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Inqovi

decitabine / cedazuridine
Used for Leukemia, Myelodysplastic Syndromes
Used for Leukemia, Myelodysplastic Syndromes

Inqovi (decitabine / cedazuridine) is an anticancer medication that’s used for treating a group of blood problems called myelodysplastic syndromes (MDS) in adults. The combination tablet contains decitabine, a type of chemotherapy called a hypomethylating agent, and cedazuridine, a cytidine deaminase inhibitor that helps the chemotherapy work better. Inqovi (decitabine / cedazuridine) is taken by mouth once daily for the first 5 days of every 28-day treatment cycle. It can cause side effects like tiredness, mouth sores, and low blood cell counts.

Reviewed by:
reviewer
Allison Baxley, PharmD, BCOP
reviewer
Cydnee Ng, PharmD
Last reviewed on November 13, 2024
BasicsSide effectsPros & consPharmacist tipsFAQsWarningsDosageCostAlternativesReferencesPricesMedicare
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What is Inqovi (decitabine / cedazuridine)?

What is Inqovi (decitabine / cedazuridine) used for?

How Inqovi (decitabine / cedazuridine) works

In people with MDS, immature blood cells don’t develop properly into normal, healthy blood cells (such as white or red blood cells). Instead, the blood cells continue to grow as immature cells. As a result, people with MDS have a lot of immature blood cells that don’t work correctly and very few fully-developed, healthy blood cells.

Inqovi (decitabine / cedazuridine) is a combination medication containing two active ingredients that work together to treat MDS.

  • Decitabine is a hypomethylating agent. It works by telling the immature blood cells to grow up and develop into mature, healthy cells. The medication also causes cell death in some immature blood cells.

  • Cedazuridine is a cytidine deaminase inhibitor. It blocks cytidine deaminase, a protein that destroys decitabine in the digestive tract. When cedazuridine blocks this protein, decitabine can stick around longer in the body and work to treat MDS.

Are you looking for information on decitabine injection instead?

Drug Facts

Common BrandsInqovi
Drug ClassHypomethylating agent / Cytidine deaminase inhibitor
Controlled Substance ClassificationNot a controlled medication
Generic StatusNo lower-cost generic available
AvailabilityPrescription only
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What are the side effects of Inqovi (decitabine / cedazuridine)?

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

Other Side Effects

Note: Side effects listed were reported from people after only the first treatment cycle of Inqovi (decitabine / cedazuridine).

Serious Side Effects

Contact your healthcare provider immediately if you experience any of the following.
  • Serious infection: temperature of 100.4 degrees Fahrenheit, with or without other symptoms like chills, cough, muscle aches, very fast heartbeat, or confusion
  • Serious bleeding: nosebleed that takes a long time to stop, unexplained bruising, blood in stool, blood in urine

Source: DailyMed

The following side effects have also been reported

Side effects that you should report to your care team as soon as possible:

Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):

pros-and-cons

Pros and cons of Inqovi (decitabine / cedazuridine)

thumbs-up

Pros

Taken by mouth, so it’s an alternative for people who don’t like needles

Can take at home

Recommended treatment option for people with MDS

thumbs-down

Cons

Must take on an empty stomach (can’t eat 2 hours before or after each dose)

Often causes low blood cell counts, which puts you at risk for infections and bleeding

Might cause nausea

pharmacist-tips

Pharmacist tips for Inqovi (decitabine / cedazuridine)

pharmacist

  • Take Inqovi (decitabine / cedazuridine) at the same time every day. Be sure you take the medication on an empty stomach, 2 hours before or 2 hours after a meal. Swallow the tablets whole and don’t crush, split, or chew them.

    • You’ll only take Inqovi (decitabine / cedazuridine) for 5 days out of each 28-day treatment cycle. The number of days you need to take it could be less if you have serious side effects. It can be difficult to keep track of your treatment schedule, so consider using an app on your phone to help you remember.

      • You can have mouth sores while you’re taking Inqovi (decitabine / cedazuridine). They can be painful and make it difficult for you to eat and drink. Take good care of your mouth and teeth, and use a soft-bristle toothbrush to avoid irritating your mouth. Speak with your care team about other ways to manage this side effect. Your oncologist might prescribe a mouthwash to numb and relieve mouth pain.

        • Inqovi (decitabine / cedazuridine) can often cause you to have a low white blood cell count, which means you’re more likely to get sick. Do your best to prevent getting sick by washing your hands often, avoiding crowds, and washing raw fruits and vegetables well before eating them.

          • Check your temperature, ideally once a day. Inqovi (decitabine / cedazuridine) can raise your risk of getting sick, and a fever can sometimes be the only sign that you’re sick. Call your care team as soon as possible if your temperature is 100.4 degrees Fahrenheit or higher because this means you have a fever.

