Ixempra
Ixempra (ixabepilone) treats certain types of breast cancer when other anticancer medications haven't worked or have stopped working. It’s given as an infusion through the vein by a healthcare provider once every three weeks. This medication can be used alone or in combination with capecitabine (Xeloda). Some common side effects caused by Ixempra (ixabepilone) include tingling or shooting nerve pain, tenderness in the hands and feet, and tiredness.
What is Ixempra (ixabepilone)?
What is Ixempra (ixabepilone) used for?
- Metastatic or locally advanced breast cancer when certain other medications didn’t work or no longer work
How Ixempra (ixabepilone) works
Ixempra (ixabepilone) is a type of anticancer medication called a microtubule inhibitor. It interferes with the way cells divide and multiply, especially in fast-growing cells like cancer cells. When this happens, the cells are unable to grow and then die.
Drug facts
Side effects of Ixempra (ixabepilone)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Nerve problems that affect touch (up to 65%)
- Tender, red palms and sole of the feet (hand-foot syndrome) (up to 64%)
- Tiredness (up to 60%)
- Nausea (up to 53%)
- Bone, muscle and joint pain (up to 49%)
- Hair loss (up to 48%)
- Diarrhea (up to 44%)
- Low white blood cell count (up to 41%)
- Vomiting (up to 39%)
- Loss of appetite (up to 34%)
- Mouth sores (up to 31%)
- Stomach pain (up to 24%)
- Changes in nails (up to 24%)
- Constipation (up to 22%)
Please note: These side effects were reported by people who were treated with Ixempra (ixabepilone) alone or in combination with capecitabine (Xeloda).
Less Common Side Effects
- Skin rash
- Damage to the nerves that help with movement
- Changes in taste
- Darkening of skin
- Weight loss
- Headache
- Fever
The following Ixempra (ixabepilone) side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor or nurse immediately if any of the following side effects occur:
More common
Black, tarry stools
body aches or pain
burning, numbness, tingling, or painful sensations
burning pain on urination
chills
difficult or labored breathing
ear congestion
headache
loss of voice
lower back or side pain
painful or difficult urination
pale skin
red, swelling, or painful skin
scaling of the skin on the hands and feet
shortness of breath
sores, ulcers, or white spots on the lips, tongue, or inside the mouth
swelling of the hands, ankles, feet, or lower legs
swollen glands
tightness in the chest
tingling of the hands and feet
troubled breathing with exertion
ulceration of the skin
unsteadiness or awkwardness
unusual bleeding or bruising
unusual tiredness or weakness
unusual weight gain
weakness in the arms, hands, legs, or feet
Less common
Bleeding gums
blood in the urine or stools
confusion
decreased urination
dizziness
fainting
fast heartbeat
hoarseness
increase in heart rate
irritation
joint pain, stiffness, or swelling
lightheadedness
pinpoint red spots on the skin
rapid breathing
rash
sunken eyes
swelling of the eyelids, face, or lips
thirst
trouble with swallowing
wrinkled skin
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Bad, unusual, or unpleasant (after) taste
bone pain
change in taste
cracked lips
difficulty having a bowel movement (stool)
discoloration of the fingernails or toenails
feeling of warmth
hair loss or thinning of the hair
lack or loss of strength
loss of appetite
redness of the face, neck, arms, and occasionally, upper chest
stomach pain
sudden sweating
swelling or inflammation of the mouth
vomiting
Less common
Darkening of the skin
flaking and falling off of the skin
trouble with sleeping
unable to sleep
watering of the eyes
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Ixempra (ixabepilone)
Pros
- Given only once every 3 weeks
- Can sometimes be used alone, without other anticancer medications
- Possible option when other therapies have not worked or stopped working
Cons
- Infused into the veins
- Can’t be used by people with liver problems
- Can cause serious infections or painful nerve problems
Pharmacist tips for Ixempra (ixabepilone)
- Each infusion appointment can take a few hours because it includes the time it takes to check in, to take pre-treatment medications, and to receive the infusion. Make sure you plan for this time. Wear comfortable clothes with sleeves that are easy to roll up. Bring a water to help you stay hydrated, and also a snack in case you get hungry. It can also be helpful to bring a book or something to help you pass the time.
- Ixempra (ixabepilone) can cause many side effects that your provider needs to know about, including nerve problems, tiredness, and nausea. It can be helpful to track your side effects so that you can let your provider know how you feel after your infusions.
