Home Drug Guide Decitabine

Drug Guide

Generic Name

Decitabine

Brand Names Dacogen

Classification

Therapeutic: Antineoplastic agent

Pharmacological: DNA hypomethylating agent

FDA Approved Indications

Myelodysplastic syndromes (MDS)
acute myeloid leukemia (AML) in certain settings

Mechanism of Action

Decitabine inhibits DNA methyltransferase enzymes, leading to hypomethylation of DNA and reactivation of silenced genes, which promotes differentiation and apoptosis of abnormal cells.

Dosage and Administration

Adult: 20 mg/m² IV over 1 hour daily for 5 days in a 28-day cycle, adjusted based on response and tolerance.

Pediatric: Not established for pediatric use.

Geriatric: Use with caution; start at lower doses due to potentially increased toxicity.

Renal Impairment: No specific dose adjustment recommended, but monitor renal function.

Hepatic Impairment: Use with caution; no specific dosing guidelines established.

Pharmacokinetics

Absorption: Administered intravenously, bypassing absorption variables.

Distribution: Widely distributed in tissues, crosses cell membranes.

Metabolism: Metabolized primarily in the liver via deamination.

Excretion: Excreted mainly in urine.

Half Life: Approximately 20-30 minutes, but effects on DNA last longer.

Contraindications

Hypersensitivity to decitabine or its components.

Precautions

Myelosuppression (cytopenias), infections, hepatic or renal impairment, pregnancy/lactation, use in combination with radiation or other myelosuppressive agents.

Adverse Reactions - Common

Myelosuppression (neutropenia, thrombocytopenia, anemia) (Very common)
Nausea (Common)
Fatigue (Common)
Fever (Common)

Adverse Reactions - Serious

Severe myelosuppression leading to bleeding or infection (Less common)
Severe allergic reactions or anaphylaxis (Rare)
Secondary malignancies (Very rare)

Drug-Drug Interactions

Other myelosuppressive agents, chemotherapy, ganciclovir, fluoroquinolones.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Baseline CBC, liver and renal function tests, watch for signs of infection or bleeding.

Diagnoses:

Risk for bleeding, Infection, Fatigue due to myelosuppression.

Implementation: Administer as prescribed, monitor blood counts frequently, manage side effects, prevent infections.

Evaluation: Assess blood counts regularly, monitor for adverse reactions, evaluate patient response to therapy.

Patient/Family Teaching

Report fever, chills, bleeding, or unusual bruising.
Use supportive care measures as advised (e.g., infection prevention).
Attend scheduled blood tests and visits.
Educate about the importance of adherence and reporting side effects.

Special Considerations

Black Box Warnings:

Myelosuppression can be severe and life-threatening.
Potential for secondary malignancies.

Genetic Factors: None specified.

Lab Test Interference: May cause transient changes in blood counts, requiring careful interpretation.

Overdose Management

Signs/Symptoms: Severe cytopenias, bleeding, infection.

Treatment: Supportive care including transfusions, antibiotics; no specific antidote.

Storage and Handling

Storage: Store refrigerated at 2-8°C.

Stability: Stable for 24 hours at room temperature; discard unused portions.