            • If you can become pregnant, use birth control while you’re taking Inqovi (decitabine / cedazuridine) and for 6 months after your last dose. If you’re male with a partner who can have children, use condoms when having sex anytime during treatment and 3 months after your last dose. Tell your care team right away if you or your partner becomes pregnant. This medication can harm an unborn baby.

              • If you’re male, talk with your care team about family planning. Inqovi (decitabine / cedazuridine) might affect your fertility, or ability to have children, in the future. Your care team can discuss fertility preservation options like sperm banking.

                • Ask your care team about the best way to safely handle and get rid of any Inqovi (decitabine / cedazuridine) tablets. Anticancer medications can be harmful to people who handle or come in contact with them. Store the medication up and away, so visitors, children, and pets can’t reach it.

                  faqs

                  Frequently asked questions about Inqovi (decitabine / cedazuridine)

                  Is Inqovi (decitabine / cedazuridine) chemotherapy?
                  Yes. Inqovi is a combination medication that contains decitabine, which is typically categorized as chemotherapy. The term chemotherapy refers to medications that work to kill fast-growing cells. At high doses, decitabine can kill cancer cells. But for treating myelodysplastic syndromes (MDS), decitabine is given at lower doses to specifically help the body recognize blood cells that aren’t growing correctly. This allows the body to either destroy unhealthy blood cells or fix them so that they can turn into healthy blood cells. The other active ingredient in this combination medication, cedazuridine, helps decitabine stick around longer in the body to treat MDS.
                  What’s the most common side effect of Inqovi (decitabine / cedazuridine)?
                  Inqovi (decitabine / cedazuridine) most commonly causes you to have a low blood cell count. It can make your white blood cell count drop. This weakens your immune system, raises your risk of getting sick, and makes it harder for you to recover from infections. Inqovi (decitabine / cedazuridine) can also make your red blood cell count lower, which can lead to anemia and make you feel tired. What’s more, you can have low platelet levels, which might put you at risk for bleeding. Your oncologist will check your blood cell counts often while you’re taking Inqovi (decitabine / cedazuridine). Contact your care team if you have any unexpected bruising, bleeding, tiredness, or any signs of infection.
                  Does Inqovi (decitabine / cedazuridine) cause hair loss?
                  Although it’s possible, most people who take Inqovi (decitabine / cedazuridine) don’t lose their hair. Some things you can do to help if you do notice any hair loss or hair thinning include using a soft-bristled brush, only washing your hair when necessary, and using mild shampoos. You might also want to talk to your oncology care team because there can be other causes of hair loss.
                  Does Inqovi (decitabine / cedazuridine) cause nausea?
                  Yes. Inqovi (decitabine / cedazuridine) can cause nausea, but it’s usually not severe. Your oncologist will prescribe medications for you to take before each time you take Inqovi (decitabine / cedazuridine) to help prevent or ease any nausea. Speak with your oncologist if you have severe nausea that doesn’t get better with medications.
                  How long does Inqovi (decitabine / cedazuridine) stay in your system?
                  It can take up to a day for most of Inqovi (decitabine / cedazuridine) to leave your system after a single dose. This time frame is based on the medication’s half-life, which is the amount of time it takes the body to get rid of half the amount of medication in the system. Ask your oncologist if you have concerns about how long Inqovi (decitabine / cedazuridine) stays in your system.
                  What should you do if you miss a dose of Inqovi (decitabine / cedazuridine)?
                  If you’ve missed a dose of Inqovi (decitabine / cedazuridine) and it’s more than 12 hours until your next dose, take the medication as soon as possible and continue with your treatment schedule. If there are less than 12 hours until your next dose, skip the missed dose and wait until the next day to take the medication at your usual time at the usual dose (don’t take extra tablets to make up for missed doses). For each missed dose that you skipped, add a day that you’ll take Inqovi (decitabine / cedazuridine) in the treatment cycle so that you end up taking 5 doses of the medication. Ask your oncologist or pharmacist if you’re not sure what to do if you forget to take the medication.
                  What should you do if you throw up right after you take Inqovi (decitabine / cedazuridine)?
                  If you vomit right after you take your Inqovi (decitabine / cedazuridine) tablet, don’t take an extra tablet to make it up. Wait until the next time you typically take the medication to take your usual dose.
                  Can you breastfeed while taking Inqovi (decitabine / cedazuridine)?
                  Avoid breastfeeding while you’re taking Inqovi (decitabine / cedazuridine) and for 2 weeks after your last dose. We don’t know whether the medication is found in breast milk, whether it affects your milk supply, and whether it affects breastfed babies. But there’s a possible risk of harm to a baby. Speak with your care team about alternative ways of feeding your baby, such as baby formula.
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                  What are the risks and warnings for Inqovi (decitabine / cedazuridine)?

