IRd

Say it: I-R-D

Ixazomib, lenalidomide and dexamethasone

IRd is a combination of three pills taken at home for multiple myeloma that has come back after earlier treatment.

Also called: IRD, Ixa-Rd, Ixazomib-Rd, Ixazomib, lenalidomide, dexamethasone, All oral triplet for myeloma

What it is

Each medicine attacks myeloma cells in a different way. Ixazomib is a proteasome inhibitor, which blocks the cell's waste disposal system so myeloma cells build up junk and die. Lenalidomide helps the immune system and directly slows myeloma cells, and dexamethasone is a steroid that kills myeloma cells. The goal is to control the myeloma for as long as possible, with the convenience of no IV infusions.

Often used for

• Multiple myeloma that came back or did not respond after at least one earlier treatment

The medicines in this plan

Ixazomib

A proteasome inhibitor capsule taken by mouth once a week, on days 1, 8 and 15 of each 28 day cycle, on an empty stomach.

Lenalidomide (Revlimid)

A capsule taken by mouth once a day on days 1 to 21 of each 28 day cycle, then 7 days off.

Dexamethasone

A steroid pill taken once a week, on days 1, 8, 15 and 22.

How you get it

All three medicines are pills you take at home. Each cycle is 28 days, and you visit the clinic about once a month for blood tests and a check in, sometimes more often at first. Treatment usually continues as long as the myeloma stays under control and side effects are manageable. Your schedule may be different.

A typical cycle

Days 1, 8 and 15

Ixazomib capsule on an empty stomach (at least 1 hour before or 2 hours after food).

Days 1, 8, 15 and 22

Dexamethasone pill, usually in the morning with food.

Days 1 to 21

Lenalidomide capsule once a day.

Days 22 to 28

Break from lenalidomide and ixazomib. Blood tests before the next cycle.

Common side effects and what helps

• Diarrhea or constipation. Drink plenty of fluids and tell your team which one you have so they can suggest the right medicine.
• Low platelets and white blood cells. Watch for bruising and wash hands often.
• Tingling or numbness in hands and feet. Tell your team early so they can adjust the plan.
• Rash. Tell your team about any new rash.
• Nausea or vomiting. Take ixazomib with water and use anti-nausea medicine if prescribed.
• Tiredness and muscle cramps. Gentle activity and fluids can help.
• Swelling in the legs or feet.
• Trouble sleeping, mood changes or high blood sugar on dexamethasone days. Take it in the morning.

Call your care team right away if you have

• A fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher, or chills
• Swelling, pain, warmth or redness in one leg, or sudden shortness of breath or chest pain (signs of a blood clot)
• Bleeding that will not stop, or many new bruises
• A rash that blisters or peels, or sores in your mouth
• Diarrhea or vomiting that does not stop, or feeling dizzy
• A painful rash with blisters on one side of the body (shingles)
• Yellow skin or eyes

Good to know

• Lenalidomide can cause serious birth defects. It is only available through a safety program (REMS) with pregnancy tests and birth control rules for anyone who could become pregnant, and condom use for men.
• Lenalidomide raises the risk of blood clots, so most people take aspirin or another blood thinner.
• Proteasome inhibitors like ixazomib can wake up the shingles virus. Most people take an antiviral pill to prevent it.
• You will have blood tests each cycle to check blood counts, kidney function and myeloma levels.
• Do not donate blood during treatment or for a while after. Your team will tell you how long.

At home

• Use a calendar or pill box to keep track of which pills to take on which days.
• Take ixazomib on an empty stomach and swallow it whole. If you miss it, ask your team before taking a late dose.
• Swallow lenalidomide capsules whole and do not open them. Others should not touch them without gloves.
• Drink plenty of fluids every day, especially when you have diarrhea.
• Keep moving: walking helps lower the chance of blood clots.

Questions to ask

• Which blood thinner will I take to prevent clots?
• What should I do if I miss a dose of any pill?
• How will we know the treatment is working?
• Will I take an antiviral to prevent shingles?
• How long will I stay on this plan?

Multiple myeloma

Last updated: 2026-10-27. Medically reviewed by Veli Bakalov, MD, medical oncologist (October 2026). General education from Step by Step, the patient portal of HemeOncBuddy.