Drug: Dacogen

Dacogen (decitabine) for Injection contains decitabine (5-aza-2'deoxycitidine), an analogue of the natural nucleoside 2'-deoxycytidine. Decitabine is a fine, white to almost white powder with the molecular formula of C8H12N4O4 and a molecular weight of 228.21. Its chemical name is 4-amino-1-(2-deoxy-β-D-erythro-pentofuranosyl)-1,3,5-triazin2(1H)-one and it has the following structural formula: Decitabine is slightly soluble in ethanol/water (50/50), methanol/water (50/50) and methanol; sparingly soluble in water and soluble in dimethylsulfoxide (DMSO). Dacogen (decitabine) for Injection is a white to almost white sterile lyophilized powder supplied in a clear colorless glass vial. Each 20 mL, single dose, glass vial contains 50 mg decitabine, 68 mg monobasic potassium phosphate (potassium dihydrogen phosphate) and 11.6 mg sodium hydroxide.

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Clinical Studies Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice. Most Commonly Occurring Adverse Reactions neutropenia, thrombocytopenia, anemia, fatigue, pyrexia, nausea, cough, petechiae, constipation, diarrhea, and hyperglycemia. Adverse Reactions Most Frequently ( ≥ 1%) Resulting in Clinical Intervention in the Phase 3 Trial in the Dacogen (decitabine injection) Arm
  • Discontinuation: thrombocytopenia, neutropenia, pneumonia, Mycobacterium avium complex infection, cardio-respiratory arrest, increased blood bilirubin, intracranial hemorrhage, abnormal liver function tests.
  • Dose Delayed: neutropenia, pulmonary edema, atrial fibrillation, central line infection, febrile neutropenia.
  • Dose Reduced: neutropenia, thrombocytopenia, anemia, lethargy, edema, tachycardia, depression, pharyngitis.
Discussion of Adverse Reactions Information Dacogen (decitabine injection) was studied in 3 single-arm studies (N = 66, N = 98, N = 99) and 1 controlled supportive care study (N = 83 Dacogen (decitabine injection) , N = 81 supportive care ). The data described below reflect exposure to Dacogen (decitabine injection) in 83 patients in the MDS trial. In the trial, patients received 15 mg/m² intravenously every 8 hours for 3 days every 6 weeks. The median number of Dacogen (decitabine injection) cycles was 3 (range 0 to 9). Table 1 presents all adverse events regardless of causality occurring in at least 5% of patients in the Dacogen (decitabine injection) group and at a rate greater than supportive care. Table 1 : Adverse Events Reported in ≥ 5% of Patients in the Dacogen (decitabine injection) Group and at a Rate Greater than Supportive Care in Phase 3 MDS Trial
  Dacogen
N = 83 (%) Supportive Care
N = 81 (%) Blood and lymphatic system disorders   Neutropenia 75 (90) 58 (72)   Thrombocytopenia 74 (89) 64 (79)   Anemia NOS 68 (82) 60 (74)   Febrile neutropenia 24 (29) 5 (6)   Leukopenia NOS 23 (28) 11 (14)   Lymphadenopathy 10 (12) 6 (7)   Thrombocythemia 4 (5) 1 (1) Cardiac disorders   Pulmonary edema NOS 5 (6) 0 (0) Eye disorders   Vision blurred 5 (6) 0 (0) Gastrointestinal disorders   Nausea 35 (42) 13 (16)   Constipation 29 (35) 11 (14)   Diarrhea NOS 28 (34) 13 (16)   Vomiting NOS 21 (25) 7 (9)   Abdominal pain NOS 12 (14) 5 (6)   Oral mucosal petechiae 11 (13) 4 (5)   Stomatitis 10 (12) 5 (6)   Dyspepsia 10 (12) 1 (1)   Ascites 8 (10) 2 (2)   Gingival bleeding 7 (8) 5 (6)   Hemorrhoids 7 (8) 3 (4)   Loose stools 6 (7) 3 (4)   Tongue ulceration 6 (7) 2 (2)   Dysphagia 5 (6) 2 (2)   Oral soft tissue disorder NOS 5 (6) 1 (1)   Lip ulceration 4 (5) 3 (4)   Abdominal distension 4 (5) 1 (1)   Abdominal pain upper 4 (5) 1 (1)   Gastro-esophageal reflux disease 4 (5) 0 (0)   Glossodynia 4 (5) 0 (0) General disorders and administrative site disorders   Pyrexia 44 (53) 23 (28)   Edema peripheral 21 (25) 13 (16)   Rigors 18 (22) 14 (17)   Edema NOS 15 (18) 5 (6)   Pain NOS 11 (13) 5 (6)   Lethargy 10 (12) 3 (4)   Tenderness NOS 9 (11) 0 (0)   Fall 7 (8) 3 (4)   Chest discomfort 6 (7) 3 (4)   Intermittent pyrexia 5 (6) 3 (4)   Malaise 4 (5) 1 (1)  Crepitations NOS 4 (5) 1 (1)   Catheter site erythema 4 (5) 1 (1)   Catheter site pain 4 (5) 0 (0)   Injection site swelling 4 (5) 0 (0) Hepatobiliary Disorders   Hyperbilirubinemia 12 (14) 4 (5) Infections and Infestations   Pneumonia NOS 18 (22) 11 (14)   Cellulitis 10 (12) 6 (7)   Candidal infection NOS 8 (10) 1 (1)   Catheter related infection 7 (8) 0 (0)   Urinary tract infection NOS 6 (7) 1 (1)   Staphylococcal infection 6 (7) 0 (0)   Oral candidiasis 5 (6) 2 (2)   Sinusitis NOS 4 (5) 2 (2)   Bacteremia 4 (5) 0 (0) Injury, poisoning and procedural complications   Transfusion reaction 6 (7) 3 (4)   Abrasion NOS 4 (5) 1 (1) Investigations   Cardiac murmur NOS 13 (16) 9 (11)   Blood alkaline phosphatase 9 (11) 7 (9) NOS increased   Aspartate aminotransferase increased 8 (10) 7 (9)   Blood urea increased 8 (10) 1 (1)   Blood lactate dehydrogenase increased 7 (8) 5 (6)   Blood albumin decreased 6 (7) 0 (0)   Blood bicarbonate increased 5 (6) 1 (1)   Blood chloride decreased 5 (6) 1 (1)   Protein total decreased 4 (5) 3 (4)   Blood bicarbonate decreased 4 (5) 1 (1)   Blood bilirubin decreased 4 (5) 1 (1) Metabolism and nutrition disorders   Hyperglycemia NOS 27 (33) 16 (20)   Hypoalbuminemia 20 (24) 14 (17)   Hypomagnesemia 20 (24) 6 (7)   Hypokalemia 18 (22) 10 (12)   Hyponatremia 16 (19) 13 (16)   Appetite decreased NOS 13 (16) 12 (15)   Anorexia 13 (16) 8 (10)   Hyperkalemia 11 (13) 3 (4)   Dehydration 5 (6) 4 (5) Musculoskeletal and connective tissue disorders   Arthralgia 17 (20) 8 (10)   Pain in limb 16 (19) 8 (10)   Back pain 14 (17) 5 (6)   Chest wall pain 6 (7) 1 (1)   Musculoskeletal discomfort 5 (6) 0 (0)   Myalgia 4 (5) 1 (1) Nervous system disorders   Headache 23 (28) 11 (14)   Dizziness 15 (18) 10 (12)   Hypoesthesia 9 (11) 1 (1) Psychiatric disorders   Insomnia 23 (28) 11 (14)   Confusional state 10 (12) 3 (4)   Anxiety 9 (11) 8 (10) Renal and urinary disorders   Dysuria 5 (6) 3 (4)   Urinary frequency 4 (5) 1 (1) Respiratory, thoracic and Mediastinal disorders   Cough 33 (40) 25 (31)   Pharyngitis 13 (16) 6 (7)   Crackles lung 12 (14) 1 (1)   Breath sounds decreased 8 (10) 7 (9)   Hypoxia 8 (10) 4 (5)   Rales 7 (8) 2 (2)   Postnasal drip 4 (5) 2 (2) Skin and subcutaneous tissue disorders   Ecchymosis 18 (22) 12 (15)   Rash NOS 16 (19) 7 (9)   Erythema 12 (14) 5 (6)   Skin lesion NOS 9 (11) 3 (4)   Pruritis 9 (11) 2 (2)   Alopecia 7 (8) 1 (1)   Urticaria NOS 5 (6) 1 (1)   Swelling face 5 (6) 0 (0) Vascular disorders   Petechiae 32 (39) 13 (16)   Pallor 19 (23) 10 (12)   Hypotension NOS 5 (6) 4 (5)   Hematoma NOS 4 (5) 3 (4) Discussion of Clinically Important Adverse Reactions In the controlled trial using Dacogen (decitabine injection) dosed at 15 mg/m², administered by continuous intravenous infusion over 3 hours repeated every 8 hours for 3 days, the highest incidence of Grade 3 or Grade 4 adverse events in the Dacogen (decitabine injection) arm were neutropenia (87%), thrombocytopenia (85%), febrile neutropenia (23%) and leukopenia (22%). Bone marrow suppression was the most frequent cause of dose reduction, delay and discontinuation. Six patients had fatal events associated with their underlying disease and myelosuppression (anemia, neutropenia, and thrombocytopenia) that were considered at least possibly related to drug treatment [See WARNINGS AND PRECAUTIONS]. Of the 83 Dacogen (decitabine injection) -treated patients, 8 permanently discontinued therapy for adverse events; compared to 1 of 81 patients in the supportive care arm. In a single-arm study (N=99) Dacogen (decitabine injection) was dosed at 20 mg/m² intravenous, infused over one hour daily for 5 consecutive days of a 4 week cycle. Table 2 presents all adverse events regardless of causality occurring in at least 5% of patients. Table 2 : Adverse Events Reported in ≥ 5% of Patients in a Single-arm Study*
  Dacogen
N = 99 (%) Blood and lymphatic system disorders   Anemia 31 (31% )   Febrile neutropenia 20 (20% )   Leukopenia 6 (6% )   Neutropenia 38 (38% )   Pancytopenia 5 (5% )   Thrombocythemia 5 (5% )   Thrombocytopenia 27 (27% ) Cardiac disorders   Cardiac failure congestive 5 (5% )   Tachycardia 8 (8% ) Ear and labyrinth disorders   Ear pain 6 (6% ) Gastrointestinal disorders   Abdominal pain 14 (14% )   Abdominal pain upper 6 (6% )   Constipation 30 (30% )   Diarrhea 28 (28% )   Dyspepsia 10 (10% )   Dysphagia 5 (5% )   Gastro-esophageal reflux disease 5 (5% )   Nausea 40 (40% )   Oral pain 5 (5% )   Stomatitis 11 (11% )   Toothache 6 (6% )   Vomiting 16 (16% ) General disorders and administration site conditions   Asthenia 15 (15% )   Chest pain 6 (6% )   Chills 16 (16% )   Fatigue 46 (46% )   Mucosal inflammation 9 (9% )   Edema 5 (5% )   Edema peripheral 27 (27% )   Pain 5 (5% )   Pyrexia 36 (36% ) Infections and infestations   Cellulitis 9 (9% )   Oral candidiasis 6 (6% )   Pneumonia 20 (20% )   Sinusitis 6 (6% )   Staphylococcal bacteremia 8 (8% )   Tooth abscess 5 (5% )   Upper respiratory tract infection 10 (10% )   Urinary tract infection 7 (7% ) Injury, poisoning and procedural complications   Contusion 9 (9% )   Investigations     Blood bilirubin increased 6 (6% )   Breath sounds abnormal 5 (5% )   Weight decreased 9 (9% ) Metabolism and nutrition disorders   Anorexia 23 (23% )   Decreased appetite 8 (8% )   Dehydration 8 (8% )   Hyperglycemia 6 (6% )   Hypokalemia 12 (12% )   Hypomagnesemia 5 (5% ) Musculoskeletal and connective tissue disorders   Arthralgia 17 (17% )   Back pain 18 (18% )   Bone pain 6 (6% )   Muscle spasms 7 (7% )   Muscular weakness 5 (5% )   Musculoskeletal pain 5 (5% )   Myalgia 9 (9% )   Pain in extremity 18 (18% ) Nervous system disorders   Dizziness 21 (21% )   Headache 23 (23% ) Psychiatric disorders   Anxiety 9 (9% )   Confusional state 8 (8% )   Depression 9 (9% )   Insomnia 14 (14% ) Respiratory, thoracic