The medication precautions for Ixazomib involve various aspects such as hematological toxicity, liver and kidney function monitoring, and infection prevention and control. The medication plan needs to be adjusted according to the individual situation of the patient and adverse reaction management needs to be strengthened. The following provides a detailed explanation of key precautions, medication for special populations, and dosage adjustment principles.

1. Management of hematological toxicity

(1) Thrombocytopenia: During the treatment period, platelet count should be monitored weekly. Treatment for grade 3 or above should be interrupted until recovery, and medication should be continued after a 25% reduction.

(2) Neutropenia: The incidence rate is about 19%. Grade 4 requires suspension of administration and support with G-CSF. After recovery, the dose should be reduced and treatment should be restarted.

2. Liver and kidney function monitoring

(1) Abnormal liver function: Patients with moderate to severe liver damage should reduce their dosage by 50%. When bilirubin>3 times ULN or transaminase>5 times ULN, the medication should be permanently discontinued.

(2) Renal function adjustment: For patients with CrCl<30mL/min, the initial dose should be reduced to 3mg, and dialysis patients should receive the medication after dialysis.

3. Infection risk prevention and control

(1) Herpes zoster reactivation: It is recommended that all patients receive antiviral prophylaxis, especially those with a history of herpes virus infection.

(2) Opportunistic infection: If pulmonary symptoms appear, PJP infection should be promptly screened, and high-risk patients should be prevented with sulfonamide drugs.

4. Medication for special populations

(1) Prohibited during pregnancy: Based on animal teratogenic data, effective contraceptive measures should be taken during the treatment period and 90 days after the last dose.

(2) Breastfeeding taboos: Medications can be excreted through breast milk, and breastfeeding must be stopped or treatment terminated during breastfeeding.

5 Principles of Dose Adjustment

(1) First reduction: from 4mg to 3mg, suitable for grade 2 non hematological toxicity or grade 3 hematological toxicity.

(2) Secondary reduction: from 3mg to 2.3mg, for recurrent grade 3 toxicity or first-time grade 4 hematological toxicity.