Ninlaro: Uses, Mechanism, Side Effects, Dosage, and Cost

Ninlaro is an oral prescription drug used with other medications to treat a type of bone marrow cancer (multiple myeloma) in adults.

Before Taking Ninlaro

Before receiving your first dose, inform your doctor if you:

• Have a history of allergy to this or other medications or any product components
• Take medicines to treat seizures, HIV infection, type II diabetes, or tuberculosis (TB)
• Take any supplements, specifically St. John’s wort
• Have or ever had liver or kidney disease

Ninlaro Introduction and Uses

Ninlaro is a brand-name product. It contains the active ingredient ixazomib, a member of a family of anticancer drugs known as proteasome inhibitors. 

Ninlaro is not chemotherapy. Chemotherapy works by killing rapidly multiplying cells in the body. Unfortunately, it kills some healthy cells as well. Thus, chemotherapy can cause very severe side effects.

On the other hand, Ninlaro is a type of targeted therapy for cancer treatment. Targeted therapies identify features specific to cancer cells. As a result, they usually have less severe side effects compared to standard chemotherapy. 

Ninlaro is used with lenalidomide (Revlimid) and dexamethasone to treat recurring or treatment-resistant multiple myeloma in adults who did not benefit from at least one prior therapy. 

It is NOT intended for use in newly diagnosed cases or those on maintenance treatment. 

Ninlaro Mechanism of Action

Ninlaro works by causing a buildup of unneeded proteins in cancer cells. When cancer cells cannot recycle damaged proteins, they die. 

Ninlaro Dosage

Ninlaro comes as 4 mg, 3 mg, and 2.3 mg oral capsules. 

The usual starting dose is 4 mg orally once weekly on Days 1, 8, and 15 of a 28-day treatment cycle. However, a doctor may reduce the starting dose to 3 mg in people with severe liver or kidney issues. 

Likewise, if you experience severe side effects when starting at 4 mg, your doctor will likely ask you to take 3 mg. If your problems persist, the amount is further reduced to 2.3 mg. Lastly, your doctor will stop treatment if you cannot tolerate the 2.3 mg dose. 

Your doctor may also give you medication with Ninlaro to prevent herpes zoster (chicken pox virus) reactivation. They may also order specific blood tests before each new cycle. 

Proper Use, Storage, and Disposal 

• Before using this medication, read the instructions on the prescription label carefully. Take your doses exactly as directed. 
• If you have any questions, talk to your doctor or pharmacist. 

• Never stop taking this or any medicine without talking to your doctor.
• Take the capsules on an empty stomach, at least 1 hour before or 2 hours after a meal. 
• Swallow the entire capsule; avoid crushing, chewing, or breaking it. 
• If you have to use Ninlaro and dexamethasone on the same day, do not take them simultaneously. Dexamethasone should be taken with food. 
• If your skin comes in contact with the capsule contents, wash the exposed area with soap and water. 
• If your eye is exposed, rinse it well with water. 
• If you vomit after swallowing a capsule, do not take it again. Instead, take your next dose as scheduled. 
• Store Ninlaro capsules at room temperature in their original packaging.
• Do not store above 86°F. 
• Do not freeze.
• Dispose of unused or expired medicines following the local requirements. 

Ninlaro Side Effects

Side effects can be mild or severe.

Common Side Effects

• Diarrhea
• Constipation
• Nausea
• Vomiting
• Back pain
• Swelling
• Neutropenia (low white blood cell counts)
• Upper respiratory tract infections or bronchitis (swelling of a tube-like structure that carries air to your lungs)

Talk to your doctor or pharmacist if any side effect worsens or persists. 

Severe Side Effects

Call your doctor immediately or seek emergency care if you have signs and symptoms of:

• Low platelet counts, such as unexplained bleeding or bruising
• Nerve problems (tingling, numbness, burning sensation in your hands or feet, or weakness in arms or legs)
• Skin reactions, such as rashes, mouth sores, or severe peeling of the skin
• Swelling, such as unusual weight gain or swollen arms, hands, legs, ankles, or feet
• Blood clots in small blood vessels, such as fever, bruising, tiredness, nosebleeds, or decreased urination
• Liver problems, such as yellow skin or eyes or pain in the upper right region of your stomach 
• Vision problems, such as blurred vision
• Chickenpox virus reactivation, such as skin rash and pain (shingles)

Use in Pregnancy and Lactation

Using Ninlaro during pregnancy can harm the baby. Please check with your provider if you are pregnant before starting treatment. Use effective contraception during treatment and for 90 days after the final dose. 

Men with partners who might become pregnant should use effective contraception during treatment and for 90 days after the final dose. 

Avoid breastfeeding during treatment and for 90 days after the final dose.

Missed Dose and Overdose

Take the missed dose only if the next scheduled dose is at least 72 hours away. Never take a double dose to compensate for the missed one. 

Overdosage can lead to death. Seek emergency medical care if you have severe nausea, vomiting, and diarrhea. 

Ninlaro Cost

Cost can vary depending on your insurance plan, location, and pharmacy. Ninlaro is a specialty medication, which means it is available to fill through specialty pharmacies.  

Ask your insurance provider if your plan covers this medication or if you need prior authorization. 
Takeda Pharmaceuticals, which makes Ninlaro, offers a program called Takeda Oncology Here2Assist to help you access Ninlaro treatment. Contact us if you are interested in exploring financial assistance options for Ninlaro.