Decitabine (intravenous)

Delivered intravenously, Decitabine is used to treat acute myeloid leukemia, as well as myelodysplastic syndromes.

Overview

Classified as a chemotherapy drug, Decitabine may be given to patients with acute myeloid leukemia, if they are unsuitable candidates for other treatments. Patients with myelodysplastic syndromes can also be treated with Decitabine. These syndromes occur when patient's bone marrow is unable to produce normal blood cells. Myelodysplastic syndromes tend to result in blood cells which are misshapen and/or a lack of healthy blood cells in the patient's body.

As a nucleic acid synthesis inhibitor, Decitabine affects the way cells replicate and survive. In order to replicate, cells must first divide. Once this happens, Decitabine is incorporated into the cell's DNA strand. When the cell then tries to replicate itself, the Decitabine prevents it from doing so successfully.

Normally, cancer cells divide and replicate at a greater rate than standard cells and this is one of the reasons cancer can spread quickly in the patient's body. As Decitabine affects cells which have already divided, it is particularly effective in attacking the formation of additional cancer cells in the body. Once the Decitabine has incorporated itself into the cancer cell, it prevents it from replicating and allows the existing cell to be destroyed.

Similarly, Decitabine kills abnormal cells in the bone marrow and prevents misshapen or unhealthy cells from multiplying. This helps the bone marrow to produce healthy cells and, therefore, is a suitable treatment for patients with myelodysplastic syndromes.

Conditions Treated

Type of Medicine

  • Chemotherapy drug
  • Hypomethylation agent
  • Cytidine analog

Side Effects

In some cases, patients may experience side-effects when they are treated with Decitabine or following treatment with Decitabine. If patients experience the following adverse effects, they should seek medical help as soon as it is possible to do so:

  • Tarry, black stools
  • Swelling at injection site
  • Bladder pain
  • Stuffy nose
  • Bleeding after defecation
  • Blue fingernails or lips
  • Bleeding gums
  • Blood in stools or urine
  • Cloudy or bloody urine
  • Blurred vision
  • Pain in chest
  • Body pain or aches
  • Chills
  • Decrease in urination
  • Coma
  • Burning or painful urination
  • Congestion
  • Difficulty urinating
  • Convulsions
  • Fast, difficult or noisy breathing, sometimes with wheezing
  • Cough
  • Lightheadedness, dizziness or faintness when getting up from sitting or lying down
  • Coughing that sometimes produces a pink frothy sputum
  • Drowsiness
  • Dry, flushed skin
  • 'Dry mouth
  • Increased frequency of urination
  • Dryness of throat
  • Fruity breath odor
  • Fever
  • Irregular or fast heartbeat
  • Diarrhea
  • Facial swelling
  • Fever
  • Collection of blood under the skin
  • Headache
  • Feeling unusually cold
  • Welts or hives
  • Hoarseness
  • Pain in side or lower back
  • Increased appetite
  • Lightheadedness
  • Increased sweating
    Tenderness, redness, pain, itching or warmth on the skin
  • Increased thirst
  • Mood or mental changes
  • 'Increased urination
  • Loss of appetite
  • Muscle cramps or pain
  • Nausea and/or vomiting
  • Muscle twitching or spasms
  • Nervousness
  • Pale skin
  • Tingling or numbness in feet, hands or lips
  • Red, pinpoint spots on the skin
  • Runny nose
  • Pain or redness at the catheter site
  • Seizures
  • Trembling
  • Shivering
  • Unusual bruising or bleeding
  • Trouble swallowing
  • Shortness of breath
  • Rash on the skin
  • Small bubbling, rattling or clicking sounds in lung when listening with a stethoscope
  • Chest tightness
  • Small purple or red spots on lips, skin or in mouth
  • Tender, painful or swollen lymph glands in armpit, groin or neck
  • Sneezing
  • Swelling of hands, ankles, lower legs, feet and/or face
  • Sore tongue or mouth
  • Sunken eyes
  • Unexplained weight loss
  • Sore throat
  • White spots, ulcers or sores in mouth or on lips
  • Trouble breathing with exertion
  • Stomach bloating and/or pain
  • Uncomfortable swelling around the anus
  • Changes to voice
  • Unusual weakness or tiredness
  • Problems with hearing or vision
  • Heaviness or weakness of legs
  • Wheezing
  • Yellow skin or eyes
  • Warmth, burning and/or pain in toes, legs and/or fingers
  • White patches on tongue and/or in mouth
  • Deep and/or dark purple bruising
  • Wrinkled skin
  • Tenderness or pain in cheekbones and/or eyes
  • Skin burning or scrapes

In addition to these adverse effects, patients may experience a range of other side-effects after receiving treatment with Decitabine. These may include:

  • Sour or acid stomach
  • Swollen joints
  • Anxiety
  • Pain in back
  • Belching
  • Pressure in stomach
  • Bumps on the skin
  • Postnasal drip
  • Itching, crawling, burning, prickling, numbness, tingling or œpins and needles feelings
  • Constipation
  • Chest discomfort
  • Difficulty when swallowing
  • Pain in tongue
  • Falls
  • Muscle aches
  • Thinning of the hair or hair loss
  • Indigestion
  • General feeling of illness or discomfort
  • Heartburn
  • Loose stools
  • Unusual dullness or drowsiness
  • Muscle stiffness
  • Feelings of sluggishness
  • Pain in legs or arms
  • Difficulty moving
  • Joint pain
  • Sleeplessness
  • Inflammation or swelling of the mouth
  • Inability to sleep
  • Stomach upset or discomfort

In many cases, patients who experience these side-effects will only have fairly mild symptoms. Often, they disappear fairly quickly after Decitabine has been administered. However, if patients experience any severe side-effects or if side-effects are prolonged or concerning, they should seek medical help.

