Azarest

Indications

Azacitidine is an anticancer medicine used to treat certain blood and bone marrow cancers, including myelodysplastic syndromes (conditions where the bone marrow makes faulty blood cells), chronic myelomonocytic leukaemia and acute myeloid leukaemia in adults who are not suitable for intensive treatment. It is used under the care of a cancer specialist.

How It Works

Azacitidine is a hypomethylating agent. It is built into the genetic material of cells and blocks an enzyme that adds chemical tags (methyl groups) to DNA. Removing these tags can switch back on genes that help cells mature normally, and it also kills abnormal, fast-dividing cells in the bone marrow. Over several cycles this can improve blood counts.

Dosage and Administration

Azacitidine is given by a doctor or nurse as an injection under the skin or into a vein, usually for 7 days in a row, repeated every 4 weeks. The dose is calculated by the specialist from body size and adjusted according to blood counts and kidney function. Treatment normally continues for at least several cycles before its benefit can be judged. Tablet forms, where available, are taken only as prescribed.

Interactions

No major drug interactions are known, but tell your specialist about all medicines, including herbal products. Live vaccines should be avoided during treatment. Other medicines that lower blood counts may add to the effect.

Contraindications

Do not use if you are allergic to Azacitidine or Mannitol, have advanced liver cancer, or are breastfeeding.

Side Effects

Common side effects are low blood counts (causing infections, tiredness and easy bruising or bleeding), nausea, vomiting, diarrhoea or constipation, fever, injection site redness or bruising, tiredness and loss of appetite.

Get urgent medical help if you have a fever of 38°C or above, chills, signs of infection, unusual bleeding or bruising, black stools, severe shortness of breath, reduced urine, or yellowing of the skin or eyes.

Pregnancy and Lactation

Azacitidine can harm an unborn baby. Women must avoid pregnancy during treatment and for at least 6 months afterwards, and men should avoid fathering a child during treatment and for 3 months afterwards, using effective contraception. Do not breastfeed during treatment.

Precautions and Warnings

Regular blood tests and kidney and liver checks are needed. Treatment may be delayed or the dose reduced if blood counts are too low. Use with caution in heart or lung disease and kidney or liver problems. Avoid contact with people who have infections and report signs of infection early. This medicine is handled as a cytotoxic drug by trained staff.

Overdose

Overdose is managed in hospital. It may cause severe diarrhoea, nausea, vomiting and very low blood counts. Treatment is supportive with blood count monitoring.

Therapeutic Class

Antineoplastic (hypomethylating agent, pyrimidine analogue).

Storage

Hospital medicine: store as directed on the pack, out of the reach of children.