and mediastinal disorders   Cough 27 (27% )   Dyspnea 29 (29% )   Epistaxis 13 (13% )   Pharyngolaryngeal pain 8 (8% )   Pleural effusion 5 (5% )   Sinus congestion 5 (5% ) Skin and subcutaneous tissue disorders   Dry skin 8 (8% )   Ecchymosis 9 (9% )   Erythema 5 (5% )   Night sweats 5 (5% )   Petechiae 12 (12% )   Pruritus 9 (9% )   Rash 11 (11% )   Skin lesion 5 (5% ) Vascular disorders   Hypertension 6 (6% )   Hypotension 11 (11% ) * In this single arm study, investigators reported adverse events based on clinical signs and symptoms rather than predefined laboratory abnormalities. Thus not all laboratory abnormalities were recorded as adverse events. Discussion of Clinically Important Adverse Reactions In the single-arm study (N=99) when Dacogen (decitabine injection) was dosed at 20 mg/m² intravenous, infused over one hour daily for 5 consecutive days, the highest incidence of Grade 3 or Grade 4 adverse events were neutropenia (37%), thrombocytopenia (24%) and anemia (22%). Seventy-eight percent of patients had dose delays, the median duration of this delay was 7 days and the largest percentage of delays were due to hematologic toxicities. Hematologic toxicities and infections were the most frequent causes of dose delays and discontinuation. Eight patients had fatal events due to infection and/or bleeding (seven of which occurred in the clinical setting of myelosuppression) that were considered at least possibly related to drug treatment. Nineteen of 99 patients permanently discontinued therapy for adverse events. No overall difference in safety was detected between patients > 65 years of age and younger patients in these myelodysplasia trials. No significant gender differences in safety or efficacy were detected. Patients with renal or hepatic dysfunction were not studied. Insufficient numbers of non-white patients were available to draw conclusions in these clinical trials. Serious Adverse Events that occurred in patients receiving Dacogen (decitabine injection) regardless of causality, not previously reported in Tables 1 and 2 include:
  • Blood and Lymphatic System Disorders: myelosuppression, splenomegaly.
  • Cardiac Disorders: myocardial infarction, cardio-respiratory arrest, cardiomyopathy, atrial fibrillation, supraventricular tachycardia.
  • Gastrointestinal Disorders: gingival pain, upper gastrointestinal hemorrhage.
  • General Disorders and Administrative Site Conditions: chest pain, catheter site hemorrhage.
  • Hepatobiliary Disorders: cholecystitis.
  • Infections and Infestations: fungal infection, sepsis, bronchopulmonary aspergillosis, peridiverticular abscess, respiratory tract infection, pseudomonal lung infection, Mycobacterium avium complex infection.
  • Injury, Poisoning and Procedural Complications: post procedural pain, post procedural hemorrhage.
  • Nervous System Disorders: intracranial hemorrhage.
  • Psychiatric Disorders: mental status changes.
  • Renal and Urinary Disorders: renal failure, urethral hemorrhage.
  • Respiratory, Thoracic and Mediastinal Disorders: hemoptysis, lung infiltration, pulmonary embolism, respiratory arrest, pulmonary mass.
  • Allergic Reaction: Hypersensitivity (anaphylactic reaction) to Dacogen (decitabine injection) has been reported in a Phase 2 trial.
