How can NINLARO® (ixazomib) treat my multiple myeloma?

See what's possible with a capsule

NINLARO is a prescription medicine used to treat multiple myeloma in combination with the medicines REVLIMID® (lenalidomide) and dexamethasone in people who have received at least 1 prior treatment for their multiple myeloma. It is not known if NINLARO is safe and effective in children.

NINLARO is different from medicines you may have taken in the past because it is the first and only oral medication of its kind, a proteasome inhibitor, that you can take at home.

Now that I’ve relapsed, I’m taking the NINLARO regimen for my multiple myeloma. An all-oral regimen—now that works for me.

Benefits of NINLARO® (ixazomib)

NINLARO has been proven in a study to help some patients live longer without their multiple myeloma getting worse*

In a study of NINLARO, the NINLARO regimen (NINLARO+lenalidomide+dexamethasone) was proven to work in some people whose multiple myeloma had come back or stopped responding to prior therapy.

This study evaluated progression-free survival (PFS), the length of time during and after treatment that a patient lives with multiple myeloma but it does not get worse. The study also looked at other measurements, including time to response.

How do proteasome inhibitors target multiple myeloma?
Nurse practitioner Kathleen Clifford explains.
Extend your knowledge

PFS refers to the length of time during and after treatment that a patient lives with multiple myeloma but it does not get worse.

A median is the middle number in a set of data. In other words, half of the numbers in the group are more than the median and half of the numbers in the group are less than the median.

Time to response is the amount of time from when a patient starts treatment to when the body responds to treatment.

Treatment with the NINLARO regimen increased the median progression-free survival by about 6 months

20.6 months with the NINLARO regimen
14.7 months with the placebo regimen

NINLARO was proven to work quickly and effectively

Fast responses

In the NINLARO study, the median time that patients experienced their first response was about 1 month with the NINLARO regimen compared with about 2 months with the placebo regimen (placebo+lenalidomide+dexamethasone). It took longer for some patients to see a response.

Effective results

The majority of people in the study responded to treatment with NINLARO+lenalidomide+dexamethasone.

Treatment responses with the NINLARO regimen and the placebo regimen

NINLARO® (ixazomib) - Treatment Response

Overall response rate (ORR)
A percentage of patients with a partial response or better in a clinical trial.

Complete response (CR)
When there are 5% or fewer plasma cells in the bone marrow and some lab tests show no myeloma proteins.

Very good partial response (VGPR)
A greater than 90% decrease in M protein. Also called very good partial remission.

Partial response (PR)
A greater than 50% decrease in M protein, also called partial remission.

*The US Food and Drug Administration (FDA) approved NINLARO based on the results of a clinical study. This study tested the NINLARO regimen (NINLARO+ lenalidomide+dexamethasone) compared with a placebo regimen (placebo+lenalidomide+dexamethasone) in 722 people whose multiple myeloma had come back or stopped responding to prior therapy. It measured the length of time a patient lived without their disease getting worse.

Placebo+lenalidomide+dexamethasone.

Discover the possibilities of a capsule

An all-oral regimen you can take at home

NINLARO® (ixazomib) is a capsule that you take once a week for 3 weeks of a 4-week cycle. NINLARO is taken along with 2 other medications, lenalidomide and dexamethasone, in 4-week cycles. This dosing calendar is a snapshot of the NINLARO regimen for a 28-day cycle.

If you miss a dose of NINLARO, you can take the missed dose as long as the next scheduled one is more than 3 days away. NINLARO is absorbed into your body very quickly.

If you spit out NINLARO or vomit after taking a dose, do not repeat the dose. Even after vomiting or spitting out a dose, your body may have taken in some of the medication. Instead of repeating the dose, take your next dose of NINLARO on the next scheduled day and time.

Already know your dosing schedule?

A blank version of the dosing calendar is available for you to print and fill out your individual dosing regimen. This can help you stay on track with your treatment.

NINLARO® (ixazomib) - Dosing Schedule Download the NINLARO Dosing Calendar Watch step-by-step instructions on the correct way to open the NINLARO packaging

Want a digital medication reminder?

NINLARO patients can use Medisafe, a medication-reminder app. When you use the Medisafe app, you will get reminders of when you need to take your medication. Download the Medisafe app, available from the Apple App Store or Google Play.

Takeda Oncology is not affiliated with Medisafe, does not endorse any particular service, and is not responsible for the content of these sites or services. Resources are provided here for informational purposes and are not meant to replace your healthcare provider’s medical advice.

