Onureg (azacitidine) is a prescription drug used to treat acute myeloid leukemia (AML) in certain cases. The drug comes as an oral tablet. It’s usually taken once daily for days 1–14 of each 28-day cycle.

Onureg is prescribed to treat AML in adults who had their first complete remission following intensive chemotherapy (traditional drugs prescribed to treat cancer). Onureg may be prescribed even if blood cell counts haven’t recovered after this remission.

Note: Your doctor will only prescribe Onureg if you can’t continue treatment with an intensive curative therapy for AML. This type of treatment includes both high dose chemotherapy and a stem cell transplant.

The active ingredient in Onureg is azacitidine. (An active ingredient is what makes a drug work.) Onureg belongs to a group of drugs called nucleoside metabolic inhibitors.

This article describes the dosage of Onureg, as well as its strengths and how to take it. To learn more about Onureg, see this in-depth article.

This section describes the usual dosage of Onureg.

What is Onureg’s form?

Onureg comes as a tablet you swallow.

What strengths does Onureg come in?

Onureg comes in two strengths: 200 milligrams (mg) and 300 mg. It’s available in bottles containing 14 tablets and blister packs containing 7 tablets.

What are the usual dosages of Onureg?

The information below describes the most commonly prescribed or recommended dosage of Onureg. Your doctor will likely start by prescribing the recommended dosage. Be sure to take the dosage they prescribe for you. They’ll determine the best dosage to fit your needs and may adjust it if you experience certain side effects.

Dosage for AML

Onureg’s dosing schedule follows a 28-day cycle. The usual dosage for adults with AML is 300 mg swallowed once daily for days 1–14 of each 28-day cycle.

Your doctor will order a complete blood count (CBC) every other week during your first two cycles of Onureg treatment. If your blood cell counts are too low, including if you have myelosuppression, your doctor may have you temporarily stop Onureg. This is to allow your blood counts to recover.

After the first two cycles, your doctor will do CBCs before the start of each cycle (once per month). However, in certain situations, they may check your blood cell counts more often, such as every other week for another two cycles.

Your doctor will likely recommend taking the first two cycles of Onureg with an antinausea medication such as Zofran (ondansetron). They’ll recommend you take the antinausea drug 30 minutes before each dose of Onureg to help prevent vomiting.

You may be able to stop taking the antinausea medication if you haven’t had nausea with Onureg after the first two treatment cycles. But be sure to talk with your doctor before stopping the antinausea drug.

Is Onureg used long term?

Yes, Onureg is usually a long-term treatment. You’ll likely take Onureg as long as you don’t have serious side effects or your condition doesn’t worsen.

Dosage adjustments

In certain cases, you may need dosage adjustments for Onureg. Your doctor will monitor you during treatment. If you have serious side effects, they may temporarily stop your medication. If you still have serious side effects, they may lower your dose of Onureg. If you continue to have serious side effects, they may stop your treatment with Onureg and discuss safer options with you.

For example, if you have serious side effects, including severe nausea, vomiting, or low blood cell counts, your doctor may lower your dose of Onureg to 200 mg to find out how a lower dose affects you.

Tell your doctor if you have liver or kidney problems. They’ll monitor you while you’re taking Onureg. They may adjust your dosage of the medication if you have serious side effects.

If you have questions about your dosage and are wondering whether you could benefit from a dosage adjustment, talk with your doctor. Do not make changes to your dosage without your doctor’s approval.

The dosage of Onureg you’re prescribed may depend on several factors. These include:

  • side effects you may experience
  • other conditions you may have (see the “Dosage adjustments” section above)
  • other medications you take

Onureg comes as an oral tablet that you take in 28-day dosing cycles. You’ll take the drug once daily on days 1–14 of each 28-day cycle.

During your first two treatment cycles, your doctor will recommend taking an antinausea medication 30 minutes before you take Onureg to help prevent vomiting.

You can take Onureg tablets with or without food, but you should swallow them whole. Do not crush, cut, or chew them. If you have difficulty swallowing tablets, see this article for tips on how to take this form of medication or talk with your doctor or pharmacist.

If your skin comes into contact with the powder from Onureg tablets, thoroughly wash the area with soap and water right away. If the powder from Onureg tablets comes into contact with your eyes or mouth, immediately flush the area well with water.

For information on the expiration, storage, and disposal of Onureg, talk with your doctor or pharmacist.

Accessible drug containers and labels

Some pharmacies provide medication labels that:

  • have large print
  • use braille
  • feature a code you can scan with a smartphone to change the text to audio

Your doctor or pharmacist may be able to recommend pharmacies that offer these accessibility features if your current pharmacy doesn’t.

Onureg is available in bottles or blister packs. Let your doctor know if you have difficulty opening medication bottles. They may be able to prescribe Onureg in blister packs instead.

If you miss a dose of Onureg and remember the same day, take it as soon as you remember. But if it’s the next day, skip the missed dose and take your next dose at its usual time. Do not take two doses of Onureg at one time to make up for a missed dose. This can increase your risk of side effects.

If you vomit after taking your dose of Onureg, do not take another tablet. Just take your next dose at its usual time.

If you’re not sure whether you should take a missed dose, talk with your doctor or pharmacist.

If you need help remembering to take your dose of Onureg on time, try using a medication reminder. This can include setting an alarm or downloading a reminder app on your phone.

Do not take more Onureg than your doctor prescribes, as this can lead to harmful effects.

What to do in case you take too much Onureg

Call your doctor right away if you think you’ve taken too much Onureg. You can also call 800-222-1222 to reach America’s Poison Centers or use its online resource. But if you have severe symptoms, immediately call 911 (or your local emergency number) or go to the nearest emergency room.

Below are answers to some commonly asked questions about Onureg’s dosage.

Is Onureg’s dosage similar to that of Vidaza?

No, it isn’t. Although Onureg (azacitidine) and Vidaza (azacitidine) have the same active ingredient, they’re prescribed for different conditions.

Onureg is prescribed for continuous treatment of AML in adults in certain situations. Vidaza is prescribed to treat certain other types of cancer, such as:

The form of the drug and the dose in mg for each drug also differ.

Onureg comes as an oral tablet that you take once daily on days 1–14 of each 28-day dosing cycle. Vidaza comes as a liquid solution for injection under the skin or via intravenous (IV) infusion (an injection into a vein given over time) by a healthcare professional.

The dosage of Vidaza depends on the condition it’s being prescribed to treat.

Note: Onureg and Vidaza are not interchangeable and should not be substituted for one another.

Your doctor will prescribe the drug and dosage that’s right for you. Talk with them to learn more about how these drugs compare.

How long does it take for Onureg to start working?

Onureg starts to work after your first dose. But because of how the drug works, you likely won’t feel it working in your body.

Your doctor will monitor you during treatment to determine whether the drug is effectively treating your condition. You’ll likely take Onureg as long as your condition doesn’t worsen and you don’t have serious side effects.

If you have other questions about what to expect from your Onureg treatment, talk with your doctor.

The sections above describe the usual dosage provided by Onureg’s manufacturer. But if your doctor recommends this drug, they’ll prescribe the most appropriate dosage for you. Do not change your dosage of Onureg without your doctor’s recommendation. Only take this drug exactly as prescribed.

Talk with your doctor if you have questions or concerns about your current dosage. Examples of questions you may want to ask include:

  • Would a lower dosage of Onureg still work to keep my condition in remission?
  • Can I take my Onureg dosage on a different dosing schedule?
  • How does the dosage of Onureg compare with that of Rydapt (midostaurin)?

To learn more about Onureg, see these articles:

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Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.