Take each dose of Ninlaro at about the same time on the scheduled days
How to take NR d*
* NINLARO (ixazomib), REVLIMID (lenalidomide) and dexamethasone
NRd is taken as a 28‑day (4‑week) treatment cycle - cycles continue one after the other
- Ninlaro is taken once a week, on the same day, for the first 3 weeks. No Ninlaro is taken in week 4 of the cycle
- Revlimid is taken every day for the first 3 weeks. No Revlimid is taken in week 4 of the cycle
- Dexamethasone is taken once a week, on the same day each week of the cycle
- Keep taking the cycles of treatment until your doctor tells you to stop
- The days you should take Ninlaro, Revlimid and dexamethasone are shown on the example treatment calendar. You can ask your doctor or nurse for a treatment calendar, or download it here
How to take Ninlaro capsules
Swallow the Ninlaro capsule whole with a glass of water. Do not crush, chew or open the capsule
Take Ninlaro at least 1 hour before or at least 2 hours after food
Be careful not to come into direct contact with the capsule contents. If the capsule does break, try not to create any dust while you're clearing it up. If the contents come into contact with your skin, wash thoroughly with soap and water. Contact your nurse who will arrange for you to get a replacement capsule
How to take Revlimid capsules
Take Revlimid at about the same time on the scheduled days
Revlimid can be taken either with or without food
Swallow the capsule whole, preferably with a glass of water. Do not break, open or chew the capsules
How to take dexamethasone tablets
Try to take your dexamethasone dose in the morning, preferably before you take your Ninlaro dose
Take dexamethasone with food and in the morning
Swallow the tablets whole with a glass of water. Do not crush or chew the tablets
What time of day to take each drug
The diagram below shows an example of when to take each drug on a typical day 1, 8 or 15 of the cycle:
Your nurse or pharmacist will advise you on the best time to take each drug of the regimen as well as any supportive treatment you might be on.
Frequently asked questions about taking NRd
What should I do if I accidentally take more Ninlaro than I should have done?
If you accidentally take more Ninlaro than you should, talk to your doctor or nurse straight away so they can monitor you. If they're not available, go to your local hospital instead and take the medicine pack with you. You'll be monitored and given any supportive care needed
What should I do if I miss a Ninlaro dose?
If you miss a dose of Ninlaro, what you do next depends on how far away the next scheduled dose is:
- If you miss a dose and the next dose is more than 3 days (72 hours) away, take the missed dose
- If you miss a dose and the next dose is less than 3 days (72 hours) away, do not take the missed dose. Just take the next scheduled dose as normal
What should I do if I vomit after taking Ninlaro?
If you vomit after taking a dose, do not take a repeat dose. Just take the next scheduled dose as normal
What should I do if I accidentally take more Revlimid than I should have done?
If you accidentally take more Revlimid than you should, tell your doctor straight away
What should I do if I miss a Revlimid dose?
If you forget to take a dose of Revlimid, what you do next depends on how long has passed since the time you usually take it:
- If less than 12 hours have passed, take your capsule straight away
- If more than 12 hours have passed, do not take the missed capsule. Just take your next capsule at the usual time the next day
What should I do if I accidentally take more dexamethasone than I should have done?
If you accidentally take more dexamethasone than you should, you may experience swelling of the throat, a skin reaction or difficulty breathing. Talk to a doctor or nurse or go to a hospital straight away. Take the medicine pack with you so the doctor knows what you have taken
What should I do if I miss a dexamethasone dose?
If you forget to take a dose of dexamethasone, take it as soon as you remember. If it is nearly time for the next dose, skip the missed one. Do not take a double dose (two doses at the same time) to make up for a forgotten dose
I feel unwell - can I stop taking my medicines?
Always talk to your doctor or nurse about stopping treatment and follow their advice. It can sometimes be dangerous to stop taking a medicine suddenly. He or she may tell you to lower the amount of medicine you're taking gradually, to stop taking it altogether or to add some supportive treatment to help with side effects
Blood tests and monitoring during treatment
During your treatment with NRd, you'll have regular appointments with your doctor or nurse so they can monitor you closely.
Before you start each new cycle of NRd, you'll have a blood test to check your number of blood cells and to see how your myeloma is responding to treatment.
It's also important to take your temperature if you're feeling unwell as this can help spot if you have an infection at an early stage. Your doctor or nurse will tell you what body temperature could indicate an infection, and when you need to contact them
Takeda Oncology has developed a practical guide for patients who have been prescribed NRd. It explains how NRd works, how to take it and possible side effects you may experience