Administration guidelines for NINLARO® (ixazomib)

NINLARO® (ixazomib) - Dosing
Take each dose of NINLARO at about the same time of day each week.
NINLARO® (ixazomib) - Dosing
Take each dose of NINLARO at least 1 hour before or at least 2 hours after food.
NINLARO® (ixazomib) - Dosing
Swallow NINLARO capsules whole with water. Do not crush, chew, or open the capsule.
NINLARO® (ixazomib) - Dosing
Do not take NINLARO at the same time as dexamethasone. (Dexamethasone should be taken with food.)
NINLARO® (ixazomib) - Dosing
Take NINLARO exactly as your healthcare provider tells you to take it.
NINLARO® (ixazomib) - Dosing
Your healthcare provider will do blood tests during treatment with NINLARO to check for side effects.

Take the right steps to protect your medication

For your safety, NINLARO® (ixazomib) has been sealed in a protective slipcase. You and your care team should keep NINLARO in this package until it's time to take your medication.

When you take NINLARO, here are some important things to remember

  • Avoid direct contact with the capsule contents
    • If you accidentally get powder from the NINLARO capsule on your skin, wash the area well with soap and water
    • If you accidentally get powder from the NINLARO capsule in your eyes, flush your eyes well with water
  • Store NINLARO capsules in the original packaging until just before each use
  • Store NINLARO at room temperature. Do not store above 30°C (86°F)
  • Do not freeze NINLARO

Need help opening your NINLARO package?

Product packaging can be tricky. Use the NINLARO Package Opening Instructions or watch the video for tips on how to open your medication.

Download NINLARO Package Opening Instructions Watch step-by-step instructions on the correct way to open the NINLARO packaging

Partnering with your care team

Even with the best intentions it’s possible to miss doses of your treatment. You may be balancing dosing schedules, be concerned about side effects, or just forget because you’re human. Staying on therapy is about partnership. You and your healthcare team work together to make decisions about your care. The goal is for you to have understanding of, and control in, your treatment plan.


Need help with staying on therapy? Read on to learn about the support programs that may be available to you.

Make every dose everyone's responsibility

The good news is that your healthcare team, caregivers, and loved ones can all help with adherence. This way, the responsibility doesn't fall entirely on you. Talk with your care team about the importance of adherence and how you can work together to stay on treatment. When talking with your healthcare team specifically, consider the following suggestions for your adherence conversation.

  • Ask questions to fully understand your treatment and clarify anything that's confusing
  • Ask for information about potential side effects of treatment
  • There are changes that can be made to your dose for certain side effects
Download the Conversation Starter

The Medisafe App

Medisafe is an app that can be used by both patients and caregivers to help you manage your NINLARO dosing schedule.

Takeda Oncology is not affiliated with Medisafe, does not endorse any particular service, and is not responsible for the content of these sites or services. Resources are provided here for informational purposes and are not meant to replace your healthcare provider’s medical advice.

Tips for remembering

Forgetting to take your medicine is a common reason for nonadherence. The important thing is that you are open with your care team and take steps to prevent it from happening. Consider the following tools and techniques to help you remember to take your medication.

NINLARO® (ixazomib) - Dosing Routine

Build a routine and take your medication during a certain activity (eg, brushing your teeth, getting ready for the day)

NINLARO® (ixazomib) - Dose Tracking

Keep track of doses you've taken by recording each one in a medication diary

NINLARO® (ixazomib) - Dose Reminder

Set alarms (eg, watches, smartphones, text/call reminders)

How does NINLARO® (ixazomib) work?

Understanding proteasome inhibitors

NINLARO is the first oral proteasome inhibitor. A proteasome inhibitor is a type of medication that targets the proteasomes inside cells. This is explained in greater detail in the graphic below.

Do you have more questions about NINLARO?

Extend your knowledge in the Fast Facts section.

NINLARO® (ixazomib) Fast facts

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NINLARO is a prescription medicine used to treat multiple myeloma in combination with the medicines REVLIMID® (lenalidomide) and dexamethasone in people who have received at least 1 prior treatment for their multiple myeloma. It is not known if NINLARO is safe and effective in children.

The NINLARO regimen is a combination of 3 medicines that you can take at home: NINLARO, REVLIMID® (lenalidomide), and dexamethasone. In the NINLARO study, adding NINLARO to REVLIMID and dexamethasone improved median PFS by nearly 6 months—20.6 months with the NINLARO regimen and 14.7 months with the placebo regimen (placebo+lenalidomide+dexamethasone). You may experience side effects while taking NINLARO.

