Azacitidine tablets, as anti-tumor drugs, should focus on the three core adverse reactions of bone marrow suppression, infection risk, and liver toxicity. The following provides detailed explanations on monitoring points, clinical interventions, and management of special populations to help ensure safe medication.

1. Management of bone marrow suppression

(1) Mechanism of occurrence: Azacitidine can cause bone marrow suppression reactions such as thrombocytopenia, neutropenia, and anemia.

(2) Monitoring requirements: Complete blood count (CBC) should be measured every 2 weeks for the first 3 months before treatment, and then once a month or adjusted according to clinical needs.

(3) Intervention measures: If there is grade 3 or above bone marrow suppression, the dosage should be reduced or suspended. If there is severe bleeding or infection, the medication should be permanently discontinued.

2. Prevention and control of infection risks

(1) High risk factors: Neutropenia increases the risk of bacterial, fungal, and viral infections, especially opportunistic infections.

(2) Preventive measures: During treatment, avoid contact with infectious sources. If fever occurs (body temperature ≥ 38 ℃), seek medical attention immediately for infection screening.

(3) Special treatment: When the absolute value of neutrophils is less than 0.5 × 10 ⁹/L, prophylactic use of antibiotics or G-CSF support should be considered.

3 Liver toxicity monitoring

(1) Clinical manifestations: Elevated transaminase levels, jaundice, or liver failure may occur, with a higher risk in patients with cirrhosis.

(2) Testing frequency: ALT/AST/bilirubin should be tested before treatment and each cycle, and those with abnormalities should be rechecked weekly until recovery.

(3) Dose adjustment: When ALT/AST>5 times ULN or bilirubin>3 times ULN, administration should be suspended and reduced after recovery.

4. Medication for special populations

(1) Liver dysfunction: Patients with moderate to severe liver damage should use it with caution, reduce the initial dose by 50%, and strengthen liver function monitoring.

(2) Renal insufficiency: No dose adjustment is required, but data on end-stage renal disease patients is limited, and close monitoring of toxic reactions is recommended.

(3) Elderly patients: Those aged 65 and above are more prone to bone marrow suppression and require individualized dose adjustment and strengthened supportive treatment.

5 Other precautions

(1) Embryotoxicity: Women with reproductive potential should take effective contraceptive measures and avoid pregnancy during treatment and for 3 months after discontinuation of medication.

(2) Drug interactions: Combination with hepatic enzyme inducers may reduce efficacy, while combination with bone marrow inhibitors increases toxicity risk.

(3) Medication specification: The whole tablet should not be broken open when swallowed. If vomiting occurs, the full dose should be taken to avoid co administration with antacids.