- Ixempra (ixabepilone) contains alcohol and might make you feel dizzy or drowsy. You might need to plan to have someone drive you home after your infusions. Don’t drive or do anything that require a lot of attention until you know how your body feels while receiving Ixempra (ixabepilone) treatment.
- Ixempra (ixabepilone) might cause painful sores in your mouth and throat. If you have trouble eating or drinking because of painful sores, let your provider know. They might recommend that you suck on ice chips to ease the pain and puree your foods to make them easier to eat. It’s important to keep your mouth and teeth clean with regular, but gentle, brushing and flossing so that your sores have a chance to heal.
- Receiving Ixempra (ixabepilone) might impact your ability to have children (fertility). If you have concerns or questions about this, talk with your provider.
Common questions about Ixempra (ixabepilone)
Typically, an Ixempra (ixabepilone) infusion takes 3 hours. The infusion time can differ depending on how well you tolerate the infusion. If you have an allergic reaction, your provider might slow down your infusion. Keep in mind that your provider will give you pre-treatment medications, such as diphenhydramine (Benadryl) or famotidine (Pepcid AC), about an hour before the Ixempra (ixabepilone) infusion. The purpose of these medications is to lower your risk of infusion-related reactions. If you're planning for your infusion day, you'll want to factor in the time it takes to receive your pre-treatment medications as well.
Nerve pain (peripheral neuropathy) is a common side effect of Ixempra (ixabepilone). It can cause symptoms such as numbness or tingling pain in your hands and feet. Nerve pain can impact your daily life because it can make it harder for you to walk or maintain your balance, or it can put you at risk for injuries. Let your provider know if you have nerve-related problems because they can recommend ways to keep you safe. For example, you can protect your hands and feet by wearing gloves when you're doing household chores and wearing shoes with rubber soles (both indoors and outdoors) when you walk. You can remove tripping hazards around your house, and use no-slip mats and handrails. And because nerve damage can also cause you to be sensitive to touch, try to avoid very hot or very cold baths or showers. Before getting in, you or someone else can test the temperature of the water.
Hand-foot syndrome is a side effect of Ixempra (ixabepilone). It happens as a result of Ixempra (ixabepilone) leaking out of small blood vessels and causing tissue damage. Hand-foot syndrome can be painful. In severe cases, it can affect your ability to walk and use your hands. If you experience symptoms of hand-foot syndrome, such as redness, swelling, or tingling in the hands and feet, let your provider know. They can recommend tips to help ease symptoms, such as applying ice packs to tender areas or taking rest breaks to lessen the pressure on your feet. It’s also important to stay out of the sun as much as possible because the sun can further damage irritated skin. When you do go outside, wear sunscreen and protective clothing. If your feet become sensitive, you can put gel inserts into your shoes and avoid wearing tight-fitting shoes.
Nausea is a common side effect of Ixempra (ixabepilone). If you experience nausea, let your provider know. They might recommend that you eat smaller, more frequent meals, spread throughout the day. They might also recommend that you eat food that is more bland, so the smells and taste don’t trigger your nausea. In some cases, your provider might prescribe anti-nausea medications for you, such as ondansetron (Zofran) or promethazine.
You're recommended to avoid breastfeeding while receiving Ixempra (ixabepilone). We don’t know if the medication can pass into breast milk, but there’s a risk of serious harm to nursing infants if it does. Because of this risk, you shouldn’t breastfeed during Ixempra (ixabepilone) treatment and for 2 weeks after your last dose. Talk with your provider if you have any questions about breastfeeding or other ways to feed your baby while receiving Ixempra (ixabepilone).
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Risks and warnings for Ixempra (ixabepilone)
Ixempra (ixabepilone) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Toxicity in people with liver problems
- Risk factors: Liver problems | Taking capecitabine (Xeloda)
If you have liver problems, your body might have a harder time getting rid of Ixempra (ixabepilone). This can cause higher levels of the medication in your body, which can raise your risk for serious side effects, such as infections and even death due to low white blood cell count. Your risk for these problems are even higher if you’re taking Ixempra (ixabepilone) with capecitabine (Xeloda). To make sure Ixempra (ixabepilone) is safe for you, your provider will do blood work to check your liver health before you start and during treatment with Ixempra (ixabepilone). If your lab work shows that you have liver problems, your provider might stop your treatment with this medication, depending on how serious the problem is.
