Home Drug Guide Azacitidine

Drug Guide

Generic Name

Azacitidine

Brand Names Vidaza, Onureg

Classification

Therapeutic: Antineoplastic agent

Pharmacological: DNA methyltransferase inhibitor

FDA Approved Indications

  • Myelodysplastic syndromes (MDS)
  • Acute myeloid leukemia (AML) in certain settings

Mechanism of Action

Azacitidine incorporates into DNA and RNA, leading to hypomethylation of DNA and restoration of normal gene function, which inhibits abnormal cell growth.

Dosage and Administration

Adult: For MDS: 75 mg/m² subcutaneously or intravenously once daily for 7 days every 28 days. For AML: dosage varies based on patient status and specific protocols.

Pediatric: Not typically used in pediatric populations; consult specialized protocols.

Geriatric: Use with caution; adjust based on renal and hepatic function.

Renal Impairment: Adjust dosage based on severity; monitor renal function.

Hepatic Impairment: Use with caution; no specific dose adjustment established.

Pharmacokinetics

Absorption: Moderately absorbed after subcutaneous or IV administration.

Distribution: Widely distributed; crosses cell membranes via passive diffusion.

Metabolism: Metabolized primarily in the liver via cytidine deaminase.

Excretion: Excreted mainly in urine.

Half Life: Approximately 4-10 hours.

Contraindications

  • Hypersensitivity to azacitidine or any component of the formulation.

Precautions

  • Myelosuppression observation required.
  • Monitoring liver and kidney function.
  • Use with caution in pregnant or breastfeeding women.

Adverse Reactions - Common

  • Nausea (Common)
  • Vomiting (Common)
  • Fatigue (Common)
  • Thrombocytopenia (Common)
  • Neutropenia (Common)

Adverse Reactions - Serious

  • Severe myelosuppression (Serious)
  • Infection (Serious)
  • Bleeding complications (Serious)
  • Gastrointestinal toxicity (Serious)

Drug-Drug Interactions

  • Myelosuppressive agents (increased risk of myelosuppression)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor complete blood counts, renal and hepatic function.

Diagnoses:

  • Risk for infection
  • Risk of bleeding
  • Impaired tissue perfusion

Implementation: Administer as prescribed, monitor for adverse effects, educate patient about signs of infection and bleeding.

Evaluation: Assess blood counts regularly, evaluate for side effects, monitor response to therapy.

Patient/Family Teaching

  • Report signs of infection (fever, chills).
  • Avoid invasive procedures without medical advice.
  • Use effective contraception during treatment and for some time after.
  • Follow scheduling and laboratory monitoring strictly.
  • Report any unusual bleeding, bruising, or symptoms of anemia.

Special Considerations

Black Box Warnings:

  • Myelosuppression, including neutropenia, thrombocytopenia, and anemia, which can be severe and lead to death.

Genetic Factors: No specific genetic screening required, but response may vary based on disease genetics.

Lab Test Interference: May cause false elevation of serum bilirubin levels.

Overdose Management

Signs/Symptoms: Severe myelosuppression, bleeding, infections.

Treatment: Supportive care, including blood product support and antibiotics; no specific antidote.

Storage and Handling

Storage: Store in a refrigerator at 2°C to 8°C (36°F to 46°F). Protect from light.

Stability: Stable for up to 24 hours at room temperature once reconstituted; reconstituted solution stable for up to 8 hours.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.