IRD
What is IRD?
IRD is a combination treatment used to treat multiple myeloma. It may sometimes be used to treat other cancers.
It is best to read this information about IRD with our general information about targeted therapy and the type of cancer you have.
The name IRD comes from the initials of the drugs used:
- I – ixazomib (Ninlaro®) belongs to a group of targeted therapy drugs known as cancer growth inhibitors.
- R – lenalidomide (Revlimid®) works as both a targeted therapy and immunotherapy drug.
- D – dexamethasone is a steroid.
Your doctor will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.
More information about this treatment
This information is correct at time of publishing. But sometimes the types of cancer this treatment is used for, or treatment side effects, may change between revision dates.
You can talk to your cancer team if you want more detailed information about this treatment. Or visit the electronic Medicines Compendium (eMC) website, which has patient information leaflets (PIL) for individual drugs.
How IRD is given
During treatment you usually see a:
- cancer doctor
- cancer nurse or a specialist nurse
- specialist pharmacist.
This is who we mean when we mention doctor, nurse or pharmacist in this information.
You will have your blood checked regularly during treatment. A nurse or person trained to take blood (phlebotomist) will take a blood sample from you. This is to check that it is safe for you to have treatment.
You will speak to a doctor, nurse or pharmacist before you have treatment. They will talk to you about your blood results and ask how you have been feeling. If your blood results are okay, the pharmacist team will prepare your treatment.
Your course of IRD
Ixazomib and lenalidomide are given as capsules. Dexamethasone comes as tablets. This means you can take them at home.
IRD is usually given as a course of several cycles of treatment over a few months. A cycle of IRD usually takes 28 days.
Your doctor, nurse or pharmacist will discuss your treatment plan with you. They may give you a copy of the treatment plan to take home.
You take IRD treatment as follows:
- You take ixazomib on days 1,8 and 15. You then have a break of 13 days where you do not take ixazomib.
- You take lenalidomide once a day for 21 days. You then have a break of 7 days when you do not take lenalidomide.
- You take dexamethasone on days 1,8,15 and 22.
The nurse or pharmacist will give you the capsules and tablets to take home. Always take them exactly as explained. This is important to make sure they work as well as possible for you. You may be given capsules and tablets of different strengths.
Your nurse or pharmacist may also give you anti-sickness drugs and other medicines to take home.
Taking your capsules and tablets
You should swallow the capsules and tablets whole with a glass of water. They should not be chewed, opened or crushed.
Here are some important things to remember about taking your capsules and tablets:
- Take ixazomib capsules one hour before food or 2 hours after food. If you forget to take a capsule, take it as soon as you realise. But if it is less than 3 days until the next dose, do not take the missed capsule. Tell your doctor or nurse.
- Take lenalidomide capsules at the same time each day. You can take lenalidomide with or without food. If you forget to take the capsules, take them as soon as you realise. But if it is less than 12 hours until the next dose, do not take the missed capsules.
- Take dexamethasone with or just after breakfast. If you forget to take dexamethasone, take the missed dose as soon as possible in the same day. If it has been a full day, tell your doctor or nurse.
Do not take a double dose of any of the drugs.
Other things to remember about your capsules and tablets:
- Wash your hands after taking your tablets and capsules.
- Other people should avoid direct contact with the drugs. If they have to handle them, they should wear gloves.
- Keep them in the original package and at room temperature, away from moisture, heat and direct sunlight.
- Keep them safe, somewhere children cannot see or reach them.
- If you are sick just after taking the capsules or tablets, contact the hospital. Do not take another dose.
- If your treatment is stopped, return any unused capsules or tablets to the pharmacist.
Preventing pregnancy while taking ixazomib and lenalidomide
You must not become pregnant or make someone pregnant while taking ixazomib and lenalidomide. This is because it may cause severe abnormalities in developing babies. You will take part in a pregnancy prevention programme during treatment.
Your doctor or specialist nurse will give you information about the risks of ixazomib and lenalidomide and pregnancy. They will ask you to sign a consent form once you have read the information.