Serious allergic reactions
- Risk factors: Allergy to paclitaxel
Ixempra (ixabepilone) can cause rare, but serious, allergic reactions. Your provider will give you medications, like diphenhydramine (Benadryl) or famotidine (Pepcid), to lower your risk of allergic reactions before each infusion. If this happens, your provider will stop the infusion and might give you more medications to treat your allergic reaction. You might still be able to continue treatment with Ixempra (ixabepilone) in the future, depending on how serious your reaction was. Let your provider know immediately if you experience symptoms, such as itchy skin, rash, flushing, swelling, trouble breathing, or chest pain, during your infusion.
Risk of serious infections from low white blood cell (WBC) count
- Risk factors: Liver problems | Taking capecitabine (Xeloda)
Ixempra (ixabepilone) can cause your white blood cell (WBC) counts to drop. When your WBC levels are too low, you can develop serious, and sometimes life-threatening, infections. You’re at higher risk for these infections if you’re taking Ixempra (ixabepilone) with capecitabine (Xeloda) or if you have liver problems.
Your provider will closely monitor your blood counts through lab work while you’re receiving Ixempra (ixabepilone). If your blood counts are too low, your provider might delay your infusion, lower your dose, or stop your treatment. Let your provider know as soon as possible if you experience symptoms of an infection, such as fever, chills, cough, or burning or pain when you urinate.
Nerve problems
- Risk factors: Nerve pain | High blood sugar
People receiving Ixempra (ixabepilone) might experience nerve problems (peripheral neuropathy), such as a burning sensation, changes in sensitivity to touch, a tingling (“pins and needles”) or numbness feeling in your hands or feet, or pain. Of the people who experienced this side effect in clinical trials, most people reported it starting around the 4th cycle of treatment. These problems typically went away on their own after about 6 weeks. If you develop nerve problems, let your provider know. They might lower your Ixempra (ixabepilone) dose or skip or delay your infusion. If the nerve problems are very severe, your provider might stop your Ixempra (ixabepilone) treatment.
Heart problems
- Risk factors: Taking capecitabine (Xeloda)
Risk factors: Taking capecitabine (Xeloda) Though rare, Ixempra (ixabepilone) can cause heart-related side effects that affect rhythm and blood flow. The risk of these side effects is higher if you’re taking this medication with capecitabine (Xeloda). Be sure to tell your provider if you have any history of heart problems before you start receiving Ixempra (ixabepilone) infusions. If you develop heart problems while receiving Ixempra (ixabepilone), your provider might have you stop getting Ixempra (ixabepilone) infusions. Let your provider know if you experience any chest pain, trouble breathing, unusual weight gain, or start to feel your heartbeat.
Harm to unborn baby
Ixempra (ixabepilone) hasn’t been studied in human pregnancy, but animal studies show that it can cause harm to an unborn baby. If you’re able to become pregnant, you should use birth control while receiving Ixempra (ixabepilone) and for at least 7 months after your last dose. If you’re a male receiving Ixempra (ixabepilone) and your partner is able to become pregnant, you should use birth control during Ixempra (ixabepilone) treatment and for at least 4 months after your last dose. Let your provider know right away if you or your partner become pregnant during this time.
Ixempra (ixabepilone) dosage
Typical dosage for Ixempra (ixabepilone)
Your provider will calculate your dose of Ixempra (ixabepilone) based on your body surface area (BSA, in units of m2), which takes into account your body weight and height.
- The typical dose of Ixempra (ixabepilone) is 40 mg/m2 infused into your veins (intravenous) once every 3 weeks.
Your dose might be different if you have liver problems, are experiencing certain side effects, or are taking certain medications that interact with Ixempra (ixabepilone).
Interactions between Ixempra (ixabepilone) and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Amprenavir
- Atazanavir
- Carbamazepine
- Clarithromycin
- Delavirdine
- Dexamethasone
- Fosamprenavir
- Fosphenytoin
- Indinavir
- Itraconazole
- Ketoconazole
- Nefazodone
- Nelfinavir
- Phenytoin
- Rifabutin
- Rifampin
- Ritonavir
- Saquinavir
- St John's Wort
- Telithromycin
- Voriconazole
Ixempra (ixabepilone) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Ixempra (ixabepilone) will not be safe for you to take.
- Dangerously low white blood cell and platelet counts
- Allergic reaction to paclitaxel (Taxol) or Cremophor EL (polyoxyethylated castor oil)
- In combination with capecitabine in people with certain amounts of liver impairment
