating and a nausea med to control the stomach issues.”
5

Speak up about practical issues like cost and access.

“Ask your doctor or pharmacy to help you get a grant. I have a grant through HealthWell Foundation.”

Connect with others who understand life with multiple myeloma. Join MyMyelomaTeam for free.

Ninlaro Side Effects

In clinical trials of Ninlaro used with lenalidomide and dexamethasone to treat multiple myeloma in people who have received at least one prior therapy, the most common side effects occurred in about 22 percent to 52 percent of people. They include:

Low platelet counts (thrombocytopenia)
Low white blood cell counts (neutropenia)
Diarrhea
Constipation
Nerve problems in the hands or feet (peripheral neuropathy)
Nausea
Swelling in the arms, legs, hands, or feet (peripheral edema)
Rash
Vomiting
Bronchitis

Serious Side Effects and Warnings

Ninlaro can cause serious side effects that require immediate medical attention. These include:

Thrombocytopenia — Dangerously low platelets that can increase the risk of bleeding or easy bruising
Severe stomach and intestinal problems — Including severe diarrhea, constipation, nausea, or vomiting
Peripheral neuropathy — Nerve damage in the hands or feet that can cause worsening numbness, tingling, burning pain, or weakness
Peripheral edema — Swelling in the arms, legs, hands, or feet
Severe skin reactions — Including Stevens-Johnson syndrome and toxic epidermal necrolysis, which can cause widespread rash, blistering, or skin peeling
Thrombotic microangiopathy — A serious blood vessel condition, including thrombotic thrombocytopenic purpura/hemolytic uremic syndrome
Liver problems — Liver injury that may cause yellowing of the skin or eyes, or pain on the right side of the upper belly
Embryo-fetal toxicity — Harm to a fetus if taken during pregnancy

Get medical help right away if you think you are having a serious side effect from Ninlaro.

How To Save on Ninlaro

Takeda Pharmaceuticals, the manufacturer of Ninlaro, offers the Takeda Oncology Co-Pay Assistance Program. Eligible individuals with commercial insurance may pay as little as $0 per prescription.

To learn more, visit the Ninlaro financial support page, or call 844-817-6468.

What To Know Before Taking Ninlaro

Tell your doctor if you have any allergies to ixazomib or any ingredients in Ninlaro.

Tell your doctor about all medicines you take, including prescription drugs, over-the-counter medicines, and supplements.

Before taking Ninlaro, tell your healthcare provider about all your medical conditions, including if you have liver problems, have kidney problems, or are on dialysis.

If you miss a dose, take it only if your next scheduled dose is at least 72 hours away. Do not take a missed dose within 72 hours of your next scheduled dose, and do not take two doses at the same time to make up for a missed dose. If you vomit after taking a dose, do not repeat the dose — take your next dose at the usual scheduled time.

If you are pregnant, planning to become pregnant, or breastfeeding while taking Ninlaro, talk with your doctor about the risks and benefits. Ninlaro can harm your baby if you are pregnant, and you will need a pregnancy test before starting Ninlaro if you can become pregnant. Use effective nonhormonal contraception during treatment and for 90 days after the last dose.

If you use hormonal birth control, also use a barrier method for additional protection. Males with partners who can become pregnant should use effective contraception during treatment and for 90 days after the last dose. Do not breastfeed during treatment and for 90 days after the last dose.

Community FAQs

These answers are fact-checked by our editorial staff.

How effective is Ninlaro?
In a clinical study of people with multiple myeloma who had at least one prior treatment, people who took Ninlaro with lenalidomide and dexamethasone went more than 1.5 years (20.6 months) without their multiple myeloma getting worse compared to 14.7 months for people who took lenalidomide and dexamethasone alone. Seventy-eight percent of people responded to the Ninlaro treatment combination compared to 72 percent with the lenalidomide and dexamethasone combination. Of those people, 48 percent had a very good partial response or a complete response.

People taking the Ninlaro treatment combination lived a similar overall length of time after diagnosis as people who received lenalidomide and dexamethasone with placebo (an inactive treatment) (53.6 months vs. 51.6 months).

How long does Ninlaro take to work for multiple myeloma?
In a clinical study, the median time to response was 1.1 months when Ninlaro was used with lenalidomide and dexamethasone. That means half of the people who responded did so in about a month or sooner, and half took longer.

How should I take Ninlaro for multiple myeloma, and what if I miss a dose?
Ninlaro is usually taken once a week on the same day for the first three weeks of a 28-day cycle. It should be taken at least one hour before food or at least two hours after food, and the capsule should be swallowed whole with water, not crushed, chewed, or opened. If you miss a dose, take it only if your next scheduled dose is at least 72 hours away.

If you vomit after taking a dose, do not take another dose.