NINLARO may cause serious side effects, including:

  • Low platelet counts (thrombocytopenia) are common with NINLARO and can sometimes be serious. You may need platelet transfusions if your counts are too low. Tell your healthcare provider if you have any signs of low platelet counts, including bleeding and easy bruising.
  • Stomach and intestinal (gastrointestinal) problems. Diarrhea, constipation, nausea, and vomiting are common with NINLARO and can sometimes be severe. Call your healthcare provider if you get any of these symptoms and they do not go away during treatment with NINLARO. Your healthcare provider may prescribe medicine to help treat your symptoms.
  • Nerve problems are common with NINLARO and may also be severe. Tell your healthcare provider if you get any new or worsening symptoms, including: tingling, numbness, pain, a burning feeling in your feet or hands, or weakness in your arms or legs.
  • Swelling is common with NINLARO and can sometimes be severe. Tell your healthcare provider if you develop swelling in your arms, hands, legs, ankles, or feet, or if you gain weight from swelling.
  • Skin reactions. Tell your healthcare provider if you get a new or worsening rash.
  • Liver problems. Tell your healthcare provider if you get these signs of a liver problem: yellowing of your skin or the whites of your eyes; pain in your right upper-stomach area.

Other common side effects have occurred. Tell your healthcare provider if you get new or worsening back pain, lowered white blood cells (neutropenia) that may increase the risk of infection, or vision conditions such as blurred vision, dry eye, or pink eye (conjunctivitis).

These are not all the possible side effects of NINLARO. Talk to your healthcare provider for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.


Before taking NINLARO, tell your healthcare provider about all your medical conditions, including if:

  • You have liver problems or kidney problems or are on dialysis.
  • You or your partner are pregnant or plan to become pregnant. NINLARO can harm your unborn baby. Avoid becoming pregnant during treatment with NINLARO. You and your partner should use effective birth control during treatment and for 90 days after the final dose of NINLARO. If using hormonal contraceptives (for example, the pill), an additional barrier method of contraception (for example, diaphragm or condom) must be used.
  • You are breastfeeding or plan to breastfeed. Do not breastfeed during treatment with NINLARO and for 90 days after your final dose of NINLARO.

Tell your healthcare provider about all the medications (prescription and over-the-counter) and nutritional supplements you are taking or before starting any new medicines.

In a clinical trial, the median time that patients experienced their first response was about 1 month with the NINLARO regimen (NINLARO+lenalidomide+dexamethasone), compared with about 2 months with the placebo regimen (placebo+lenalidomide+dexamethasone).

In the study, people received NINLARO long term, meaning they stayed on treatment until their disease worsened or their treatment was no longer tolerable.

  • Take NINLARO exactly as your healthcare provider tells you to take it. Do not change your dose or stop taking NINLARO without talking to your healthcare provider first
  • NINLARO is taken in “cycles.” Each cycle lasts 4 weeks (28 days)
    • The usual dose of NINLARO is 1 capsule taken 1 time each week, on the same day of the week for the first 3 weeks of each cycle
    • Take each dose of NINLARO at about the same time of day
    • Take REVLIMID® (lenalidomide) and dexamethasone exactly as your healthcare provider tells you to
    • Your healthcare provider will do blood tests during treatment with NINLARO to check for side effects
    • Your healthcare provider may change your dosage or stop NINLARO, REVLIMID, or dexamethasone if you have side effects
  • Take NINLARO at least 1 hour before or at least 2 hours after food
  • On the days that you take both NINLARO and dexamethasone, do not take NINLARO and dexamethasone at the same time. Take dexamethasone with food
  • Swallow NINLARO capsules whole with water. Do not crush, chew, or open the capsule
  • Avoid direct contact with the capsule contents. If you accidentally get powder from the NINLARO capsule on your skin, wash the area well with soap and water. If you accidentally get powder from the NINLARO capsule in your eyes, flush your eyes well with water
  • If you miss a dose of NINLARO, or if you are late taking a dose, take the dose as long as the next scheduled dose is more than 3 days (72 hours) away. Do not take a missed dose of NINLARO if it is within 3 days (72 hours) of your next scheduled dose
  • If you vomit after taking a dose of NINLARO, do not repeat the dose. Take your next dose of NINLARO on the next scheduled day and time
  • Your doctor may prescribe a medicine to take with NINLARO to decrease the risk of the chicken pox virus (herpes zoster) coming back (reactivation)
  • If you take more NINLARO than your healthcare provider tells you to take, call your healthcare provider right away or go to the nearest hospital emergency room

If you vomit after taking a dose of NINLARO, do not repeat the dose. Even after vomiting or spitting out a dose, your body may have taken in some of the medication. Instead of repeating the dose, take your next dose of NINLARO on the next scheduled day and time.