If you could become pregnant
You will have a pregnancy test before starting treatment with lenalidomide. The pregnancy test will be repeated before each cycle, and for 4 weeks after treatment finishes.
You must use an effective form of contraception, such as an implant, injection or the progesterone-only pill. If using the pill, you must also use a barrier method such as a condom. This is because ixazomib taken with dexamethasone can stop the pill from working. The combined oral contraceptive pill is not recommended because it increases the risk of developing blood clots. Tell your doctor or nurse what type of contraception you are using to make sure it is effective.
You must use contraception during treatment and for 4 weeks before treatment starts. You must continue to use contraception for 90 days after treatment finishes.
If you think you may be pregnant at any time during your treatment, contact your doctor or specialist nurse straight away.
If you could make someone pregnant
You must use a condom during sex while taking ixazomib and lenalidomide. You will also need to do this for 90 days after treatment finishes. This is because ixazomib and lenalidomide can pass into your semen.
If your partner thinks they might be pregnant during your treatment, contact your doctor or specialist nurse straight away.
If you have any questions about contraception, talk to your doctor or nurse.
About side effects
We explain the most common side effects of this treatment here. We also include some that are less common.
You may get some of the side effects we mention, but you are unlikely to get all of them. And you may have some side effects, including rarer ones, that we have not listed here.
Other cancer treatments may cause different side effects. If you are also having other cancer treatment, you may have other side effects.
Always tell your doctor, nurse or pharmacist about any side effects you have. They can give you:
- drugs to help control some side effects
- advice about managing side effects.
It is important to take any drugs exactly as explained. This means they will be more likely to work for you.
Serious and life-threatening side effects
Some cancer treatments can cause serious side effects. Sometimes, these may be life-threatening. Your doctor, nurse or pharmacist can explain the risk of these side effects to you.
Contact the hospital
Your doctor, nurse or pharmacist will give you 24-hour contact numbers for the hospital. If you feel unwell or need advice, you can call at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.
Side effects while treatment is being given
Some people may have side effects while they are being given this treatment or shortly after they have it:
Allergic reaction
Some people have an allergic reaction while having lenalidomide. Signs of a reaction can include:
- feeling hot or flushed
- shivering
- itching
- a skin rash
- feeling dizzy
- a headache
- feeling breathless or wheezy
- swelling of your face or mouth
- pain in your back, tummy or chest.
If you feel unwell or have any of these signs, tell your doctor or nurse straightaway. Do not take any more of the treatment until you have spoken to them.
Common side effects
Risk of infection
This treatment can reduce the number of white blood cells in your blood. These cells fight infection. If your white blood cell count is low, you may be more likely to get an infection. A low white blood cell count is called neutropenia.
An infection can be very serious when the number of white blood cells is low. Your doctor may give you antibiotics and other drugs to take during this treatment. These may help reduce your risk of getting an infection.
But it is still important to get any infection treated as soon as possible. If you have any of the following symptoms, contact the hospital straight away on the 24-hour number:
- a temperature above 37.5°C
- a temperature below 36°C
- you feel unwell, even with a normal temperature
- you have symptoms of an infection.
Symptoms of an infection include:
- feeling shivery and shaking
- a sore throat
- a cough
- breathlessness
- diarrhoea
- needing to pass urine (pee) often, or discomfort when you pass urine.
It is important to follow any specific advice your cancer treatment team gives you.
Your white blood cell count will usually return to normal before your next treatment. You will have a blood test before having more treatment. If your white blood cell count is low, your doctor may delay your treatment for a short time, until your cell count increases.
You may be given a drug called G-CSF. This encourages the body to make more white blood cells. You have it as a small injection under the skin.
Bruising and bleeding
This treatment can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot.
If the number of platelets is low, you may bruise or bleed easily. You may have:
- nosebleeds
- bleeding gums
- heavy periods
- blood in your urine (pee) or stools (poo)
- tiny red, brown or purple spots that may look like a rash – these spots can be harder to see if you have black or brown skin.
