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Dosing Overview

ZENBEXUS + Dd: Fits into your existing workflow1

A combination of oral therapies and daratumumab*

ZENBEXUS STARTING DOSE1

ZENBEXUS starting dose is 1mg daily.

On Days 1-21 of each 28-day cycle in combination with standard dosages of daratumumab* (SC) and dexamethasone (oral) until disease progression or unacceptable toxicity1

Same starting dose for most† patients; dose modifications may be required for renal impairment and CYP3A inhibitors1

Clear dose adjustments available to manage ARs and help keep patients on therapy if clinically appropriate1

CYP3A inhibitors & inducers1

  • Avoid concomitant use of strong or moderate CYP3A inhibitors with ZENBEXUS
  • If concomitant use with strong CYP3A inhibitors is unavoidable, reduce ZENBEXUS dose to 1 mg every other day on Days 1 to 21 of a 28-day cycle
  • If concomitant use with moderate CYP3A inhibitors is unavoidable, reduce ZENBEXUS dose to 0.75 mg once daily on Days 1 to 21 of a 28-day cycle. If dose modification is needed due to adverse events, reduce ZENBEXUS dose to 1 mg every other day on Days 1 to 21 of a 28-day cycle
  • Avoid concomitant use of strong or moderate CYP3A inducers with ZENBEXUS

Renal impairment1

  • In patients with eGFR less than 30 mL/min/1.73 m2 not receiving dialysis, reduce ZENBEXUS dose to 0.75 mg once daily on Days 1 to 21 of a 28-day cycle. If dose modification is needed due to adverse events, reduce ZENBEXUS dose to 1 mg every other day on Days 1 to 21 of a 28-day cycle
  • In patients with eGFR greater than 30 mL/min/1.73 m2 or eGFR less than 30 mL/min/1.73 m2 receiving intermittent hemodialysis, no dose adjustment is recommended

*Daratumumab and hyaluronidase-fihj.
†Preinitiation pregnancy testing may be required for some patients.1

APP=advanced practice provider; AR=adverse reaction; Dd=daratumumab and hyaluronidase-fihj and dexamethasone; eGFR=estimated glomerular filtration rate; MOA=mechanism of action; SC=subcutaneous.

ZENBEXUS dosing and administration considerations for your patients1

 

Instruct patients to take ZENBEXUS at approximately the same time each day

  • If a dose of ZENBEXUS is missed and it has been less than 12 hours since the missed dose, patients should take it as soon as they remember
  • If it has been more than 12 hours, patients should skip the missed dose. They should not take 2 doses at the same time
 

ZENBEXUS can be taken with or without food

 

ZENBEXUS capsules should be taken whole with water

  • Advise patients not to open, break, or chew the capsules
  • Remind patients to avoid direct contact with the capsule contents
  • In case of capsule breakage, patients should avoid raising dust during clean-up. If contact occurs, advise them to wash thoroughly with soap and water
  • ZENBEXUS is a hazardous drug. Follow applicable special handling and disposal procedures

Dose Modifications Seen in Study

ZENBEXUS is available in 2 dosage strengths1

1mg starting dose of ZENBEXUS

1 mg starting dose
Not actual size

The majority of dose interruptions with ZENBEXUS were less than 1 week2

84% (n=172/204) of patients had a dose interruption due to ARs.1,3

  • 58% of dose interruptions were ≤7 days2
  • 91% of dose interruptions were ≤21 days2
  • ARs which required dosage interruption in >10% of patients included neutropenia, upper respiratory tract infection, pneumonia, and COVID-191
0.75mg reduced dose of ZENBEXUS

0.75 mg reduced dose
Not actual size

Reduced dose for AR management available, if needed

29% of patients had dose reductions due to ARs with ZENBEXUS.1

  • ARs which required dose reductions in >2% of patients included neutropenia, fatigue, pneumonia, and sensory neuropathy1

AR=adverse reaction; COVID-19=coronavirus disease 2019.

