Pemetrexed

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Generic Name: Pemetrexed Brand Name(s): Generics only. No brands available.

Uses

What is Pemetrexed used for?

Pemetrexed is used to treat certain types of cancer (such as lung cancer, mesothelioma). It is a chemotherapy drug that works by slowing or stopping the growth of cancer cells.

How should I take Pemetrexed?

This medication is given by injection into a vein by a healthcare professional. It is given over 10 minutes as directed by your doctor, usually once every 3 weeks. The dosage is based on your medical condition, body size, and response to treatment. To lower your chance of having a skin reaction while using pemetrexed, your doctor will prescribe a corticosteroid medicine (such as dexamethasone) to take for a short period around the time of each treatment. Consult your doctor or pharmacist for more details.

To lower your chance of other side effects, it is very important that you take folic acid vitamins and receive vitamin B12 shots before and during treatment with pemetrexed. Folic acid vitamins are available over-the-counter without a prescription, and folic acid can be found in many multivitamin products. Make sure your vitamin contains between 400 to 1000 micrograms (0.4 to 1 milligram) of folic acid. Take folic acid daily for at least 5 out of 7 days before your first dose of pemetrexed, during treatment, and for 3 weeks after your last dose of pemetrexed. If you need help choosing a folic acid vitamin, ask your doctor or pharmacist. Your doctor will give you a vitamin B12 shot into the muscle, usually 1 week before your first dose of pemetrexed and then once every 9 weeks during your treatment. Do not substitute vitamin B12 taken by mouth for the vitamin B12 shots. Consult your doctor or pharmacist for more details.

How do I store Pemetrexed?

Store intact vials at 25°C (77°F); excursions permitted to 15°C to 30°C (59°F to 86°F). Reconstituted solution and solution diluted for infusion are stable for 24 hours when refrigerated at 2°C to 8°C (36°F to 46°F). If you need to store pemetrexed at home, talk with your doctor, nurse, or pharmacist about how to store it.

There may be different brands of Pemetrexed that may have different storage needs. It is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

You should not flush Pemetrexed down the toilet or pour them into a drain unless instructed to do so. It is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.

Precautions & warnings

What should I know before using Pemetrexed?

Before using pemetrexed, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney disease, liver disease, radiation treatment.

Pemetrexed can make you more likely to get infections or may worsen any current infections. Avoid contact with people who have infections that may spread to others (such as chickenpox, measles, flu). Consult your doctor if you have been exposed to an infection or for more details.

Do not have immunizations/vaccinations without the consent of your doctor. Avoid contact with people who have recently received live vaccines (such as flu vaccine inhaled through the nose).

To lower the chance of getting cut, bruised, or injured, use caution with sharp objects like razors and nail cutters, and avoid activities such as contact sports.

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

Tell your doctor if you are pregnant or plan to become pregnant. You should not become pregnant while using pemetrexed. Pemetrexed may harm an unborn baby. Female patients should ask about reliable forms of birth control while using this medication and for 6 months after stopping treatment. Male patients with female partners should ask about reliable forms of birth control while using this medication and for 3 months after stopping treatment. If you or your partner become pregnant, talk to your doctor right away about the risks and benefits of this medication.

It is unknown if this drug passes into breast milk. Because of the possible risk to the infant, breast-feeding while using this drug and for 1 week after stopping treatment is not recommended. Consult your doctor before breast-feeding.

Is it safe during pregnancy or breast-feeding?

There are no adequate studies in women for determining risk when using this Pemetrexed during pregnancy or while breastfeeding. Please always consult with your doctor to weigh the potential benefits and risks before taking Pemetrexed. Pemetrexed is pregnancy risk category D according to the US Food and Drug Administration (FDA).

FDA pregnancy risk category reference below:

  • A=No risk,
  • B=No risk in some studies,
  • C=There may be some risk,
  • D=Positive evidence of risk,
  • X=Contraindicated,
  • N=Unknown

Side effects

What side effects can occur from Pemetrexed?

Nausea, vomiting, loss of appetite, diarrhea, stomach upset, changes in taste, constipation, mouth sores, and tiredness may occur. Nausea, vomiting, and diarrhea can be severe. In some cases, your doctor may prescribe medication to prevent or relieve nausea, vomiting, and diarrhea. Eating several small meals, not eating before treatment, or limiting activity may help lessen nausea and vomiting. If any of these effects last or get worse, tell your doctor or pharmacist promptly.