If you have any unexplained bruising or bleeding, contact the hospital straight away on the 24-hour number. You may need a drip to give you extra platelets. This is called a platelet transfusion.
Anaemia (low number of red blood cells)
This treatment can reduce the number of red blood cells in your blood. Red blood cells carry oxygen around the body. If the number of red blood cells is low, this is called anaemia. You may feel:
- very low in energy
- breathless
- dizzy and light-headed.
If you have these symptoms, contact the hospital straight away on the 24-hour number. You may need treatment for anaemia. If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.
Diarrhoea
This treatment may cause diarrhoea. Diarrhoea means passing more stools (poo) than is normal for you, or having watery or loose stools. You may also have stomach cramps. If you have a stoma, it may be more active than usual.
If you are passing loose stools 3 or more times a day and this is not normal for you, contact the hospital as soon as possible on the 24-hour number. Follow the advice they give you about:
- taking anti-diarrhoea medicines
- drinking enough fluids to keep you hydrated and to replace lost salts and minerals
- any changes to your diet that might help.
They might also ask you for a specimen of your stool to check for infection.
Constipation
This treatment can cause constipation. Constipation means that you are not able to pass stools (poo) as often as you normally do. It can become difficult or painful. Here are some tips that may help:
- Drink at least 2 litres (3½ pints) of fluids each day.
- Eat high-fibre foods, such as fruit, vegetables and wholemeal bread.
- Do regular gentle exercise, like going for short walks.
If you have constipation, contact the hospital on the 24-hour number for advice. They can give you drugs called laxatives to help.
If you have not been able to pass stools for over 2 days and are being sick, contact the 24-hour number straight away.
Feeling sick
Your doctor, nurse or pharmacist will prescribe anti-sickness drugs to help prevent or control sickness. Take the drugs exactly as they tell you to, even if you do not feel sick. It is easier to prevent sickness than to treat it after it has started.
If you feel sick, take small sips of fluid often and eat small amounts regularly. It is important to drink enough fluids. If you continue to feel sick, or if you are sick (vomit) 1 to 2 times in 24 hours, contact the hospital on the 24-hour number as soon as possible. They will give you advice. They may change your anti-sickness treatment. Let them know if you still feel sick.
Numb or tingling hands or feet (peripheral neuropathy)
This treatment may affect the nerves in your fingers and toes. This can cause numbness, tingling or pain in your hands or feet. This is called peripheral neuropathy. You might find it hard to do fiddly tasks such as fastening buttons or tying shoelaces.
If you have these symptoms, always tell your doctor, nurse or pharmacist. They sometimes need to change the drug or the dose of the drug. The symptoms usually improve slowly after treatment ends. But for some people they continue and are a long-term side effect of treatment.
Skin changes
This treatment can affect your skin. It may cause a rash, which may be itchy. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using soap-free cleansers and unperfumed moisturising cream every day.
Always tell your doctor or nurse about any skin changes. They can give you advice and may prescribe creams or medicines to help. Changes to your skin usually improve when treatment ends.
Fluid build-up
This treatment can cause a build-up of fluid in the body. This will slowly get better after treatment ends. Contact the hospital on the 24-hour number if you:
- are gaining weight
- have swelling in your face, legs or ankles.
They can give you advice and treatment to help.
Muscle and joint pain
You may have:
- pain in your muscles, joints or back
- muscle spasms or cramps.
If this happens, tell your doctor so they can give you give you painkillers. Tell them if the pain does not get better.
Eye problems
Your eyes may feel dry or sore. Your doctor can prescribe eye drops to help with this. If your eyes get red and inflamed (conjunctivitis), tell your doctor.
IRD may cause blurry vision. Sometimes, it may cause clouding of the lens of the eyes (cataracts). Always tell the doctor or nurse if you notice any changes in your vision. Do not drive if you have any changes to your vision.
Feeling tired (fatigue)
Feeling tired is a common side effect. Try to pace yourself and plan your day so you have time to rest between activities.