Recommended dosage modifications for ARs1

ADVERSE REACTION SEVERITY* DOSE MODIFICATION†
Neutropenia
ANC <500 cells/mcL		 Grade 4
Interrupt ZENBEXUS
  • Consider initiating granulocyte colony-stimulating factors (GCSF), as appropriate
  • Follow complete blood count (CBC) at least weekly
  • ANC must return to ≥1,000 cells/mcL before restarting
The dose of ZENBEXUS may be maintained if:
  • Neutropenia was the only ZENBEXUS-related toxicity requiring a dose modification and GCSF treatments are continued
Decrease to 0.75 mg once daily and restart ZENBEXUS if:
  • A dose reduction is clinically appropriate
Febrile neutropenia
ANC <1,000 cells/mcL with:
  • a single temperature of >38.3 °C (101 °F) or
  • a sustained temperature of ≥38 °C (100.4 °F) for more than 1 hour
 Grade 3
Thrombocytopenia
Platelet count <25,000/mcL		 Grade 4
Withhold ZENBEXUS for the remainder of the cycle
  • Platelet count must return to ≥50,000/mcL before restarting
Decrease ZENBEXUS to 0.75 mg once daily when restarting treatment
Thrombocytopenia
with bleeding or any requirement for a platelet transfusion		 Grade 3
Thromboembolism ≥Grade 3
Interrupt ZENBEXUS
  • Initiate anticoagulant therapy
Restart treatment at a decreased ZENBEXUS dose to 0.75 mg once daily when:
  • Acute symptoms of thrombosis/embolism have been resolved, at the discretion of the treating physician
Other ZENBEXUS-related adverse reactions ≥Grade 3
Interrupt ZENBEXUS
  • Restart ZENBEXUS when adverse event has resolved or improved to ≤Grade 2
Decrease to 0.75 mg once daily and restart ZENBEXUS if:
  • A dose reduction is clinically appropriate

*Based on NCI CTCAE v5.0.
†Refer to daratumumab and hyaluronidase-fihj and dexamethasone Prescribing Information for information about dosage modifications for daratumumab and hyaluronidase-fihj and dexamethasone.

ANC=absolute neutrophil count; AR=adverse reaction; NCI CTCAE=National Cancer Institute Common Terminology Criteria for Adverse Events.

ZENBEXUS REMS Program

ZENBEXUS REMS program logo

ZENBEXUS is only available through a restricted distribution program called ZENBEXUS REMS

Only prescribers and pharmacies certified with ZENBEXUS REMS can prescribe and dispense the product to patients who are enrolled and meet all the conditions of the ZENBEXUS REMS Program.

Help your patients start and manage their treatment journey with ZENBEXUS

REMS=Risk Evaluation and Mitigation Strategy.

References: 1. ZENBEXUS [package insert]. Princeton, NJ: Bristol-Myers Squibb Company; 2026. 2. Data on file. BMS-REF-00036-2070. Princeton, NJ: Bristol-Myers Squibb Company; 2026. 3. Data on file. BMS-REF-00030-2070. Princeton, NJ: Bristol-Myers Squibb Company; 2026.

References

IMPORTANT SAFETY
INFORMATION

WARNING: EMBRYO-FETAL TOXICITY AND SERIOUS VENOUS AND ARTERIAL THROMBOEMBOLISM

EMBRYO-FETAL TOXICITY

ZENBEXUS is contraindicated in pregnancy. ZENBEXUS is embryo-fetal toxic in animals and can cause birth defects or embryo-fetal death in humans. In females of reproductive potential, obtain 2 negative pregnancy tests before starting ZENBEXUS treatment.

Females of reproductive potential must use 2 effective forms of contraception or continuously abstain from heterosexual sex during and for 4 weeks after last dose of ZENBEXUS treatment.

Because of the risk of embryo-fetal toxicity, ZENBEXUS is only available through a restricted distribution program called ZENBEXUS REMS.

SERIOUS VENOUS AND ARTERIAL THROMBOEMBOLISM

Increased risk of deep vein thrombosis (DVT), pulmonary embolism (PE), myocardial infarction, and stroke in patients with multiple myeloma receiving ZENBEXUS with daratumumab and hyaluronidase-fihj and dexamethasone. Anti-thrombotic prophylaxis is recommended.

CONTRAINDICATIONS

Based on the mechanism of action and findings in animal studies, ZENBEXUS can cause birth defects or embryo-fetal death in humans. ZENBEXUS is contraindicated in females who are pregnant. If this drug is used during pregnancy or if the patient becomes pregnant while taking this drug, the patient should be informed of the potential hazard to a fetus.