                  Inqovi (decitabine / cedazuridine) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

                  risk-warning

                  Low blood cell counts (myelosuppression)

                  Inqovi (decitabine / cedazuridine) commonly causes low blood cell counts. This can be serious and life-threatening. Having low levels of red blood cells can lead to problems like feeling more tired and anemia. In addition, having low platelets can put you at risk for easy bleeding. And having low levels of white blood cells can put you at risk for serious, dangerous infections.

                  Low blood cell counts are more common during the first or second cycles of Inqovi (decitabine / cedazuridine). In particular, you might be more likely to develop low white blood cell counts if you’re older than 65 or if you’ve had chemotherapy or radiation before.

                  You’ll need to get a blood test done to check your blood cell counts before every treatment cycle with Inqovi (decitabine / cedazuridine). If your counts are too low, your oncologist might make adjustments to your treatment to give your body time to make new blood cells. This could mean taking the cancer medication for fewer days than usual per cycle or pausing treatment. Your oncologist might also add medications to your treatment plan to boost your white blood cell count or prescribe antibiotics to prevent infections.

                  risk-warning

                  Harm to unborn baby

                  • Risk factors: Pregnancy

                    Based on studies and the way Inqovi (decitabine / cedazuridine) works, the medication could cause harm to an unborn baby if it’s taken during pregnancy.

                    If you’re able to become pregnant, you should use effective birth control while you’re taking Inqovi (decitabine / cedazuridine) and for 6 months after your last dose. If you’re a male who’s sexually active with a partner who can become pregnant, use birth control like condoms if you have sex while you’re taking this cancer medication and during the 3 months after your last dose. Contact your oncology care team right away if you or your partner becomes pregnant while you’re taking Inqovi (decitabine / cedazuridine).

                    dosage

                    Inqovi (decitabine / cedazuridine) dosage forms

                    Typical dosing for Inqovi (decitabine / cedazuridine)

                    Each tablet contains 35 mg of decitabine and 100 mg of cedazuridine.

                    The usual dose is 1 tablet by mouth once a day on days 1 through 5 of each 28-day treatment cycle.

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                    How much does Inqovi (decitabine / cedazuridine) cost?

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                    There are a number of medications that your doctor can prescribe in place of Inqovi (decitabine / cedazuridine). Compare a few possible alternatives below.
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                    References

                    Best studies we found

                    American Cancer Society. (2019). Chemotherapy safety.

                    American Cancer Society. (2024). Anemia (low red blood cell counts).

                    American Cancer Society. (2024). Fevers.

                    View All References (22)

                    American Cancer Society. (2024). Medicines for myelodysplastic syndromes (MDS).

                    American Cancer Society. (2024). Neutropenia (low white blood cell counts).

                    American Cancer Society. (2024). Thrombocytopenia (low platelet count).

                    Bell, A., et al. (2023). Oral mucositis. StatPearls.

                    Brown, T. J., et al. (2020). Management of cancer therapy-associated oral mucositis. Journal of Clinical Oncology Oncology Practice.

                    Centers for Disease Control and Prevention. (n.d.). What you need to know: Neutropenia and risk for infection.

                    Centers for Disease Control and Prevention. (2024). Know the signs and symptoms of infection.

                    de Vos, D., et al. (2005). Decitabine: A historical review of the development of an epigenetic drug. Annals of Hematology.

                    de Witte, T. (2024). Oral decitabine plus cedazuridine versus intravenous decitabine. The Lancet Haematology.

                    Eunice Kennedy Shriver National Institute of Child Health and Human Development. (2017). What is fertility preservation?

                    Jabbour, E., et al. (2008). Evolution of decitabine development: Accomplishments, ongoing investigations, and future strategies. Cancer.

                    MedlinePlus. (2023). Low white blood cell count and cancer.

                    MedlinePlus. (2024). Hemoglobin.

                    Myelodysplastic Syndromes Foundation, Inc. (n.d.). MDS by the numbers.

                    National Cancer Institute. (n.d.). Myelosuppression.

                    National Cancer Institute. (2024). Myelodysplastic syndromes treatment (PDQ®) – Patient version.

                    National Comprehensive Cancer Network. (2021). Anemia and neutropenia: Low red and white blood cell counts.

                    National Comprehensive Cancer Network. (2024). Myelodysplastic syndromes.

                    Patel, K., et al. (2017). Febrile neutropenia. Journal of the American Medical Association Oncology.

                    Rossi, A., et al. (2017). Chemotherapy-induced alopecia management: Clinical experience and practical advice. Journal of Cosmetic Dermatology.

                    Taiho Pharmaceutical Co., Ltd. (2024). Inqovi- cedazuridine and decitabine tablet, film coated [package insert]. DailyMed.

                    Thota, S., et al. (2021). Role of cedazuridine/decitabine in the management of myelodysplastic syndrome and chronic myelomonocytic leukemia. Future Oncology.

                    GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.
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