Being physically active can help to manage tiredness and give you more energy. It also:
- helps you sleep better
- reduces stress
- improves your bone health.
If you feel sleepy, do not drive or operate machinery.
Loss of appetite
This treatment can affect your appetite. Don’t worry if you do not eat much for 1 or 2 days. But if your appetite does not come back after a few days, or if you are losing weight, tell your doctor, nurse or pharmacist. They can give you advice. They may give you food or drink supplements. Or they may suggest changes to your diet or eating habits to help.
Changes to your taste
Some foods may taste different or have no taste. Try different foods to find out what tastes best to you. You may also get a bitter or metallic taste in your mouth. Your doctor, nurse or pharmacist can give you advice. It might help to try:
- sucking sugar-free sour or boiled sweets
- eating cold foods
- eating sharp-tasting fresh fruit.
Taste changes usually get better after treatment ends. We have more information about coping with changes to taste.
Tummy pain
You may get pain in your tummy (abdomen), or have indigestion. Your doctor, nurse or pharmacist can give you advice or treatment to help. Contact the hospital straight away on the 24-hour number if your symptoms do not go away, or get worse.
Changes in blood pressure
This treatment may cause low or high blood pressure. Tell your doctor or nurse if you have ever had any problems with your blood pressure. Your nurse will check your blood pressure regularly during treatment. Let them know if you feel dizzy or have any headaches.
Blood clot risk
Cancer and some cancer treatments can increase the risk of a blood clot. Contact the hospital straight away on the 24-hour number if you have any of these symptoms during or after treatment:
- throbbing pain or swelling in a leg or arm
- reddening of the skin in the area – if you have black or brown skin, this can be harder to notice, but the skin might become darker
- suddenly feeling breathless or coughing.
Always call 999 if you have:
- chest pain
- difficulty breathing.
A blood clot is serious, but it can be treated with drugs called anticoagulants. These thin the blood. Your doctor, nurse or pharmacist can give you more information about preventing and treating blood clots.
Effects on the heart
This treatment can affect how the heart works. You may have tests to check how well your heart is working. These may be done before, during and after treatment.
If the treatment is causing heart problems, your doctor may change the type of treatment you are having.
Contact the hospital straight away on the 24-hour number if you have any of these symptoms during or after treatment:
- breathlessness
- dizziness
- changes to your heartbeat (palpitations)
- swollen feet and ankles.
Other conditions can cause these symptoms, but it is important to get them checked by a doctor.
Always call 999 if you have:
- chest pain, pressure, heaviness, tightness or squeezing across the chest
- difficulty breathing.
Changes in the way the kidneys and liver work
Raised blood sugar levels
This treatment can raise your blood sugar levels and increase the risk of diabetes.
Signs of raised blood sugar include:
- feeling thirsty
- needing to pass urine (pee) more often than usual
- feeling more tired than usual.
Tell your doctor or nurse if you have these symptoms. They can do tests to check your blood sugar level and give you advice.
If you already have diabetes, your blood sugars may be higher than usual. You may need to check them more often, or make changes to your diabetic treatment. Your diabetic doctor or nurse will talk to you about how to manage this.
Mood and behaviour changes
Steroids can affect your mood and behaviour. They can cause:
- feelings of anxiety or restlessness
- mood swings (moods that go up and down)
- low mood or depression.
Sometimes, when taken in higher doses, steroids can cause confusion or changes in thinking. This can include having strange or frightening thoughts.
If you notice any changes in your mood or behaviour, tell your doctor or nurse. They may make some changes to your treatment if the side effects are causing you problems.
Less common side effects
Effects on the brain
Rarely, this treatment causes a brain condition that can be serious. You can make a full recovery from this. But it must be diagnosed and treated quickly.
This condition can cause:
- a headache that does not get better
- drowsiness or confusion
- changes in eyesight
- fits (seizures).
If you have any of these symptoms, it is important to either:
- contact the hospital straight away on the 24-hour number
- go to the hospital straight away.
You should not drive yourself to hospital.
