ixazomib citrate: clinical use

Prescribing considerations

• Treatment should be initiated and monitored by a clinician experienced in managing multiple myeloma.
• Assess kidney and liver function because increased exposure may require product-specific adjustment.
• Consider antiviral prophylaxis against herpes zoster and thromboprophylaxis based on individual clinical risk.
• Review precautions associated with lenalidomide and dexamethasone.

Contraindications and cautions

• Hypersensitivity to ixazomib or any excipient.
• Apply the additional contraindications of lenalidomide and dexamethasone.

Monitoring

• Full blood count, particularly platelets and neutrophils.
• Liver enzymes and renal function.
• Peripheral neuropathy, rash, oedema and gastrointestinal toxicity.
• Serum potassium during severe gastrointestinal toxicity.
• Signs of infection, thrombotic microangiopathy, severe cutaneous reactions and posterior reversible encephalopathy syndrome.

Clinical pharmacology

Ixazomib citrate is a prodrug rapidly hydrolysed to ixazomib, a selective, reversible inhibitor of the proteasome beta-5 subunit. Food reduces systemic exposure; ixazomib is highly protein-bound, has a long terminal half-life and is not removed by dialysis.

Formulation and product differences

• The selected presentation is a hard capsule that must be swallowed intact.
• The capsule is cytotoxic; avoid direct contact with its contents and handle damaged or unused capsules appropriately.

Capsule

Route: Oral

Strengths: 2.3 mg, 3 mg, 4 mg