Nose bleeds or bruising easily, which can be signs of low platelet counts (thrombocytopenia)
Possible Side effects with NRd*
* NINLARO (ixazomib), REVLIMID (lenalidomide) and dexamethasone
Like all myeloma treatments, NRd can cause side effects, but not everybody gets them, and each person will experience them differently. Sometimes side effects can make it challenging to stay on treatment, so it's important to talk to your doctor, nurse or pharmacist about them. You can use your treatment calendar to help keep track of side effects so you don't forget anything. Click here to find out how to get a copy of the treatment calendar.
You might be worried that your treatment will be stopped if you have side effects, but rest assured there are lots of other ways of dealing with them. Your doctor or nurse will develop a plan that could involve adding supportive treatment, reducing the dose, or a temporary break in treatment to help you manage the side effects.
The effects of Ninlaro on the ability to drive or use machines is unknown. However, patients have experienced fatigue and dizziness while taking it. Do not drive or operate machines if you experience these side effects.
There are some side effects that are important to look out for - these are listed below.
Side effects to look out for with NRd
There are certain things that you need to look out for to help spot any side effects early. If you notice any of the signs or symptoms listed below, tell your doctor or nurse straight away.
May affect more than 1 in 10 people
Nausea, vomiting and diarrhoea
Numbness, tingling or burning of the hands or feet, which can be symptoms of peripheral neuropathy
Unusual swelling of the legs or feet (peripheral oedema)
A skin rash that may be itchy either in a few areas or all over the body
May affect up to 1 in 1000 people
Severe skin rashes such as red to purple bumps or rash with skin peeling and mouth sores
Muscle weakness, loss of feelings of the toes and feet or loss of leg movement, which can be signs of a condition called transverse myelitis
Changes in vision or mental status, or seizures, which can be signs of a condition called posterior reversible encephalopathy syndrome
Dizziness, decreased urination, confusion, vomiting, nausea, swelling, shortness of breath, or heart rhythm disturbances, which are caused by rapid death of cancer cells (tumour lysis syndrome)
Fatigue, fever, bruising, nose bleeds or decreased urination, which can be signs of a rare blood condition resulting from blood clots (thrombotic thrombocytopenic purpura)
Other side effects
Other side effects that have been seen with NRd are listed below. Tell your doctor, nurse or pharmacist if any of the side effects below become severe.
Very common side effects which may affect more than 1 in 10 people:
Cold‑like symptoms (upper respiratory tract infection)
Feeling tired or weak (fatigue)
Lowered levels of white blood cells called neutrophils (neutropenia) that may result in an increased risk of infection
Not feeling like eating (decreased appetite)
Irregular heart rate (arrhythmia)
Vision conditions including blurred vision, dry eye and pink eye (conjunctivitis)
Common side effects which may affect up to 1 in 10 people:
Reactivation of the chicken pox virus (shingles) that can cause a skin rash and pain (herpes zoster)
Lowered blood pressure (hypotension)
Shortness of breath or persistent coughing or wheezing (heart failure)
Yellow discolouration of eyes and skin (jaundice, which could be a symptom of liver impairment)
Low levels of potassium in the blood (hypokalaemia)
Reporting of side effects
Ninlaro (ixazomib) and Revlimid (lenalidomide) are subject to additional monitoring. This will allow quick identification of new safety information. You can help by reporting any side effects you may get. If you get any side effects whilst taking the Ninlaro regimen, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed on this website or in the package leaflets. You can also report side effects directly via the Yellow Card Scheme at https://yellowcard.mhra.gov.uk. By reporting side effects you can help provide more information on the safety of these medicines.
As well as taking NRd, you may also be taking other treatments to help manage the symptoms of myeloma or the side effects of your myeloma treatment. These may include:
Bisphosphonates to minimise bone loss and increase bone formation. This will help to prevent bone fractures and pain
High‑dose steroids for kidney damage
Erythropoietin (EPO) to increase your red blood cell count and treat anaemia. This will help reduce your feeling of tiredness
Growth factors for low white blood cell counts. This will boost your immune system and will help fight against infections
Anti‑sickness tablets (anti-emetics) to reduce nausea and vomiting
Anti‑clotting drugs to prevent clots forming and make your blood thinner
Anti‑diarrhoeal, laxative and antacid tablets to help with gastrointestinal problems
Antibiotics or antivirals to prevent or treat infection
Your healthcare professional will decide which supportive treatments are suitable for you. They can also add them to your treatment calendar to help you to keep track of the medicines that you have to take each day
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