Care During Chemotherapy and Beyond
Trade names: Vidaza®
Other name: 5-Azacitidine
Drug type: Azacitidine is an anti-cancer ("antineoplastic"
or "cytotoxic") chemotherapy drug. This medication is classified as an "antimetabolite"
and a "demethylation" agent. (For more detail, see "How this drug works" section
What Azacitidine Is Used For:
- Treatment of myelodysplastic syndrome (MDS)
- Chronic myelomonocytic leukemia (CMML)
Note: If a drug has been approved for one use, physicians
may elect to use this same drug for other problems if they believe it may be helpful.
How Azacitidine Is Given:
- As a once-a-day subcutaneous (under the skin) injection or as an IV (intravenous)
- The amount of azacitidine that you will receive depends on many factors, including
your height and weight, your general health or other health problems, and the type
of cancer or condition being treated. Your doctor will determine your dose
Important things to remember about the side effects of azacitidine:
- Most people do not experience all of the side effects listed.
- Side effects are often predictable in terms of their onset and duration.
- Side effects are almost always reversible and will go away after treatment is complete.
- There are many options to help minimize or prevent side effects.
- There is no relationship between the presence or severity of side effects and the
effectiveness of the medication
The following side effects are common (occurring in greater than 30%) for
patients taking azacitidine:
- Low red blood cell count (Anemia).
- Low platelet count. (This can put you at increased risk for bleeding.)
- Low white blood cell count. (This can put you at increased risk for infection.)
Nadir: Meaning low point, nadir is the point in time between chemotherapy
cycles in which you experience low blood counts.
Nadir: 10-17 days
Recovery: 28-31 days
- Injection site redness
- Ecchymosis, petechiae
These side effects are less common side effects (occurring in about 10-29%)
of patients receiving azacitidine:
- Shortness of breath
- Injection site pain
- Joint and muscle pain (arthralgia and myalgia)
- Poor appetite
- Sore throat
- Back pain
- Swelling in ankles
- Chest pain
- Weight loss
- Abdominal pain
- Low potassium (hypokalemia) (see blood test abnormalities)
- Upper respiratory infection
- Insomnia (see sleep problems)
Not all side effects are listed above. Some that are rare (occurring in less than
10% of patients) are not listed here. However, you should always inform your
health care provider if you experience any unusual symptoms.
When to contact your doctor or health care provider:
Contact your health care provider immediately, day or night, if you
should experience any of the following symptoms:
- Fever of 100.4° F (38° C) or higher, chills (possible signs of infection)
The following symptoms require medical attention, but are not an emergency.
Contact your health care provider within 24 hours of noticing any of the
- Nausea (interferes with ability to eat and unrelieved with prescribed medication).
- Vomiting (vomiting more than 4-5 times in a 24 hour period).
- Diarrhea (4-6 episodes in a 24-hour period).
- Unusual bleeding or bruising
- Black or tarry stools, or blood in your stools.
- Blood in the urine.
- Extreme fatigue (unable to carry on self-care activities).
- Constipation unrelieved by laxative use.
- Swelling of the feet or ankles. Sudden weight gain.
- Signs of infection such as redness or swelling, pain on swallowing, coughing up
mucous, or painful urination.
- Unable to eat or drink for 24 hours or have signs of dehydration: tiredness, thirst,
dry mouth, dark and decrease amount of urine, or dizziness.
Always inform your health care provider if you experience any unusual symptoms.
- Before starting azacitidine treatment, make sure you tell your doctor about any
other medications you are taking (including prescription, over-the-counter, vitamins,
herbal remedies, etc.).
- Do not receive any kind of immunization or vaccination without your doctor's approval
while taking azacitidine.
- Inform your health care professional if you are pregnant or may be pregnant prior
to starting this treatment. Pregnancy category D (azacitidine may be hazardous
to the fetus. Women who are pregnant or become pregnant must be advised of
the potential hazard to the fetus.)
- For both men and women: Do not conceive a child (get pregnant) while taking azacitidine.
Barrier methods of contraception, such as condoms, are recommended. Discuss with
your doctor when you may safely become pregnant or conceive a child after therapy.
- Do not breast feed while taking this medication.
- Drink at least two to three quarts of fluid every 24 hours, unless you are instructed
- You may be at risk of infection so try to avoid crowds or people with colds and
those not feeling well, and report fever or any other signs of infection immediately
to your health care provider.
- Wash your hands often.
- Use an electric razor and a soft toothbrush to minimize bleeding.
- Avoid contact sports or activities that could cause injury.
- To reduce nausea, take anti-nausea medications as prescribed by your doctor, and
eat small, frequent meals.
- Keep your bowels moving. Your health care provider may prescribe a stool softener
to help prevent constipation that may be caused by this medicine.
- You may experience drowsiness or dizziness; avoid driving or engaging in tasks that
require alertness until your response to the drug is known.
- Acetaminophen or ibuprophen may help relieve discomfort from fever, headache and/or
generalized aches and pains. However, be sure to talk with your doctor before
- Avoid sun exposure. Wear SPF 15 (or higher) sunblock and protective clothing.
- In general, drinking alcoholic beverages should be kept to a minimum or avoided
completely. You should discuss this with your doctor.
- Get plenty of rest.
- Maintain good nutrition.
- If you experience symptoms or side effects, be sure to discuss them with your health
care team. They can prescribe medications and/or offer other suggestions that
are effective in managing such problems.
Monitoring and Testing:
You will be checked regularly by your health care professional while you are taking
azacitidine, to monitor side effects and check your response to therapy. Periodic
blood work to monitor your complete blood count (CBC) as well as the function of
other organs (such as your kidneys and liver) will also be ordered by your doctor.
How Azacitidine Works:
Azacitidine is a member of a new class of drugs known as DNA "demethylating" agents.
Methylation of DNA is a major mechanism that regulates gene expression in cells.
When there is an increase in DNA methylation this can result in the blockage of
the activity of "suppressor genes" that regulate cell division and growth.
When suppressor genes are blocked, cell division becomes unregulated, allowing or
Azacitidine's anticancer effects are believed to be twofold. One way
that it works is by demethylation or interfering with the methylation of DNA.
By this process of demethylation, normal function to the tumor suppressor genes
is restored, thus restoring control over cell growth.
Azacitidine also belongs to the category of chemotherapy called antimetabolites.
Antimetabolites are very similar to normal substances within the cell. When
the cells incorporate these substances into the cellular metabolism, they interact
with a number of targets within the cell to produce a direct cytotoxic effect that
causes death of rapidly dividing cancer cells.
Note: We strongly encourage you to talk with your health
care professional about your specific medical condition and treatments. The information
contained in this website is meant to be helpful and educational, but is not a substitute
for medical advice.
Chemocare.com is designed to provide the latest information about chemotherapy to patients and their families, caregivers and friends. For information about the 4th Angel Mentoring Program visit www.4thangel.org