Temporary hair loss may occur. Normal hair growth should return after treatment has ended.

People using this medication may have serious side effects. However, your doctor has prescribed this drug because he or she has judged that the benefit to you is greater than the risk ofside effects. Careful monitoring by your doctor may decrease your risk.

This medication may affect male fertility. Consult your doctor for more details.

Tell your doctor right away if you have any serious side effects, including: numbness/tingling skin, swelling ankles/feet/hands, signs of kidney problems (such as change in the amount of urine), signs of liver disease (such as nausea/vomiting that doesn’t stop, stomach/abdominal pain, yellowing eyes/skin, dark urine).

This medication may decrease bone marrow function, an effect that may lead to a low number of blood cells such as red cells, white cells, and platelets. This effect can cause anemia, decrease your body’s ability to fight an infection, or cause easy bruising/bleeding. Tell your doctor right away if you develop any of the following symptoms: unusual tiredness, pale skin, signs of infection (such as sore throat that doesn’t go away, fever, chills), easy bruising/bleeding.

Get medical help right away if you have any very serious side effects, including: blisters or sores, signs of lung problems (such as new or worsening shortness of breath, cough).

Pemetrexed may cause a serious skin reaction that looks like a severe sunburn (radiation recall) on any area that has been treated with radiation weeks to years before. Get medical help right away if you have skin redness, pain, tenderness, swelling, peeling, or blisters.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

Pemetrexed can commonly cause a rash that is usually not serious and that can be prevented by taking corticosteroid medication (see How to Use section). However, you may not be able to tell the rash apart from a rare rash that could be a sign of a severe reaction. Get medical help right away if you develop any rash.

Not everyone experiences these side effects. There may be some side effects not listed above. If you have any concerns about a side-effect, please consult your doctor or pharmacist.

Interactions

What drugs may interact with Pemetrexed?

Pemetrexed may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs and herbal products) and share it with your doctor and pharmacist. For your safety, do not start, stop, or change the dosage of any drugs without your doctor’s approval.

Does food or alcohol interact with Pemetrexed?

Pemetrexed may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.

What health conditions may interact with Pemetrexed?

Pemetrexed may interact with your health condition. This interaction may worsen your health condition or alter the way the drug works. It is important to always let your doctor and pharmacist know all the health conditions you currently have.

Dosage

The information provided is not a substitute for any medical advice. You should ALWAYS consult with your doctor or pharmacist before using this Pemetrexed.

What is the dose of Pemetrexed for an adult?

Usual Adult Dose for Malignant Pleural Mesothelioma

500 mg/m2 IV over 10 minutes on day 1 of each 21 day cycle along with cisplatin

Cisplatin 75 mg/m2 infused over 2 hours beginning approximately 30 minutes after the end of the pemetrexed administration. Patients should receive hydration consistent with local practice prior to and/or after receiving cisplatin.

PREMEDICATION REGIMEN AND CONCURRENT MEDICATIONS:

-Vitamin Supplementation: Patients should initiate folic acid 400 to 1000 mcg orally once daily beginning 7 days before the first dose of chemotherapy. Folic acid should be continued during the full course of therapy and for 21 days after the last dose.

-Vitamin B12 1 mg should be administered IM 1 week prior to the first dose of chemotherapy and every 3 cycles thereafter.

-Subsequent vitamin B12 injections may be given the same day as treatment.

-Corticosteroids: Dexamethasone 4 mg orally 2 times a day the day before, the day of, and the day after chemotherapy administration.

Comments:

-See the manufacturer product information for cisplatin dosing.

Use: For the treatment of patients with malignant pleural mesothelioma whose disease is unresectable or who are otherwise not candidates for curative surgery in combination with cisplatin

Usual Adult Dose for Non-Small Cell Lung Cancer

COMBINATION USE WITH CISPLATIN FOR NONSQUAMOUS NON-SMALL CELL LUNG CANCER: 500 mg/m2 IV over 10 minutes on day 1 of each 21 day cycle along with cisplatin:

-Cisplatin 75 mg/m2 infused over 2 hours beginning approximately 30 minutes after the end of the pemetrexed administration. Patients should receive hydration consistent with local practice prior to and/or after receiving cisplatin.

