Azacitidine

2. Presentation on
Azacitidine
Presented by:
Anju Shah
Roll No. 2
BNS 3rd Year

3. Introduction
Azacitadine is a is a chemical analog of cytidine,
a nucleoside in DNA and RNA
 Functional class –Anti-neoplastic hormone
Chemical class - DNA de-methylation agent
Pregnancy category – “D”

4. Mechanism of Action
A pyrimidine nucleoside analogue that inhibits DNA
methyltransferase, impairing DNA methylation. It works by
helping the bone marrow to produce normal blood cells and by
killing abnormal cells in the bone marrow
It is also an anti-metabolite of cytidine, producing damage
to double-strand DNA during DNA synthesis
Therapeutic outcome: Improved blood counts in refractor
anemia

5. Uses:
 Myelodysplastic syndrome (MDS)
Contraindications:
 Pregnancy D
 Advanced malignant hepatic tumors
 Hypersensitivity to azacitidine or mannitol
Precautions:
 Breastfeeding, children, geriatric, renal/hepatic disease

6. Dosage and routes
 Adult:
• 75 mg/m2 IV or SC every day for 7 days
• Repeat cycle every 4 weeks for minimum of 4-6 cycles
• May increased to 100 mg/m2 if no benefit observed after 2
treatment cycles and if no toxicity other than nausea and
vomiting
 Available forms:
Powder for Inj. 100 mg

7. Available form of Azacitidine

8. Preparation
SUBCUT route
• Reconstitute with 4 ml sterile water for injection (25 mg/ml),
solution will be cloudy, use immediately
• Divide doses ie. 4 ml into two syringes and gently roll syringe
between the palms for 30 sec immediately before administration.
Also, rotate Inj. site.
IV intermittent infusion route
• Reconstitute each vial with 4 ml sterile water for Inj, shake well
until all solids are dissolved,
• withdraw solution and inject in 50-100 NS, and infuse over 10-
40 min.

9. Preparation in Oncocogy ward
• Pre-medication:
Not needed
• Preparation:
Inj. Azacitidine 100 mg dilute with 10 ml NS
(1ml = 10 mg)
or
Inj. Azacitidine 100 mg with 100 ml NS over 10-30 min

10. Adverse effects
 CNS: Anxiety, depression, dizziness, fatigue,
headache, fever, insomnia
 CV: Cardiac murmur, hypotension, tachycardia,
peripheral edema, chest pain
 GI: Diarrhea, nausea, vomiting, stomatitis, anorexia,
constipation, abdominal pain, distention, tenderness,
hemorrhoids, tongue ulceration, dyspepsia,
hepatotoxicity, hepatic coma etc.
 GU: Real failure, dysuria, UTI

11. Adverse effects contd…
 HEMA: Leukopenia, anemia, thrombocytopenia,
neutropenia, ecchymosis, febrile neutropenia,
 Skin : Irritation at injection site, rash, sweating,
pyrexia, pruritus
 Metabolism: Hypokalemia
 MS: Weakness, arthralgia, muscle cramps,
myalgia, back pain
 RESP: Cough, dyspnea, pharyngitis, pleural effusion

12. Pharmacokinetics
Absorption - Rapid
Distribution -Unknown
Metabolism - Liver
Excretion - Kidney
Half-life - 35-49 min

13. Pharmacodynamics
Onset - Unknown
Peak - ½ hr
Duration – Unknown
Interactions
Anti-neoplastics: Increased bone marrow depression

14. Nursing Considerations
Assessment
 Assess for CNS symptoms: fever, headache, chills,
dizziness
 Monitor bone marrow suppression in patients with baseline
WBC
 Assess buccal cavity every 8 hr for dryness, sores, or
ulceration, white patches, oral pain, bleeding, dysphagia
 Assess for bruising, bleeding, blood in stools, urine,
sputum, emesis, splenomegaly

15. Implementation
 Increase patient’s fluid intake to 2-3 L/day to prevent
dehydration, unless contraindicated
 Assist patient with rinsing of mouth with water, brushing of
teeth 3-4 times with soft brush or cotton-tipped applicator
 Provide a nutritious diet with iron, vitamin supplement, low
fiber, few dairy products
 Use cytotoxic handling procedures

16. Patient/family education
Instruct patient to avoid foods with citric acid or hot or
rough texture if stomatitis is present & to drink adequate
fluids
Instruct patient to report any bleeding, white spots,
ulcerations in mouth
Instruct patient to avoid crowds, persons with known
infections & not to receive immunizations

17. Patient/family education contd…
• Advise patient to use contraception during and for several
months after therapy
• Pregnancy D not to breastfeed
• Not to father a child while receiving this product

18. Evaluation
Positive therapeutic outcome
- Improvement in blood counts of the patient

19. References
Medlineplus (2021). Azacitidine Injection. Accessed
https://medlineplus.gov/druginfo/meds/a607068.html on 13th
December 2021
Medscape(n.d.). Azacitidine. Accessed
https://reference.medscape.com/drug/onureg-vidaza-
azacitidine-342263 on 14th December 2021
Skidmore L. S.(2015). Mosby’s Drug Guide For Nursing
Students. ( 11th ed.).p. 106-108. Elsevier.
Webmed(n.d.). Azacitidine . Accessed
https://www.webmd.com/drugs/2/drug-90380/azacitidine-
injection/details on 13th December 2021