Azacitidine: An Overview of This Blood Cancer Drug

Woman taking Onureg pill

Azacitidine (Vidaza, Onureg) is a chemotherapy medication used to treat different types of blood cancers. The Vidaza brand is commonly given as an injection under the skin (subcutaneous), but it can also be given as an injection through the veins (intravenous or IV). Onureg is a brand of azacitidine that’s available as a tablet taken by mouth. 

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How Does Azacitidine Work?

Azacitidine is a demethylating agent and belongs to the class of drugs called antimetabolites. DNA methylation works by regulating gene expression in cells and promotes the growth and development of cells. Azacitidine prevents and interferes with the methylation of DNA. This activity inhibits the uncontrolled growth of cancer cells.

What Is Azacitidine Used To Treat?

Vidaza is used to treat a group of blood problems called myelodysplastic syndromes. Myelodysplastic syndromes are a group of blood disorders in which immature blood cells in the bone marrow can’t grow into healthy blood cells. 

Onureg is used to treat acute myeloid leukemia (AML) in people with first complete remission or incomplete blood count recovery. Acute myeloid leukemia or myeloid leukemia is a type of bone marrow cancer that develops in the platelets, red blood cells (RBCs), and WBCs-producing areas (blood-forming cells) of the bone marrow.

Onureg and Vidaza are not interchangeable with each other, meaning one brand can’t be substituted for another. 

Dose and Administration

Before taking azacitidine, your provider will likely have you take an antiemetic (a medication to prevent nausea/vomiting) about 30 minutes before your azacitidine.

Vidaza is given by a healthcare provider as an injection either into the veins (intravenous) or under the skin (subcutaneous). A treatment cycle consists of injections given once per day for 7 days. Then, subsequent treatment cycles occur every 4 weeks for a minimum of 4 to 6 treatment cycles, depending on your condition. Your provider will calculate your dose based on your body surface area.

Onureg is available as a tablet taken by mouth. It should be swallowed whole and never crushed or chewed. The recommended dose is 300 mg by mouth once per day for 2 weeks of a 4-week cycle. Onureg tablets can be taken with or without food, but if it’s hurting your stomach, taking it with food might help. If you vomit a dose, don’t take another dose the same day, just skip the dose and resume the normal schedule the next day. 

Your provider will likely have you continue taking azacitidine until your cancer is no longer responding to the medication or if you’re having too many side effects and aren’t tolerating the medication any longer.

Side Effects of Azacitidine

Azacitidine patient with fever

Common side effects of Vidaza include:

  • Low red blood cell count (anemia)
  • Low platelet count
  • Nausea
  • Fever
  • Low white blood cell count (neutropenia)
  • Injection-site reactions (e.g., redness, pain, bruising, itching, swelling)
  • Low appetite
  • Joint pain
  • Muscle pain
  • Headache
  • Dizziness
  • Shortness of breath

Common side effects of Onureg include:

  • Nausea
  • Vomiting
  • Diarrhea
  • Constipation
  • Stomach pain
  • Fatigue

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Rare or severe side effects of azacitidine may include:

  • Swelling of the face, fingers, lower legs, or feet
  • Coughing or vomiting of blood
  • Thickened bronchial secretions
  • Chest discomfort
  • Irregular heartbeat 
  • Liver problems
  • Kidney problems
  • Changes in the amount or color of urine 
  • Depression or anxiety 
  • Loss of consciousness.
  • Seizures
  • Numbness or tingling in the hands, lips, or feet.

Azacitidine should be avoided, or used cautiously if the benefit outweighs the risk, in patients with the following medical conditions because the medication can worsen these conditions:

  • Kidney and liver diseases
  • Low red blood cell, white blood cell, or platelet count
  • Advanced malignant hepatic tumors.
  • Allergy to mannitol or azacitidine.

Azacitidine should never be used in pregnant females due to the risk of severe and life-threatening harm to babies. Females of reproductive potential should use effective contraception (birth control) during and for at least 6 months after the last dose of azacitidine. Additionally, males receiving azacitidine with female partners of reproductive potential should use effective contraception during and for at least 3 months after the last dose of azacitidine.


The price of azacitidine depends on various factors, including:

  • Your disease and health condition
  • The type of pharmacy you visit
  • Dosage form and route of azacitidine you’ve been prescribed
  • The number of treatment cycles

On average, the cost of Vidaza for a 100 mg injection is $49 for one vial. The cost of an Onureg oral tablet is around $12,349 for seven 200 mg tablets.

This information is not a substitute for medical advice or treatment. Talk to your doctor or healthcare provider about your medical condition prior to starting any new treatment. AmeriPharma™ Specialty Care assumes no liability whatsoever for the information provided or for any diagnosis or treatment made as a result, nor is it responsible for the reliability of the content. AmeriPharma™ Specialty Care does not operate all the websites/organizations listed here, nor is it responsible for the availability or reliability of their content. These listings do not imply or constitute an endorsement, sponsorship, or recommendation by AmeriPharma™ Specialty Care. This webpage may contain references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with AmeriPharma™ Specialty Care.

Dr. Robert Chad Hakim, PharmD, was born and raised in Northridge, CA. He received his pharmacy degree from the University of Wisconsin-Madison School of Pharmacy. The most rewarding part of his job is taking initiative to advance clinical programs that maximize impact on patient care. He has a board certification in critical care (BCCCP), and his areas of expertise are critical care, drug information, general medicine, and cardiology. In his free time, he enjoys traveling. 

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