+ -Text Size

Decitabine

(duh-sye-tuh-bean)

Trade/other name(s): Dacogen

Why would this drug be used?

Decitabine is used to treat myelodysplastic syndromes (MDS), which are diseases of the bone marrow.

How does this drug work?

Decitabine is thought to act as an anti-metabolite. It seems to work by having a toxic effect on the abnormal (MDS) cells. It also appears to affect the DNA in genes that control cell growth. This promotes normal specialization and blood cell growth, so that the body is better able to make red blood cells, white blood cells, and platelets.

Before taking this medicine

Tell your doctor…

  • If you are allergic to anything, including medicines, dyes, additives, or foods.
  • If you have any medical conditions such as kidney disease, liver disease (including hepatitis), heart disease, congestive heart failure, diabetes, gout, or infections. These conditions may require that your medicine dose, regimen, or timing be changed.
  • If you are pregnant, trying conceive a child, or if there is any chance of pregnancy. This drug may cause birth defects if either the male or female is taking it at the time of conception or during pregnancy. Check with your doctor about what kinds of birth control can be used with this medicine.
  • If you are breast-feeding. It is not known whether this drug passes into breast milk. If it does, it could harm the baby.
  • If you think you might want to have children in the future. Some drugs can cause sterility. Talk with your doctor about the possible risk with this drug and the options that may preserve your ability to have children.
  • About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

Interactions with other drugs

Any drugs or supplements that interfere with blood clotting can raise the risk of bleeding during treatment with decitabine. These include:

  • vitamin E
  • non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and many others
  • warfarin (Coumadin)
  • ticlopidine (Ticlid)
  • clopidogrel (Plavix)

Note that many cold, flu, fever, and headache remedies contain aspirin or ibuprofen. Ask your pharmacist if you aren't sure what's in the medicines you take.

Check with your doctor, nurse, or pharmacist about other medicines, vitamins, herbs, and supplements, and whether alcohol can cause problems with this medicine.

Interactions with foods

No serious interactions with food are known at this time. Check with your doctor, nurse, or pharmacist about whether foods may be a problem.

Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

This drug is given in the vein (IV) over about 3 hours, and the dose is repeated every 8 hours over a 3-day period. The dose is based on your body size and may vary depending on your blood counts or other factors. This 3-day course is repeated every 6 weeks for 4 times or more, depending on whether it still helps you. The 3-day course may be postponed or the dose adjusted if your blood cells do not recover well between cycles.

Precautions

Your doctor will likely test your blood throughout your treatment, looking for possible effects of the drug on blood counts (described below) or on other body organs. Based on the test results, you may be given medicines to help treat any effects. Your doctor may also need to reduce or delay your next dose of this drug, or even stop it altogether. Be sure to keep all your appointments for lab tests and doctor visits.

Decitabine can lower your white blood cell count, especially in the weeks after the drug is given. This can raise your chance of getting an infection. Be sure to let your doctor or nurse know right away if you have any signs of infection, such as fever (100.5° or higher), chills, pain when passing urine, a new cough, or bringing up sputum.

This drug may lower your platelet count in the weeks after it is given, which can increase your risk of bleeding. Speak with your doctor before taking any drugs or supplements that might affect your body's ability to stop bleeding, such as aspirin or medicines containing aspirin, warfarin (Coumadin), or vitamin E. Tell your doctor right away if you have any unusual bruising, or bleeding such as nosebleeds, bleeding gums when you brush your teeth, or black, tarry stools.

Decitabine may lower your red blood cell count. If this occurs, it is usually a few weeks after starting treatment. A low red blood cell count (known as anemia) can cause shortness of breath, or make you to feel weak or tired all the time. Your doctor may give you medicines to help prevent or treat this condition, or you may need to get blood transfusions.

Do not get any immunizations (vaccines), either during or after treatment with decitabine, without your doctor's OK. Decitabine may affect your immune system. This could make vaccinations ineffective, or could even lead to serious infections if you get a live virus vaccine during or soon after treatment. Try to stay away from people who have recently received a live virus vaccine, such as the oral polio vaccine or smallpox vaccine. Check with your doctor about this.

You may have nausea and vomiting on the days you receive this drug or in the first few days afterward. Your doctor may give you medicine before your treatment to help prevent nausea and vomiting. You will likely also get a prescription for an anti-nausea medicine that you can take at home. It is important to have these medicines on hand and to take them as prescribed by your doctor. Tell your doctor if these drugs do not control your vomiting.

This drug may cause sores in the mouth, on the tongue, or on the lips, often within the first few weeks after starting treatment. This can cause pain, bleeding, or even trouble eating. Your doctor or nurse can suggest ways to reduce this, such as changing the way you eat or how you brush your teeth. If needed, your doctor can prescribe medicine to help with the pain.

A few people taking decitabine build up fluid in their lungs, which can make it hard to breathe. If you notice any breathing problems, call your doctor or nurse right away.

Call your doctor right away if you have symptoms of high blood sugar, such as extreme thirst or hunger, passing urine frequently, weakness, or blurred vision

Men should wait at least 2 months after finishing this drug before trying to conceive a baby (causing pregnancy). Women should avoid pregnancy during and for at least a few months after treatment, since exposure to this drug may harm the fetus. Talk with your doctor about this.

Possible side effects

You will probably not have most of the following side effects, but if you have any talk to your doctor or nurse. They can help you understand the side effects and cope with them.

Common

  • low platelet count with increased risk of bruising/bleeding*
  • low white blood cell count with increased risk of infection*
  • low red blood cell count (anemia) with symptoms like tiredness, low energy, or shortness of breath*
  • nausea*
  • vomiting*
  • diarrhea
  • constipation
  • tiredness
  • fever
  • pain or swelling in the arms or legs

Less common

  • blurred vision
  • pain
  • high blood sugar*
  • headache
  • bruises or bleeding
  • swollen lymph nodes ("glands")
  • sores in mouth, on tongue, or on lips*
  • infection
  • indigestion or sour stomach
  • abnormal blood tests which suggest that the drug is affecting the liver (Your doctor will discuss the importance of this finding, if any.)

Rare

  • confusion
  • trouble sleeping
  • fluid in the lungs*
  • severe allergic reaction, with symptoms like flushing, hives, trouble breathing or swallowing, dizziness, swelling of mouth or throat (while drug is being infused)
  • serious infections
  • death from infection, bleeding, or other cause

*See "Precautions" section for more detailed information.

There are other side effects not listed above that can also occur in some patients. Tell your doctor or nurse if you develop these or any other problems.

FDA approval

Yes – first approved in 2006.

Disclaimer: This information does not cover all possible uses, actions, precautions, side effects, or interactions. It is not intended as medical advice, and should not be relied upon as a substitute for talking with your doctor, who is familiar with your medical needs.


Last Medical Review: 02/11/2010
Last Revised: 02/11/2010