WARNINGS AND PRECAUTIONS

Embryo-Fetal Toxicity

Females of Reproductive Potential: Must avoid pregnancy while taking ZENBEXUS and for at least 4 weeks after completing therapy. Advise females of reproductive potential of the potential risk to a fetus and to use 2 methods of effective contraception for at least 4 weeks before beginning ZENBEXUS therapy, during therapy, during dose interruptions and for at least 4 weeks after the last dose of ZENBEXUS therapy. Refer patients who can become pregnant to a qualified provider of contraceptive methods, if needed.

Two negative pregnancy tests with a sensitivity of at least 25 mIU/mL must be obtained prior to initiating therapy. Pregnancy testing should be performed weekly during the first 4 weeks of treatment. Thereafter, testing should occur every 4 weeks in patients with regular menstrual cycles, or every 2 weeks in patients with irregular menstrual cycles.

Females of reproductive potential taking ZENBEXUS must not donate eggs during treatment and for 4 weeks after completion.

Males: ZENBEXUS may pass into human semen. Advise patients who can impregnate partners to use effective contraception during treatment and for 4 weeks following the discontinuation of ZENBEXUS therapy. Male patients taking ZENBEXUS must not donate sperm during treatment and for 4 weeks after completion.

Blood Donation: Patients must not donate blood during treatment with ZENBEXUS and for 4 weeks following discontinuation of ZENBEXUS therapy.

ZENBEXUS REMS

ZENBEXUS is available only through a restricted program called ZENBEXUS REMS, because of the risk of embryo-fetal toxicity. Prescribers must be certified with, and patients must be enrolled in the ZENBEXUS REMS Program and comply with ongoing monitoring and contraception requirements. Further information about ZENBEXUS REMS, including information for pharmacies, wholesalers, and distributors, is available at www.ZENBEXUSREMS.com or by telephone at 1-888-423-5436.

Serious Venous and Arterial Thromboembolism

ZENBEXUS can cause serious and life-threatening venous thromboembolic events (DVT and PE) and arterial thromboembolic events (myocardial infarction and stroke). In the EXCALIBER-RRMM study (N=204), venous thromboembolic events occurred in 6.4% of patients treated with ZENBEXUS combined with daratumumab and hyaluronidase-fihj and dexamethasone (IberDd) despite mandatory thromboembolism prophylaxis. The incidence of DVT was 3.4% and the incidence of PE was 1.5%.

Arterial thromboembolic events occurred in 3.4% of patients. The incidence of myocardial infarction was 2.0%, and the incidence of stroke (CVA) was 1.5%.

Monitor patients for signs and symptoms of thromboembolic events during treatment with ZENBEXUS. Patients with known risk factors, including prior thrombosis, may be at greater risk, and actions should be taken to try to minimize all modifiable factors (e.g., hyperlipidemia, hypertension, smoking). Thromboprophylaxis is recommended, and the choice of regimen should be based on assessment of the patient's underlying risk factors. In patients who develop a thromboembolism, interrupt ZENBEXUS and initiate anticoagulant therapy according to guidelines.

Neutropenia

ZENBEXUS can cause severe neutropenia. In the EXCALIBER-RRMM study, all-grade neutropenia was reported in 90.2%, Grade 3 in 30.9%, and Grade 4 in 53.4% of patients in the IberDd arm. Febrile neutropenia occurred in 5.4% of patients.

Monitor complete blood count throughout treatment with ZENBEXUS. Interrupt, reduce dosage, or discontinue ZENBEXUS, as necessary. Initiate granulocyte colony-stimulating factor (GCSF) as appropriate per guidelines.

Infections

ZENBEXUS can cause serious infections, including life-threatening or fatal infections. Patients with active or uncontrolled infection should not start ZENBEXUS treatment until the infection is controlled. In the EXCALIBER-RRMM study, infections, including opportunistic infections, were reported in 78.9%, Grade 3 in 35.8%, Grade 4 in 3.4%, and fatal infections in 2% of patients receiving IberDd. Serious infections occurred in 40% of patients. Discontinuations due to infections occurred in 1.5% of patients.

Monitor patients for signs and symptoms of infection prior to and during treatment with ZENBEXUS and treat appropriately. Withhold or reduce the dose based on severity.

