Ixazomib

• Patients should be checked for platelet counts, absolute neutrophil counts, and for the presence of any other toxicity such as peripheral neuropathy or rashes before an ixazomib therapy is initiated. • Treatment with ixazomib can be temporarily stopped if the platelet count reaches 30,000/mm3 and neutrophil count reaches 500/mm3. • The ixazomib treatment can be permanently discontinued if the platelet levels go below 30,000/mm3 and the neutrophil count is below 500/mm3. • Following the recovery of platelet and neutrophil counts, the treatment with lenalidomide can be resumed with its most recent dose and ixazomib with its next lower dose. • Patients should be monitored for the platelet and the neutrophil counts every month during the treatment with ixazomib.​‍​​​​​‍​‍‍‍‍​‍‍ In low platelet counts frequent monitoring is necessary and in severe cases, platelet transfusions can be considered. • Monitor patients for symptoms and signs of peripheral neuropathy, rashes, liver damage, and stomach upset such as loose stools, nausea, and vomiting. The dose of ixazomib can be modified according to the severity of the side effects. • The dose of dexamethasone (steroid) can be reduced if patients experience any symptoms or signs of peripheral edema or swelling of the legs or the feet. • Monitor the levels of liver enzymes regularly to detect any symptoms or signs of liver damage much earlier. In such cases, the dose of ixazomib can be reduced and patients should be treated appropriately. • Male and female patients of reproductive potential should be advised to use effective contraceptive measures during the treatment with ixazomib and for at least three months (90 days) after the last dose of ixazomib. • Women of childbearing age must be tested for their pregnancy status before starting ixazomib therapy. Treatment should be initiated only if the pregnancy status is negative.