The management of common side effects of Azacitidine tablets should focus on the three major symptoms of nausea, vomiting, fatigue, and decreased blood cells. Effective control can be achieved through preventive medication, dose adjustment, and supportive treatment. The following will explain the symptom mechanism, clinical intervention, and monitoring points.

1. Nausea and vomiting management

(1) Mechanism of occurrence: Chemotherapy drugs directly stimulate the vomiting center of the medulla oblongata and the gastrointestinal mucosa.

(2) Preventive measures: Use 5-HT3 receptor antagonists (such as ondansetron) in combination with dexamethasone 30 minutes before administration.

(3) Emergency response: Add NK-1 inhibitor (aripipitan) or replace dopamine receptor blocker during explosive vomiting.

2 Weak coping strategies

(1) Graded management: Non pharmacological interventions (exercise therapy/sleep management) are recommended for levels 1-2 fatigue, and anemia/thyroid function assessments are required for levels 3 and above.

(2) Drug support: EPO treatment is considered for hemoglobin<80g/L, and short-term use of methylphenidate is recommended for refractory fatigue.

(3) Nutritional support: Daily calorie intake ≥ 25kcal/kg, protein 1.2-1.5g/kg to maintain negative nitrogen balance.

Prevention and control of blood cell reduction

(1) Monitoring frequency: Blood routine twice a week in the first treatment cycle, and must be checked before subsequent cycles.

(2) Intervention threshold: Neutrophils<0.5 × 10 ⁹/L activate G-CSF, platelets<20 × 10 ⁹/L transfuse platelets.

(3) Infection prevention and control: If fever occurs (body temperature ≥ 38 ℃), blood culture should be immediately performed and broad-spectrum antibiotics should be empirically used.

4. Treatment of other symptoms

(1) Diarrhea management: Use loperamide when defecating more than 4 times a day to maintain electrolyte balance.

(2) Skin reaction: Skin rash can be treated with topical corticosteroids, and Steven Johnson syndrome requires permanent discontinuation of medication.

(3) Hepatotoxicity: Discontinue administration of ALT>5 times ULN, reduce dosage by 25% after recovery.