Post-marketing Experience The following adverse reactions have been identified during post-approval use of Dacogen (decitabine injection) . Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. Cases of Sweet's Syndrome (acute febrile neutrophilic dermatosis) have been reported. Read the Dacogen (decitabine injection) Side Effects Center for a complete guide to possible side effectsLearn More »

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There are two regimens for Dacogen (decitabine injection) administration. With either regimen it is recommended that patients be treated for a minimum of 4 cycles; however, a complete or partial response may take longer than 4 cycles. Complete blood counts and platelet counts should be performed as needed to monitor response and toxicity, but at a minimum, prior to each cycle. Liver chemistries and serum creatinine should be obtained prior to initiation of treatment. Treatment Regimen – Option 1 Dacogen (decitabine injection) is administered at a dose of 15 mg/m² by continuous intravenous infusion over 3 hours repeated every 8 hours for 3 days. This cycle should be repeated every 6 weeks. Patients may be premedicated with standard anti-emetic therapy. If hematologic recovery (ANC ≥ 1,000/μL and platelets ≥ 50,000/μL) from a previous Dacogen (decitabine injection) treatment cycle requires more than 6 weeks, then the next cycle of Dacogen (decitabine injection) therapy should be delayed and dosing temporarily reduced by following this algorithm:
  • Recovery requiring more than 6, but less than 8 weeks-Dacogen (decitabine injection) dosing to be delayed for up to 2 weeks and the dose temporarily reduced to 11 mg/m² every 8 hours (33 mg/m²/day, 99 mg/m²/cycle) upon restarting therapy.
  • Recovery requiring more than 8, but less than 10 weeks-Patient should be assessed for disease progression (by bone marrow aspirates); in the absence of progression, the Dacogen (decitabine injection) dose should be delayed up to 2 more weeks and the dose reduced to 11 mg/m² every 8 hours (33 mg/m²/day, 99 mg/m²/cycle) upon restarting therapy, then maintained or increased in subsequent cycles as clinically indicated.
Treatment Regimen – Option 2 Dacogen (decitabine injection) is administered at a dose of 20 mg/m² by continuous intravenous infusion over 1 hour repeated daily for 5 days. This cycle should be repeated every 4 weeks. Patients may be premedicated with standard anti-emetic therapy. If myelosuppression is present, subsequent treatment cycles of Dacogen (decitabine injection) should be delayed until there is hematologic recovery (ANC ≥ 1,000/μL platelets ≥ 50,000/μL ). Patients with Non-hematologic Toxicity Following the first cycle of Dacogen (decitabine injection) treatment, if any of the following non-hematologic toxicities are present, Dacogen (decitabine injection) treatment should not be restarted until the toxicity is resolved: 1) serum creatinine ≥ 2 mg/dL; 2) SGPT, total bilirubin ≥ 2 times ULN; 3) and active or uncontrolled infection. Instructions for Intravenous Administration Dacogen (decitabine injection) is a cytotoxic drug and caution should be exercised when handling and preparing Dacogen (decitabine injection) . Procedures for proper handling and disposal of antineoplastic drugs should be applied. Several guidances on this subject have been published.1-4 . Dacogen (decitabine injection) should be aseptically reconstituted with 10 mL of Sterile Water for Injection (USP); upon reconstitution, each mL contains approximately 5.0 mg of decitabine at pH 6.7-7.3. Immediately after reconstitution, the solution should be further diluted with 0.9% Sodium Chloride Injection, 5% Dextrose Injection, or Lactated Ringer's Injection to a final drug concentration of 0.1 - 1.0 mg/mL. Unless used within 15 minutes of reconstitution, the diluted solution must be prepared using cold (2°C - 8°C) infusion fluids and stored at 2°C - 8°C (36°F - 46°F) for up to a maximum of 7 hours until administration. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. Do not use if there is evidence of particulate matter or discoloration.

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Drug interaction studies with decitabine have not been conducted. In vitro studies in human liver microsomes suggest that decitabine is unlikely to inhibit or induce cytochrome P450 enzymes. In vitro metabolism studies have suggested that decitabine is not a substrate for human liver cytochrome P450 enzymes. As plasma protein binding of decitabine is negligible ( < 1%), interactions due to displacement of more highly protein bound drugs from plasma proteins are not expected.Read the Dacogen Drug Interactions Center for a complete guide to possible interactions Learn More »

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Dacogen (decitabine injection) is indicated for treatment of patients with myelodysplastic syndromes (MDS) including previously treated and untreated, de novo and secondary MDS of all French-American-British subtypes (refractory anemia, refractory anemia with ringed sideroblasts, refractory anemia with excess blasts, refractory anemia with excess blasts in transformation, and chronic myelomonocytic leukemia) and intermediate-1, intermediate-2, and high-risk International Prognostic Scoring System groups.