Often, patients can be given additional medications to help treat side-effects. Nausea and vomiting are not uncommon side-effects when patients are treated with chemotherapy drugs, for example, and an antiemetic is often prescribed to help reduce these adverse effects.

Furthermore, if patients experience any adverse effects which are not listed above, they should seek medical advice.

Dosage

As Decitabine is delivered intravenously, patients will receive this medication in a clinical setting. The medication will be administered into a vein and monitored by a doctor or an alternative healthcare practitioner.

Available in various strengths, the amount of Decitabine given to each patient will depend on their condition, as well as their age, weight and medical history. If patients have received treatment with high doses of Decitabine within the last six weeks, for example, their dose may be lowered.

For patients with myelodysplastic syndromes, Decitabine at a strength of 50mg is often used and a typical dose may be 15mg of medication per square meter of body mass area, delivered intravenously over a period of 3 hours. Often, this process will repeated every 8 hours, over a period of 3 days and subsequent cycles will be administered every 6 weeks.

Alternatively, patients may be given 20mg of Decitabine per meter of body mass area intravenously over a period of 1 hour. This is usually repeated daily for a period of 5 days, with the cycle being repeated every 4 weeks.

In most cases, four cycles of treatment are recommended but this may be increased if the patient requires additional therapy.

Although this is indicative of a standard treatment regime, doctors and oncologists will prescribe Decitabine in accordance with the patient's specific needs. When treating myelodysplastic syndromes and/or acute myeloid leukemia, the strength and dose of Decitabine will vary, depending on the exact treatment required by the patient.

Warnings

In some instances, medications can interact with one another. Patients should inform their physician if they are taking any other substances, including prescribed medications, over-the-counter medicines, vitamins and/or supplements. Patients should also seek medical advice before taking any other medicines, supplements or vitamins once they are receiving treatment with Decitabine.

Before patients are treated with Decitabine, any existing medical conditions should be taken into account. Liver and/or kidney disease may prevent Decitabine from being used, for example, as the medicine could cause these conditions to worsen.

Physicians will assess any additional conditions before determining whether Decitabine is an appropriate form of treatment for the patient.

Decitabine presents a risk to an unborn fetus if it is administered due to a pregnant patient. Although pregnant patients should not be treated with this medications, doctors may propose treatment with Decitabine if the patient is in a life-threatening condition. The potential risks of using Decitabine when pregnant should be explained to the patient and thoroughly discussed before treatment begins.

If male patients impregnate their sexual partner whilst receiving treatment with Decitabine, it may cause the unborn fetus to develop birth defects. Men should not, therefore, father a child whilst using Decitabine or for at least two months after their treatment has finished.

Whilst undergoing treatment with Decitabine, both male and female patients should use a reliable form of birth control. If patients become pregnant or if male patients impregnate a sexual partner whilst receiving treatment with Decitabine, they should seek medical advice straight away.

It is not yet known if Decitabine can be passed on to an infant via breastfeeding. However, patients who are undergoing treatment with Decitabine are typically advised not to breastfeed due to the possible risks to the infant. Patients should discuss this with their physician before receiving treatment with Decitabine and/or breastfeeding.

When Decitabine is administered to the patients, it can lower the platelet count in their blood and lower the amount of white blood cells in their system. Due to this, patients may have an increased risk of contracting an infection. Patients should aim to avoid anyone who is ill whilst they are undergoing treatment. If patients suspect they are becoming unwell whilst receiving treatment with Decitabine, they should seek medical help straight away.

Decitabine can also affect the way the patient's blood clots. Due to this, patients may experience more bleeding than usual if they suffer a cut or laceration. If patients experience unusual bruising and/or bleeding, blood in their stools or urine, red pinpoint spots on their skin or black, tarry stools they should contact their doctor immediately.

Patients may be advised to avoid crowds, busy areas and contact sports as they are more likely to contract illnesses and/or experience bumps and bruising in these environments.

If patients consult any medical professional, including their dentist, whilst receiving treatment, they should inform them that they are being treated with Decitabine.

Patients should notify their physician if they suffer from any allergies, before they begin treatment. If patients begin to experience an allergic reaction to Decitabine, it should be treated as a medical emergency and assistance should be sought immediately. Allergic reactions are often characterized by wheezing, itching, skin rashes, trouble breathing, difficulty swallowing and/or swelling of the lips, throat, mouth or face.

Storage

Generally, Decitabine is supplied in powder form and is available in single dose vials. Before administering the drug, healthcare practitioners will add sterile water to create a solution which can be injected into the patient's vein.

Typically, Decitabine powder should be stored in vials at a temperature of approximately 25°C (77°F). However, temperatures ranging from 15-30°C (59-86°F) may be deemed acceptable.

As Decitabine is delivered in a hospital or clinical setting, patients will not be expected to store, prepare or administer the medication themselves.

Summary

Although Decitabine is associated with some side-effects, these are often tolerated due to the effectiveness of the medication. When treating patients with acute myeloid leukemia or myelodysplastic syndromes, it's vital that abnormal cells are prevented from replicating and removed from the body. In addition to this, patients may require medical assistance to increase the production of healthy cells in their body.

Decitabine prevents abnormal cells, including cancer cells, from replicating and can, therefore, halt the disease. Once existing cancer cells are also destroyed, the patient may enter a state of remission and treatment can be suspended or stopped.

Whilst receiving treatment, patients will need to be monitored carefully but, if successful, treatment with Decitabine can help to treat myelodysplastic syndromes and acute myeloid leukemia.