Before taking NINLARO, tell your healthcare provider about all of your medical conditions, including if you:

  • Have liver problems
  • Have kidney problems or are on dialysis
  • Are pregnant or plan to become pregnant. NINLARO can harm your unborn baby
    • Avoid becoming pregnant during treatment with NINLARO
    • Females who are able to become pregnant must use effective birth control during treatment and for 90 days after your final dose of NINLARO. If using hormonal contraceptives (for example, the pill), an additional barrier method of contraception (for example, diaphragm or condom) must be used
    • Males with a female partner who is able to become pregnant must use effective birth control during treatment and for 90 days after your final dose of NINLARO
    • Talk to your healthcare provider about birth control methods that may be right for you
    • Tell your healthcare provider right away if you or your partner become pregnant while you are receiving NINLARO
  • Are breastfeeding or plan to breastfeed. It is not known if NINLARO passes into breast milk, if it affects an infant who is breastfed, or breast milk production. Do not breastfeed during treatment with NINLARO and for 90 days after your final dose of NINLARO

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Talk to your healthcare provider before starting any new medicines during treatment with NINLARO.

It is possible that you’ve taken other proteasome inhibitors in the past, such as VELCADE® (bortezomib). NINLARO is different because it is the first and only proteasome inhibitor that you can take at home in a capsule form.

NINLARO targets a part of cells called proteasomes. It works by slowing down or blocking proteasomes from doing their job of digesting proteins. In myeloma cells, there is a greater need for proteasomes to digest proteins; the buildup of excess proteins causes cell death.

Use the Conversation Starter to prepare questions for your healthcare team about any topics that you would like to know more about. This guide can also help you get the most out of your discussion, with helpful tips to use when talking with your healthcare team.

Download the Conversation Starter 
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Multiple myeloma is a cancer of plasma cells (a type of white blood cell). For people who have the disease, multiple myeloma affects the part of the bone called bone marrow.

A relapse happens when multiple myeloma signs and symptoms return after a period of improvement. Refractory means that the myeloma either never initially responded or no longer responds to a certain treatment.

A multiple myeloma diagnosis is often given as a result of abnormalities in routine blood work, or following an evaluation of an individual who is presenting symptoms.

Prior to diagnosis, people with multiple myeloma may experience a number of symptoms that lead them to seek medical attention. Some common signs and symptoms of multiple myeloma are listed below; however, some people may not have any symptoms or their symptoms may be vague.

  • Bone pain and broken bones
  • Nausea or vomiting
  • Weakness and tiredness
  • Frequent infections
  • Nervous system problems, such as back pain, numbness, and muscle weakness
  • Low red blood cell count, known as anemia
  • High calcium levels in the blood, known as hypercalcemia

Symptoms like these could be signs of other medical problems. Talk with your healthcare team about any questions you may have.

Bone marrow is the spongy inner part of your bone. Your blood is produced in your bone marrow, which is made up of many different types of cells, including red blood cells, white blood cells, platelets, and plasma cells.

NINLARO® (ixazomib) - Bone Marrow

Plasma cells are a type of white blood cell that normally helps your body fight off infections by producing antibodies. People with multiple myeloma have cancerous plasma cells, also called myeloma cells, which replace normal cells and form tumors in bones. Occasionally, these tumors can also form in soft tissue areas of the body. Myeloma cells often produce large quantities of an abnormal antibody (referred to as M protein) and may also prevent bone marrow from making enough red blood cells, white blood cells, and platelets.

Myeloma cells multiply quickly and can build up in the bone marrow. When they do, they prevent bone marrow from making enough blood cells for the body to fight infection and other diseases. Myeloma cells (and the production of M protein from the myeloma cells) can lead to anemia, bone damage, and kidney impairment.

Even though treatment can reduce the number of myeloma cells in the body, there may be cells that remain or become resistant to treatment. Over time, these cells may start to increase and cause symptoms to come back, called a relapse. Most people will take several different treatments throughout their journey with multiple myeloma.

Lab tests play a big role in monitoring treatment progress and side effects. Your doctor will use lab tests to help diagnose and assess your multiple myeloma. Take a look at the Lab Test Tracker to familiarize yourself with the terms and reference ranges for different tests. This way, you can have a more productive conversation when speaking with your doctor about your treatment progress.