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None Last reviewed on RxList: 4/1/2010
This monograph has been modified to include the generic and brand name in many instances.

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There is no known antidote for overdosage with Dacogen (decitabine injection) . Higher doses are associated with increased myelosuppression including prolonged neutropenia and thrombocytopenia. Standard supportive measures should be taken in the event of an overdose.

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Dosage Forms And Strengths Dacogen (decitabine) for Injection is supplied as a sterile, lyophilized white to almost white powder, in a single-dose vial, packaged in cartons of 1 vial. Each vial contains 50 mg of decitabine. Storage And Handling NDC 62856-600-01, 50 mg single-dose vial individually packaged in a carton. Storage Store vials at 25°C (77°F); excursions permitted to 15-30°C (5986°F). REFERENCES 1. NIOSH Alert: Preventing occupational exposures to antineoplastic and other hazardous drugs in healthcare settings. 2004. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 2004-165. 2. OSHA Technical Manual, TED 1-0.15A, Section VI: Chapter 2. Controlling Occupational Exposure to Hazardous Drugs. OSHA, 1999. http://www.osha.gov/dts/osta/otm/otm_vi/otm_vi_2.html3. American Society of Health-System Pharmacists. ASHP Guidelines on Handling Hazardous Drugs: Am J Health-Syst Pharm. 2006;63:1172-1193. 4. Polovich M., White JM, Kelleher LO (eds). Chemotherapy and biotherapy guidelines and recommendations for practice (2nd ed.) 2005. Pittsburgh, PA: Oncology Nursing Society. Manufactured by Pharmachemie B.V. Haarlem, The Netherlands. Manufactured for Eisai Inc., Woodcliff Lake, NJ 07677. Revised: 03/2010Last reviewed on RxList: 4/1/2010
This monograph has been modified to include the generic and brand name in many instances.

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Neutropenia and Thrombocytopenia Treatment with Dacogen (decitabine injection) is associated with neutropenia and thrombocytopenia. Complete blood and platelet counts should be performed as needed to monitor response and toxicity, but at a minimum, prior to each dosing cycle. After administration of the recommended dosage for the first cycle, treatment for subsequent cycles should be adjusted [see DOSAGE AND ADMINISTRATION]. Clinicians should consider the need for early institution of growth factors and/or antimicrobial agents for the prevention or treatment of infections in patients with MDS. Myelosuppression and worsening neutropenia may occur more frequently in the first or second treatment cycles, and may not necessarily indicate progression of underlying MDS. Use in Pregnancy Dacogen (decitabine injection) can cause fetal harm when administered to a pregnant woman. Based on its mechanism of action, Dacogen (decitabine injection) is expected to result in adverse reproductive effects. In preclinical studies in mice and rats, decitabine was teratogenic, fetotoxic, and embryotoxic. There are no adequate and well-controlled studies of Dacogen (decitabine injection) in pregnant women. If this drug is used during pregnancy, or if a patient becomes pregnant while receiving this drug, the patient should be apprised of the potential hazard to the fetus. Women of childbearing potential should be advised to avoid becoming pregnant while taking Dacogen (decitabine injection) [see Use in Specific Populations] Use in Women of Childbearing Potential Women of childbearing potential should be advised to avoid becoming pregnant while receiving Dacogen (decitabine injection) and for 1 month following completion of treatment. Women of childbearing potential should be counseled to use effective contraception during this time [see Use in Specific Populations]. Based on its mechanism of action, Dacogen (decitabine injection) can cause fetal harm if used during pregnancy. Use in Men Men should be advised not to father a child while receiving treatment with Dacogen (decitabine injection) , and for 2 months following completion of treatment [see Nonclinical Toxicology]. Men with female partners of childbearing potential should use effective contraception during this time. Based on its mechanism of action, Dacogen (decitabine injection) alters DNA synthesis and can cause fetal harm. Nonclinical Toxicology Carcinogenesis, Mutagenesis and Impairment of Fertility Carcinogenicity studies with decitabine have not been conducted. The mutagenic potential of decitabine was tested in several in vitro and in vivo systems. Decitabine increased mutation frequency in L5178Y mouse lymphoma cells, and mutations were produced in an Escherichia coli lac-I