Tumour lysis syndrome (TLS)
Some people are at risk of developing a condition called tumour lysis syndrome (TLS). The risk is highest at the beginning of treatment. TLS happens when treatment makes large numbers of cancer cells die and break down quickly. This releases lots of waste products into the blood and can affect the kidneys and heart.
TLS can be prevented or treated. You will have regular blood tests to check for TLS. You may have:
- extra fluids through a drip
- medicines such as allopurinol tablets or rasburicase through a drip.
Drinking at least 2 litres (3½ pints) of fluid a day will also help.
Hepatitis B and shingles
Some viral infections can become active again while you are taking this treatment. These may need treatment with anti-viral drugs. This includes hepatitis B (a liver infection) and herpes zoster (shingles). Your doctor or nurse will talk to you about this. Before you start treatment you will have a blood test to check if you have had hepatitis B.
Second cancer
This treatment can increase the risk of developing a second cancer years later. This is rare. The benefits of treatment usually far outweigh this risk. Your doctor, nurse or pharmacist can talk to you about this.
Inflammation of the spinal cord (transverse myelitis)
This treatment may cause an inflammation of the spinal cord. This is rare. If you have any of these symptoms, contact the hospital straight away:
- weakness in the arms or legs
- sharp pain in the back that moves to the arms and legs
- burning, tingling, numbness or loss of feeling in the legs
- changes to the bowel, such as needing to poo more often, leaking poo, or constipation
- changes to the bladder, such as needing to pee more often, leaking pee, or finding it difficult to pee.
Other information
Other medicines
Some medicines can affect how this treatment works or be harmful while you are having it. Always tell your cancer doctor, nurse or pharmacist about any drugs you are taking or planning to take, such as:
- medicines you have been prescribed
- medicines you buy in a shop, pharmacy or online
- vitamins or supplements
- herbal drugs and complementary or homeopathic therapies
- recreational drugs – for example, cannabis.
Lactose
This treatment contains lactose. If you have an intolerance to some sugars, talk to your doctor before you start this treatment.
Vaccinations
Doctors usually recommend that people with cancer have vaccinations for flu and for coronavirus (covid). These help reduce your risk of serious illness from these infections. Most people can have these vaccines, including people with weak immune systems.
If your immune system is weak, you should not have live vaccinations. Live vaccines can make you unwell because they contain a very weak version of the illness they will protect you against. Live vaccines include Zostavax®, which is a shingles vaccine, and the yellow fever vaccine.
It is important to ask your doctor, nurse or pharmacist for advice about having vaccinations. They can explain what vaccines are right for you and when it is best to have them.
Fertility
Some cancer drugs can affect whether you can get pregnant or make someone pregnant. If you are worried about this, it is important to talk with your doctor before you start treatment.
Changes to periods
If you have periods, these may become irregular or stop while you are having this treatment. They might return after treatment, but this does not always happen. Your menopause may start sooner than it would have done. Your doctor, nurse or pharmacist can give you more information.
Breastfeeding
You are advised not to breastfeed while having this treatment, or for some time after treatment ends. This is because the drugs could be passed to the baby through breast milk.
Your doctor, nurse or pharmacist can give you more information.
Medical and dental treatment
If you need medical treatment for any reason other than cancer, always tell the healthcare professional that you are having cancer treatment. Give them the contact details for your cancer doctor or cancer team so they can ask for advice.
If you have appointments with a dentist, always tell them you are having cancer treatment. Talk to your cancer team before you have any dental treatment.
About our information
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References
Visit the electronic Medicines Compendium (eMC) to download a Patient Information Leaflet (PIL) for more detailed information. The leaflet lists all known side effects.
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Reviewers
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert health professionals and people living with cancer.
Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.
The language we use
We want everyone affected by cancer to feel our information is written for them.
We want our information to be as clear as possible. To do this, we try to:
- use plain English
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We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected.
You can read more about how we produce our information here.
Date reviewed
Our cancer information meets the PIF TICK quality mark.
This means it is easy to use, up-to-date and based on the latest evidence. Learn more about how we produce our information.