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Hypomethylating agent (specialist)

Decitabine

Brand names: Dacogen

Decitabine is a hypomethylating cytotoxic agent (a cytidine analogue) used in the treatment of acute myeloid leukaemia, particularly in older adults not suitable for intensive chemotherapy.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

After incorporation into DNA it inhibits DNA methyltransferase, causing hypomethylation that can restore expression of silenced tumour suppressor genes, alongside direct cytotoxicity to abnormal haematopoietic cells.

Prescribing in practice

  • Causes severe and prolonged myelosuppression with high risk of neutropenic infection and bleeding, which is the dominant safety concern.
  • Treatment is given in repeated cycles and requires blood count recovery between cycles.
  • A specialist agent administered only under haemato-oncology supervision per the SPC.

Monitoring

Monitor full blood count before and during each cycle and remain vigilant for infection and bleeding.

Counselling the patient

  • Report fever, sore throat, bruising or bleeding promptly as blood counts can fall significantly.
  • Treatment is delivered as repeated cycles in a specialist setting.
  • Effective contraception is required during treatment as the drug can harm a pregnancy.

Evidence & guidelines

Its use in acute myeloid leukaemia in older patients is supported by trial evidence and the SPC.

Reference: NICE TA218; NICE TA399; BSH; ESMO; SmPC; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

Pathways