transgene in colonic DNA of decitabine-treated mice. Decitabine caused chromosomal rearrangements in larvae of fruit flies. The effect of decitabine on postnatal development and reproductive capacity was evaluated in mice administered a single 3 mg/m² IP injection (approximately 7% the recommended daily clinical dose) on day 10 of gestation. Body weights of males and females exposed in utero to decitabine were significantly reduced relative to controls at all postnatal time points. No consistent effect on fertility was seen when female mice exposed in utero were mated to untreated males. Untreated females mated to males exposed in utero showed decreased fertility at 3 and 5 months of age (36% and 0% pregnancy rate, respectively). In male mice given IP injections of 0.15, 0.3 or 0.45 mg/m² decitabine (approximately 0.3% to 1% the recommended clinical dose) 3 times a week for 7 weeks, decitabine did not affect survival, body weight gain or hematological measures (hemoglobin and WBC counts). Testes weights were reduced, abnormal histology was observed and significant decreases in sperm number were found at doses ≥ 0.3 mg/m². In females mated to males dosed with ≥ 0.3 mg/m² decitabine, pregnancy rate was reduced and preimplantation loss was significantly increased. Use In Specific Populations Pregnancy Pregnancy Category D [see WARNINGS AND PRECAUTIONS] Dacogen (decitabine injection) can cause fetal harm when administered to a pregnant woman. There are no adequate and well-controlled studies of Dacogen in pregnant women. The developmental toxicity of decitabine was examined in mice exposed to single IP (intraperitoneal) injections (0, 0.9 and 3.0 mg/m², approximately 2% and 7% of the recommended daily clinical dose, respectively) over gestation days 8, 9, 10 or 11. No maternal toxicity was observed but reduced fetal survival was observed after treatment at 3 mg/m² and decreased fetal weight was observed at both dose levels. The 3 mg/m² dose elicited characteristic fetal defects for each treatment day, including supernumerary ribs (both dose levels), fused vertebrae and ribs, cleft palate, vertebral defects, hind-limb defects and digital defects of fore- and hind-limbs. In rats given a single IP injection of 2.4, 3.6 or 6 mg/m² (approximately 5, 8, or 13% the daily recommended clinical dose, respectively) on gestation days 9-12, no maternal toxicity was observed. No live fetuses were seen at any dose when decitabine was injected on gestation day 9. A significant decrease in fetal survival and reduced fetal weight at doses greater than 3.6 mg/m² was seen when decitabine was given on gestation day 10. Increased incidences of vertebral and rib anomalies were seen at all dose levels, and induction of exophthalmia, exencephaly, and cleft palate were observed at 6.0 mg/m². Increased incidence of foredigit defects was seen in fetuses at doses greater than 3.6 mg/m². Reduced size and ossification of long bones of the fore-limb and hind-limb were noted at 6.0 mg/m². If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to the fetus. Women of child bearing potential should be advised to avoid becoming pregnant while taking Dacogen. Nursing Mothers It is not known whether decitabine or its metabolites are excreted in human milk. Because many drugs are excreted in human milk, and because of the potential for serious adverse reactions from Dacogen (decitabine injection) in nursing infants, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother. Pediatric Use The safety and effectiveness of Dacogen (decitabine injection) in pediatric patients have not been established. Geriatric Use Of the total number of patients exposed to Dacogen (decitabine injection) in the controlled clinical trial, 61 of 83 patients were age 65 and over, while 21 of 83 patients were age 75 and over. No overall differences in safety or effectiveness were observed between these subjects and younger subjects, and other reported clinical experience has not identified differences in responses between the elderly and younger patients, but greater sensitivity of some older individuals cannot be ruled out. Renal Impairment There are no data on the use of Dacogen (decitabine injection) in patients with renal dysfunction; therefore, Dacogen (decitabine injection) should be used with caution in these patients. Hepatic Impairment There are no data on the use of Dacogen (decitabine injection) in patients with hepatic dysfunction; therefore, Dacogen (decitabine injection) should be used with caution in these patients.Last reviewed on RxList: 4/1/2010
This monograph has been modified to include the generic and brand name in many instances.

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