This section is intended for patients prescribed Ninlaro. If you are a member of the public click here. If you are a UK healthcare professional click here.

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.

Very common

May affect more than 1 in 10 people

Nose bleeds or bruising easily, which can be signs of low platelet counts (thrombocytopenia)

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:


Back pain

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 By reporting side effects you can help provide more information on the safety of these medicines.

Supportive treatments

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

Pain killers

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

Your Guide to Treatment with the NRd Regimen

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

My Treatment Calendar

Takeda Oncology has developed a practical treatment calendar for patients who have been prescribed NRd