AS A SINGLE AGENT FOR NONSQUAMOUS NON-SMALL CELL LUNG CANCER MAINTENANCE AND NONSQUAMOUS NON-SMALL LUNG CANCER AFTER PRIOR CHEMOTHERAPY: 500 mg/m2 IV over 10 minutes on day 1 of each 21 day cycle

PREMEDICATION REGIMEN AND CONCURRENT MEDICATIONS:

-Vitamin Supplementation: Patients should initiate folic acid 400 to 1000 mcg orally once daily beginning 7 days before the first dose of chemotherapy. Folic acid should be continued during the full course of therapy and for 21 days after the last dose.

-Vitamin B12 1 mg should be administered IM 1 week prior to the first dose of chemotherapy and every 3 cycles thereafter.

-Subsequent vitamin B12 injections may be given the same day as treatment.

-Corticosteroids: Dexamethasone 4 mg orally 2 times a day the day before, the day of, and the day after chemotherapy administration.

Renal Dose Adjustments

CrCl 45 mL/min or greater: No adjustment recommended

CrCl less than 45 mL/min: Use is not recommended

Dose Adjustments

DOSE REDUCTION FOR PEMETREXED (SINGLE-AGENT OR IN COMBINATION) AND CISPLATIN:

HEMATOLOGIC TOXICITIES:

-Nadir absolute neutrophil count (ANC) less than 500/mm3 and nadir platelets 50,000/mm3 or more: Use 75% of the previous dose for pemetrexed and cisplatin

-Nadir platelets less than 50,000/mm3 without bleeding regardless of nadir ANC: Use 75% of the previous dose for pemetrexed and cisplatin

-Nadir platelets less than 50,000/mm3 with bleeding, regardless of nadir ANC: Use 50% of the previous dose for pemetrexed and cisplatin

NONHEMATOLOGIC TOXICITIES (excluding neurotoxicity) Grade 3 or higher, treatment should be withheld until resolution to less than or equal to the patient pretherapy value. Treatment should be resumed as shown:

-Any Grade 3 or 4 toxicities except mucositis: Use 75% of the previous dose for pemetrexed and cisplatin

-Any diarrhea requiring hospitalization (irrespective of Grade) or Grade 3 or 4 diarrhea: Use 75% of the previous dose for pemetrexed and cisplatin

-Grade 3 or 4 mucositis: Use 50 % of the previous dose for pemetrexed and 100% of the previous dose for cisplatin

NEUROTOXICITY:

-Common Toxicity Criteria (CTC) Grade 0 to 1: Use 100 % of the previous dose for pemetrexed and 100% of the previous dose for cisplatin

-Common Toxicity Criteria (CTC) Grade 2: Use 100 % of the previous dose for pemetrexed and 50% of the previous dose for cisplatin

DISCONTINUATION RECOMMENDATION:

-Therapy should be discontinued if a patient experiences any hematologic or nonhematologic Grade 3 or 4 toxicity after 2 dose reductions or immediately if Grade 3 or 4 neurotoxicity is observed.

Other Comments

Administration advice:

-This drug should be administered under the supervision of a qualified physician experienced in the use of antineoplastic agents. Appropriate management of complications is possible only when adequate diagnostic and treatment facilities are readily available.

Storage requirements:

-Refer to the manufacturer product information.

Reconstitution/preparation techniques:

-Refer to the manufacturer product information.

IV compatibility:

-This drug is incompatible with calcium containing solutions such as lactated Ringers injection and Ringers injection.

General:

-This drug is not indicated for the treatment of patients with squamous cell non-small cell lung cancer.

Monitoring:

-Complete blood cell counts, including platelet counts, should be performed on all patients receiving this drug.

-Patients should be monitored for nadir and recovery, which were tested in the clinical study before each dose and on days 8 and 15 of each cycle. Patients should not begin a new cycle of treatment unless the ANC is 1500 cells/mm3 or greater, the platelet count is 100,000 cells/mm3 or greater, and CrCl is 45 mL/min or greater.

-Periodic chemistry tests should be performed to evaluate renal and hepatic function.

What is the dose of Pemetrexed for a child?

The dosage has not been established in pediatric patients. It may be unsafe for your child. It is always important to fully understand the safety of the drug before using. Please consult with your doctor or pharmacist for more information.

How is Pemetrexed available?

Pemetrexed is available in the following dosage forms and strengths:

  • Intravenous powder for injection.

What should I do in case of an emergency or overdose?

In case of an emergency or an overdose, call your local emergency services or go to your nearest emergency room.

What should I do if I miss a dose?

If you miss a dose of Pemetrexed, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Review Date: April 11, 2018 | Last Modified: April 11, 2018

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