Oncology Drug Reference Sheet: Decitabine and Cedazuridine

March 30, 2021 by Kristine B. LeFebvre MSN, RN, AOCN®

In July 2020, the U.S. Food and Drug Administration approved decitabine and cedazuridine (Inqovi®) tablets for the treatment of adults with myelodysplastic syndromes (MDS).


Oral formulation of the antimetabolite decitabine combined with an inhibitor of the enzyme that degrades decitabine in the gastrointestinal tract

Mechanism of Action

Decitabine is a nucleoside metabolic inhibitor that inhibits the methylation of DNA that causes cellular differentiation and leads to cell death. Decitabine is available as an injectable product as a single agent. The oral combination product includes a cedazuridine, a substance that blocks the enzyme cytidine deaminase that breaks down decitabine in the gastrointestinal tract. The combination of this cedazuridine increases the exposure of decitabine when administered orally without substantial degradation in the gut and liver.


Treatment of adult patients with previously treated and untreated MDS


One tablet (decitabine 35 mg and cedazuridine 100 mg) orally daily for five days each 28 days


Give by mouth on an empty stomach for five days on days 1–5 of a 28-day regimen at the same time each day. Tablets should be taken whole, not cut or crushed. Do not eat food for two hours before or after each dose.

Adverse Reactions

Severe (grades 3 and 4) myelosuppression has been reported. Adverse reactions in more than 20% of patients include fatigue, constipation, hemorrhage, myalgia, mucositis, arthralgia, nausea, dyspnea, diarrhea, rash, dizziness, febrile neutropenia, edema, headache, cough, decreased appetite, upper respiratory tract infection, pneumonia, and increased transaminase levels.

Nursing Considerations

Patient Education

Gero-Oncology Considerations

No change in effectiveness has been found between patients older than 65 years and younger patients.

Safe Handling

Use hazardous drug precautions.

Patient Assistance Program


Oral Chemotherapy Education Sheet


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