Cancer drugs A to Z list
Azacitidine is a type of chemotherapy drug. You pronounce it as ay-za-sye-tih-deen. It is a treatment for people who can’t have a or for the following conditions:
chronic myelomonocytic leukaemia (CMML)
acute myeloid leukaemia (AML)
myelodysplastic syndrome
Find out more about treatment for your cancer type
You can have azacitidine:
by mouth
as an injection
The information on this page is about having azacitidine as an injection.
Find out more about having azacitidine by mouth
Azacitidine is a type of chemotherapy called an anti metabolite. It stops cells making and repairing . Cancer cells need to make and repair DNA so they can grow and multiply.
You have azacitidine as an injection just under your skin (subcutaneously). Your doctor or nurse gives you the injection.
You usually have your injection into your stomach, thigh or top of your arm.
You might have stinging or a dull ache for a short time after this type of injection, but they don't usually hurt much. The skin in the area may go red and itchy for a while.
Your next injection is usually in a different place and at least 2.5 cm from the previous injection site.
You have treatment in cycles. A cycle means that you have the medicine and then a rest to allow your body to recover. Each cycle of treatment lasts 28 days (4 weeks).
You usually have azacitidine injections for at least 6 cycles. You continue treatment for as long as it is working and you are not experiencing too many side effects.
Each cycle of azacitidine can vary slightly between hospitals. Your healthcare team will let you know your treatment plan.
Here are 2 examples of how you might have azacitidine:
You have azacitidine as an injection under the skin.
You have no treatment.
You have azacitidine as an injection under the skin.
You have no treatment.
You then start a new cycle of treatment.
You have azacitidine as an injection under the skin.
You have no treatment.
You then start a new cycle of treatment.
You have blood tests before and during your treatment. They check your levels of and other substances in the blood. They also check how well your liver and kidneys are working.
Before treatment starts you may have a blood test to check for viruses such as hepatitis B, hepatitis C, and HIV. This is called a viral screen.
It’s important for your doctor to know if you have had any of these viruses. This is because this treatment can weaken your and can cause the virus to become active again (reactivation).
Side effects can vary from person to person. They also depend on what other treatments you're having.
Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:
you have severe side effects
your side effects aren’t getting any better
your side effects are getting worse
Early treatment can help manage side effects better.
We haven't listed all the side effects here. Talk to your healthcare team if you have any new symptoms that you think might be a side effect of your treatment.
Remember it is very unlikely that you will have all of these side effects. But you might have some of them at the same time.
These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:
You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.
Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, cough, headaches, feeling cold and shivery, pain or a burning feeling when peeing, or generally feeling unwell. You might have other symptoms depending on where the infection is.
Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection.
This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs. This is known as petechiae.
Less commonly azacitidine can cause bleeding from other parts of the body. This includes passing blood in your poo; bleeding in the brain; bleeding in the eyes; or bleeding into the skin (haematoma).
Let your healthcare team know straight away if you notice you have any signs of bleeding. Or if you have a sudden severe headache or are unable to move your face, arms or legs. Or you feel suddenly weak or numb.
Tell your healthcare team straight away if you get a high temperature. Ask them if you can take paracetamol to help lower your temperature.
Azacitidine can cause shortness of breath. Less commonly, this could also happen because of a lung infection, moving more (physical activity) or due to fluid build up around the lung.
Rarely, your lungs can become stiff, scar and get inflamed. This is known as interstitial lung disease. This damage makes it difficult to breathe and get oxygen into the lungs.
Let your doctor or nurse know straight away if you suddenly become breathless, develop a cough or chest pain.
You might not feel like eating and may lose weight. Eating several small meals and snacks throughout the day can be easier to manage. You can talk to a dietitian if you are concerned about your appetite or weight loss.
If you have difficulty sleeping or staying asleep, it can help to change a few things about how you try to sleep. Try to go to bed and get up at the same time each day and spend some time relaxing before you go to bed. Some light exercise each day may also help.
Let your doctor or nurse know if you have headaches. They can give you painkillers such as paracetamol to help.
This treatment might make you feel dizzy. You might also feel dizzy when standing or moving around. Or it might feel like the world is spinning.
Don’t drive or operate machinery if you have this.
Tell your healthcare team if you have diarrhoea or constipation. They can give you medicine to help.
Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also help.
It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.
Skin problems include a skin rash and itching. Other skin problems include reddening of the skin, a rash with raised and flat bumps or an itchy raised rash (hives), but these is less common.
Rarely azacitidine can cause skin conditions such as:
acute febrile neutrophilic dermatosis - symptoms include high temperature (fever) with large plum coloured, raised painful patches on your skin
pyoderma gangrenosum that causes painful skin ulcers
Skin changes usually go back to normal when your treatment finishes. Your healthcare will tell you what products you can use on your skin to help.
You might have pain in your chest, tummy (abdomen), muscles, joints, bones, back, arms and legs.
You might also have pain in your throat or voice box, but this is less common.
Speak to your doctor, nurse or pharmacist about what painkillers you can take to help with this.
You might feel very tired and as though you lack energy.
Various things can help you to reduce tiredness and cope with it, for example exercise. Some research has shown that taking gentle exercise can give you more energy. It is important to balance exercise with resting.