Consider prophylactic anti-infective medications according to current practice guidelines.

Second Primary Malignancies

In the EXCALIBER-RRMM study, at a median follow-up time of 16 months, second primary malignancies (SPM) occurred in 6.9% of patients in the IberDd arm and 4.9% of patients in the daratumumab and hyaluronidase-fihj, bortezomib, and dexamethasone (DVd) arm.

Monitor patients for the development of SPM.

ADVERSE REACTIONS

Serious adverse reactions occurred in 58.3% of patients receiving ZENBEXUS. Serious adverse reactions in ≥2% of patients included pneumonia (26%), upper respiratory tract infection (6.4%), SPM (5.9%), neutropenia (4.9%), febrile neutropenia (3.9%), COVID-19 (4.4%), and sepsis (2.9%). Fatal adverse reactions occurred in 10 patients (4.9%) who received ZENBEXUS. Sepsis (1.5%) was the only fatal drug reaction that occurred in more than 1 patient. The following fatal adverse reactions occurred in 1 patient each: listeria encephalitis, influenza, lung adenocarcinoma, cardiac arrest, large intestine perforation, metabolic acidosis, and respiratory failure.

The most common adverse reactions (≥20%) in the IberDd arm and DVd arm, respectively, were upper respiratory tract infection (54% and 52%), fatigue (36% and 33%), musculoskeletal pain (35% and 33%), pneumonia (34% and 17%), diarrhea (33% and 36%), motor dysfunction (26% and 17%), rash (26% and 15%), sleep disorder (25% and 28%), hypogammaglobulinemia (24% and 12%), COVID-19 (23% and 16%), and constipation (20% and 22%).

The most common Grade 3 to 4 laboratory abnormalities (≥30%) in the IberDd arm and DVd arm, respectively, were neutropenia (77% and 11%), leukopenia (69% and 18%), and lymphopenia (62% and 51%).

DRUG INTERACTIONS

Effects of Other Drugs on ZENBEXUS

Strong or Moderate CYP3A Inhibitors: Coadministration of ZENBEXUS with strong or moderate CYP3A inhibitors should be avoided. If a strong or moderate CYP3A inhibitor must be used in combination with ZENBEXUS, reduce the ZENBEXUS dose. Concomitant use with strong or moderate CYP3A inhibitors may increase the risk of adverse reactions.

Strong or Moderate CYP3A Inducers: Coadministration of ZENBEXUS with strong or moderate CYP3A inducers should be avoided. Concomitant use with a strong or moderate CYP3A inducer may decrease the efficacy of ZENBEXUS.

SPECIFIC POPULATIONS

Pregnancy (See Boxed WARNINGS)

There is a pregnancy exposure registry that monitors outcomes in patients exposed to ZENBEXUS during pregnancy. See the ZENBEXUS REMS WARNINGS AND PRECAUTIONS section.

Lactation

Advise women not to breastfeed during treatment with ZENBEXUS. Refer to the Prescribing Information for daratumumab and hyaluronidase-fihj or dexamethasone for additional information.

Females and Males of Reproductive Potential

ZENBEXUS can cause fetal harm when administered during pregnancy.

Pregnancy Testing, Females of Reproductive Potential, and Males: See the Embryo-Fetal Toxicity WARNINGS AND PRECAUTIONS section.

Geriatric Use

In patients treated with IberDd, the incidence of serious adverse reactions was 53%, 56%, and 74% in adult patients younger than 65 years of age, 65 years of age to younger than 75 years of age, and 75 years of age and older, respectively.

Renal Impairment

Reduce the ZENBEXUS dose in patients with estimated glomerular filtration rate (eGFR) less than 30 mL/min/1.73 m2 not on dialysis. If dose modification is needed due to adverse events, reduce the ZENBEXUS dose to 1 mg every other day on Days 1 to 21 of a 28-day cycle.

Please see full Prescribing Information for ZENBEXUS including Boxed WARNINGS.

Bristol Myers Squibb corporate logo.

ZENBEXUS and its associated logo are trademarks of Celgene Corporation, a Bristol Myers Squibb company.
All other trademarks are the property of their respective owners.

© 2026 Bristol-Myers Squibb Company.

2070-US-2600011  08/26