Azacitidine (ONUREG)

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Indication

Acute myeloid leukemia

Dose

Acute myeloid leukemia

Oral: 300 mg once daily for 14 days, repeated every 28 days until disease progression or unacceptable toxicity

Supplied

Available as 200 mg and 300 mg tablets. Tablets contain lactose. Tablets should NOT be crushed or broken. Store at room temperature in original aluminum blisters.

Pharmacological Category

Antimetabolite

Administration

Take with or without food

Missed Dose

If a dose is missed, patients should be instructed to take it as soon as they can if it is within 12 hours of the missed dose. If it is over 12 hours since the missed dose, patients should skip the missed dose and resume with the next scheduled dose.

Adverse Effects

Common: Anemia, Thrombocytopenia, Neutropenia, Constipation, Diarrhea, Nausea, Vomiting, Anorexia, Pyrexia, Arthralgias, Myalgias, Headache.

Less Common: Dizziness, Dyspnea.

The adverse effects listed above are not exhaustive. Please refer to the relevant product monograph for full details.

Monitoring Parameters

Baseline before treatment: CBC & differential, platelets, creatinine, urea, GGT, alkaline phosphatase, ALT, bilirubin, LDH, albumin, sodium, potassium, chloride.

During treatment: CBC & differential, platelets, creatinine, urea, GGT, alkaline phosphatase, ALT, bilirubin, LDH, albumin, sodium, potassium, chloride.

Cycle 1 – weekly CBC & differential, platelets.
Cycle 2 – biweekly CBC & differential, platelets.

If clinically indicated: (on Day 15 of subsequent cycles) CBC & differential, platelets (for 2 cycles if dose adjusted for myelosuppression).

Drug Interactions

This drug can impact or be impacted by metabolic enzymes for absorption and excretion. Many drugs can also affect or be affected by these enzymes, so please consult with pharmacy to assess for interactions.
Current drug interaction databases should be consulted for more information.

Clinical Pearls

Avoid in pregnancy and lactation.
Azacitidine as an oral medication is not interchangeable with azacitidine for injection.

References

BC Cancer. BC Cancer Drug Manual. Azacitidine. Vancouver, British Columbia: BC Cancer Agency. Available at: http://www.bccancer.bc.ca/drug-database-site/Drug%20Index/Azacitidine_monograph.pdf. Updated October 1, 2022. Accessed January 22, 2024.

Lexicomp. Azacitidine Monograph. In: Lexi-Drugs. Hudson, Ohio: Lexi-Comp, Inc. Available at: https://online-lexi-com.qe2a-proxy.mun.ca/lco/action/doc/retrieve/docid/patch_f/6403?cesid=2Drtpc8reHl&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3Dazacitidine%26t%3Dname%26acs%3Dfalse%26acq%3Dazacitidine. Updated January 31, 2024. Accessed January 31, 2024.

Cancer Care Ontario. Azacitidine Monograph. Drug Formulary. Toronto, Ontario: Cancer Care Ontario. Available at: https://www.cancercareontario.ca/en/drugformulary/drugs/monograph/43741. Updated July 2023. Accessed January 22, 2024.Celgene Inc. VIDAZA® Product monograph. Mississauga, Ontario. Updated March 22, 2018.