Azacitidine (Vidaza)

Azacitidine is a type of chemotherapy drug. It is pronounced ay-sah-sit-a-dean. It is also called Vidaza. It is a treatment for people who can’t have high dose treatment with a stem cell transplant for

• Chronic myelomonocytic leukaemia (CMML)
• Acute myeloid leukaemia
• Myelodysplastic syndrome which is intermediate 2 or high risk

Azacitidine is a type of chemotherapy called an anti metabolite. Anti metabolites work by joining with the cell DNA,which stops cells dividing. This reduces the number of abnormal blood cells and helps to control cell growth.

You usually have azacitidine as an injection just under your skin (subcutaneously). This can be in your arm, leg, buttock or stomach. Occasionally it is given as a drip or as an injection through a small tube into a vein (intravenously).

You usually have chemotherapy as a course of several cycles of treatment. How many cycles of treatment you have depends on your treatment plan. Most people have at least 6 cycles. There is detailed information about the way doctors plan chemotherapy in the planning chemotherapy section.

You have azacitidine daily for 7 days. Or daily from Monday to Friday and then also on Monday and Tuesday of the following week. Then you don’t have any treatment for the next 21 days. This is one cycle of treatment. You then start the next treatment cycle. You continue with the treatment for as long as it is working.

The side effects associated with azacitidine are listed below. You can use the links to find out more about each effect. For general information, see our cancer drug side effects section.  Many people find that the side effects are worse with the first 2 cycles of treatment.

More than 10 in every 100 people have one or more of the side effects listed below.

Temporary drop in the number of blood cells made by the bone marrow, causing

• Increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, sore throat, pain passing urine or feel cold and shivery
• Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
• Bruising more easily due to a drop in platelets – you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia)

Some of these side effects can be life threatening, particularly infections. You should contact your treatment centre if you have any of these effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.

Other common side effects include

• Fatigue (tiredness) in 4 in 10 people (40%) during and after treatment – some people find their energy levels are back to normal within 6 months to a year but some people with myelodysplastic syndrome may continue to be tired
• Feeling or being sick happens in about half the people having azacitidine (50%), but is usually well controlled with anti sickness medicines
• Irritation, including redness, around the site of the injection – if you are giving the injections yourself make sure you don’t give it the same place twice, and don’t give it in an area that is bruised or sore
• A skin rash
• Diarrhoea in just under 4 out of 10 people (40%) – drink plenty of fluids and tell your doctor or nurse if diarrhoea becomes severe, or continues for more than 3 days
• Constipation in about 4 out of 10 people (40%) – your doctor or nurse may give you laxatives to help prevent this but do tell them if you are constipated for more than 3 days
• Loss of appetite in about 2 out of 10 people (20%)
• A cough and shortness of breath
• Headache
• Dizziness
• Difficulty sleeping
• This drug may have a harmful effect on a developing baby – do talk to your doctor or nurse about contraception before having treatment if there is any chance that you or your partner could become pregnant
• Loss of fertility – we don’t know exactly how this drug affects fertility so do talk with your doctor before starting treatment if having a baby is important to you

Between 1 and 10 in every 100 people have one or more of these.

• Difficulty sleeping
• Mood changes, including feeling anxious or confused
• A sore mouth
• Indigestion
• Muscle pain
• Blood in your urine
• Low levels of potassium in your blood (hypokalaemia) – you will have blood tests to check the levels of potassium
• Feeling weak, a high temperature and chills
• Infections – including chest infections (pneumonia) and urine infections

Fewer than 1 in 100 people have these.

• Liver changes – the liver will almost certainly go back to normal when treatment finishes, but you will have regular blood tests to check how well your liver is working
• Bleeding – there is a small increase in risk of bleeding. This may be in your bowel, stomach, eyes or brain. Tell your doctor immediately if you have a headache, vomit any blood, or there is blood in your stool
• Some people have an allergic reaction while having azacitidine treatment, usually at the first or second treatment – let your treatment team know immediately if you feel hot or have any skin rashes, itching, dizziness, headaches, shivering, breathlessness, anxiety, flushing of the face, or a sudden need to pass urine

You won’t get all these side effects. A side effect may get worse through your course of treatment. Or you may have more side effects as the course goes on. This depends on

• How many times you've had a drug before
• Your general health
• How much of the drug you have (the dose)
• Other drugs you are having

Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them.

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements, and over the counter remedies – some drugs can react together.

Azacitidine is a relatively new drug in cancer treatment. This means that the information about side effects is based on only a few trials. And there is no information available at the moment about possible longer term effects that it may cause. If you notice anything that is not normal for you tell your doctor or nurse.

You should not have immunisations with live vaccines while you are having this treatment or for at least 6 months afterwards. In the UK, live vaccines include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but not many people in the UK have oral vaccines now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.