Tell your nurse if you have any pain or notice any signs of redness, irritation or bleeding around the injection site.
It is common for azacitidine to cause low levels of potassium in the blood. Let your doctor or nurse know if you have cramping in your arm or leg muscles, tingling or numbness, or if you feel faint.
Less commonly your blood tests might show that you have high levels of a substance called creatinine. Creatinine is a protein made by the muscles. The kidneys remove them from our bodies and get rid of them in the urine.
You have regular blood tests to check these levels in your blood.
These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:
sepsis - a serious reaction to an infection. Signs can include feeling very unwell, not passing urine, a very high or very low temperature, shivering, slurred speech, confusion, breathlessness, mottled or discoloured skin, or muscle pain. Call 999 or go to accident and emergency (A&E) immediately if you have any of these symptoms
not enough fluid in your body (dehydration)
feeling confused or anxious
fainting
fluid around your heart or more rarely inflammation of the heart. Symptoms can include chest pain, pressure or discomfort. Or more rarely it can feel like a sharp stabbing pain in your chest. Other symptoms include shortness of breath, feeling lightheaded, or felling you heart beating very fast
feeling very drowsy or sleepy (somnolence)
high blood pressure that might cause headaches, confusion, vision problems or chest pain
low blood pressure that can cause you to feel lightheaded or dizzy, sometimes this can happen when you stand up from sitting or lying down
indigestion symptoms include heartburn, bloating, and burping
hair loss
uncontrolled muscle movement (spasms)
your kidneys not working properly, symptoms might include confusion, not passing enough urine and shortness of breath
sore mouth and ulcers
generally feeling unwell
shivering (chills)
These side effects happen in fewer than 1 in 100 people (less than 1%). You might have one or more of them. They include:
an allergic reaction that can cause a rash, shortness of breath, redness or swelling of the face and dizziness. Some allergic reactions can be life-threatening, alert your nurse or doctor if notice any of these symptoms
your liver not working (liver failure), some of the symptoms can include yellowing of the skin and whites of the eyes, abdominal pain or swelling, feeling or being sick, feeling confused or finding it hard to stay awake
changes to the levels of chemicals in your blood due to the breakdown of tumour cells (tumour lysis syndrome) - you have regular blood tests to check for this
There isn't enough information to work out how often these side effects might happen. You might have one or more of them. They include:
necrotising fasciitis, a rare life threatening infection of the tissue under the skin. Signs are fever, flu-like symptoms, painful cut or scratch, swelling, diarrhoea, sickness, skin blotches, blisters. Contact a doctor straight away
a fast release of immune substances () into your blood. This needs to be treated quickly as it can be life threatening. Let your team know straight away if you develop symptoms such as difficulty in breathing, a cough, chest pain or high temperature
of the in the skin which may cause a rash (cutaneous vasculitis)
We have more information about side effects and tips on how to cope with them.
Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.
Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.
This drug may harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you are having treatment with this drug and for at least 6 months after treatment.
Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner falls pregnant while having treatment.
It is not known whether this treatment affects in people. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.
It is not known whether this drug comes through into the breast milk. Doctors usually advise that you don’t breastfeed during this treatment.
If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.
Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having.
Ask your doctor or pharmacist how long you should avoid live vaccinations.
In the UK, live vaccines include rubella, mumps, measles, BCG, and yellow fever.
You can usually have:
other vaccines, but they might not give you as much protection as usual
the flu vaccine (as an injection)
the coronavirus (COVID-19) vaccine
Talk to your doctor or pharmacist about the best time to have a vaccine in relation to your cancer treatment.
You can be in contact with other people who have had live vaccines as injections. If someone has had a live vaccine by mouth or nasal spray there may be a small risk the vaccine virus can be passed onto you if your is weakened.
Your healthcare team will let you know if you need to take any precautions if you are in close contact with someone who has had a live vaccine.
For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.
You can report any side effect you have to the Medicines and Healthcare products Regulatory Agency (MHRA) as part of their Yellow Card Scheme.
Last reviewed: 14 Jan 2025
Next review due: 14 Jan 2028
AML starts from young white blood cells called granulocytes or monocytes in the bone marrow. Find out about symptoms, how it is diagnosed and treated, and how to cope.
Chronic myelomonocytic leukaemia (CMML) is a rare form of blood cancer. Get information on the different types and possible symptoms.
Myelodysplastic syndromes are a group of blood cancers. They are also called myelodysplasia or MDS for short.
Cancer drugs have side effects and these can vary from person to person. But there are things that you can do to help you cope.
Chemotherapy is a standard treatment for some types of cancer. It uses anti cancer drugs to destroy cancer cells.
Coping with cancer can be difficult. There is help and support available. Find out about the emotional, physical and practical effects of cancer and how to manage them.
About Cancer generously supported by Dangoor Education since 2010. Learn more about Dangoor Education
Search our clinical trials database for all cancer trials and studies recruiting in the UK.
Connect with other people affected by cancer and share your experiences.
Questions about cancer? Call freephone 0808 800 40 40 from 9 to 5 - Monday to Friday. Alternatively, you can email us.
