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Health Guide

Pemetrexed (Intravenous route)

Pronunciation:

pem-e-TREX-ed

Brand Names:

  • Alimta

Dosage Forms:

  • Powder for Solution

Classifications:

Therapeutic—

Antineoplastic Agent

Uses of This Medicine:

Pemetrexed injection treats lung cancer and belongs to the group of medicines called antineoplastics. It is used together with cisplatin (a cancer medicine) to treat a type of cancer called malignant pleural mesothelioma (MPM). This cancer affects the inside lining of the chest cavity. Pemetrexed injection may also be used alone or together with cisplatin to treat a type of lung cancer called nonsquamous non-small cell lung cancer.

To lower your chances of side effects with pemetrexed, you must also take folic acid and vitamin B12 prior to and during your treatment. Your doctor will prescribe a medicine called a corticosteroid (cortisone medicine) to take for 3 days during your treatment. Corticosteroid medicines lower your chances of getting skin reactions with pemetrexed.

This medicine is available only with your doctor's prescription.

Before Using This Medicine:

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies—

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Children—

Appropriate studies have been performed on the relationship of age to the effects of pemetrexed injection in the pediatric population. However, efficacy has not been established.

Older adults—

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of pemetrexed injection in the elderly. However, elderly patients are more likely to have age-related kidney problems, which may require an adjustment in the dose for patients receiving pemetrexed injection.

Pregnancy—

Pregnancy CategoryExplanation
All TrimestersDStudies in pregnant women have demonstrated a risk to the fetus. However, the benefits of therapy in a life threatening situation or a serious disease, may outweigh the potential risk.

Breast-feeding—

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Other medicines—

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

  • Measles Virus Vaccine, Live
  • Mumps Virus Vaccine, Live
  • Rotavirus Vaccine, Live
  • Rubella Virus Vaccine, Live
  • Varicella Virus Vaccine

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Aceclofenac
  • Acemetacin
  • Adenovirus Vaccine
  • Amtolmetin Guacil
  • Aspirin
  • Bacillus of Calmette and Guerin Vaccine, Live
  • Bromfenac
  • Bufexamac
  • Celecoxib
  • Cholera Vaccine, Live
  • Choline Salicylate
  • Clonixin
  • Dexibuprofen
  • Dexketoprofen
  • Diclofenac
  • Diflunisal
  • Dipyrone
  • Droxicam
  • Etodolac
  • Etofenamate
  • Etoricoxib
  • Felbinac
  • Fenoprofen
  • Fepradinol
  • Feprazone
  • Floctafenine
  • Flufenamic Acid
  • Flurbiprofen
  • Ibuprofen
  • Indomethacin
  • Influenza Virus Vaccine, Live
  • Ketoprofen
  • Ketorolac
  • Lornoxicam
  • Loxoprofen
  • Lumiracoxib
  • Meclofenamate
  • Mefenamic Acid
  • Meloxicam
  • Morniflumate
  • Nabumetone
  • Naproxen
  • Nepafenac
  • Niflumic Acid
  • Nimesulide
  • Nimesulide Beta Cyclodextrin
  • Oxaprozin
  • Oxyphenbutazone
  • Parecoxib
  • Phenylbutazone
  • Piketoprofen
  • Piroxicam
  • Poliovirus Vaccine, Live
  • Proglumetacin
  • Propyphenazone
  • Proquazone
  • Rofecoxib
  • Salicylic Acid
  • Salsalate
  • Smallpox Vaccine
  • Sodium Salicylate
  • Sulindac
  • Tenoxicam
  • Tiaprofenic Acid
  • Tolfenamic Acid
  • Tolmetin
  • Typhoid Vaccine
  • Valdecoxib
  • Yellow Fever Vaccine

Other interactions—

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other medical problems—

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

  • Anemia (low red blood cells) or
  • Bone marrow problems or
  • Neutropenia (low while blood cells) or
  • Thrombocytopenia (low platelets in the blood)—Use with caution. May make these conditions worse.
  • Kidney disease—Use with caution. The effects may be increased because of slower removal of the medicine from the body.

Proper Use of This Medicine:

It is very important to take folic acid and vitamin B12 during your treatment with pemetrexed to lower your chances of harmful side effects. You must start taking 400 to 1000 micrograms (mcg) of folic acid every day for at least 5 days out of the 7 days before your first dose of pemetrexed. You must keep taking folic acid every day during the time you are getting treatment with pemetrexed, and for 21 days after your last treatment. You can get folic acid vitamins over-the-counter. Folic acid is also found in many multivitamin pills. Ask your doctor or pharmacist for help if you are not sure how to choose a folic acid product. Your doctor will give you vitamin B12 injections while you are getting treatment with pemetrexed. You will get your first vitamin B12 injection during the week before your first dose of pemetrexed, and then about every 9 weeks during treatment.

You will receive this medicine while you are in a hospital or cancer treatment center. A nurse or other trained health professional will give you this medicine. This medicine is given through a needle placed in one of your veins.

Pemetrexed is given together with certain other medicines. If you are using a combination of medicines, it is important that you receive each one at the proper time. If you are taking some of these medicines by mouth, ask your doctor to help you create a plan to take them at the right times.

Your doctor will prescribe a medicine called a corticosteroid (cortisone medicine) to take for 3 days during your treatment with pemetrexed. Corticosteroid medicines lower your chances for getting skin reactions with pemetrexed.

This medicine comes with a patient information insert. It is very important that you read and understand this information. Be sure to ask your doctor about anything you do not understand.

Precautions While Using This Medicine:

It is very important that your doctor check your progress at regular visits to make sure this medicine is working properly. Blood tests may be needed to check for unwanted effects.

Make sure your doctor knows if you are pregnant before you receive this medicine. Using this medicine while you are pregnant can harm your unborn baby. If you are a woman of childbearing potential, you should use two forms of birth control together to avoid getting pregnant while you are receiving this medicine. If you have become pregnant during your treatment, tell your doctor right away.

It is important that you check with your doctor right away if you have fever or chills, diarrhea, or mouth sores. These may be signs that you have an infection.

You may feel tired or weak for a few days after your pemetrexed treatment. If you have severe weakness or tiredness, call your doctor.

You may get redness or sores in your mouth, throat, or lips. These symptoms may happen a few days after pemetrexed treatment.

You may get a rash or itching during treatment. These usually appear between treatments with pemetrexed and usually go away before the next treatment. Call your doctor if you get a severe rash or itching.

Pemetrexed and cisplatin (a cancer medicine) can sometimes cause nausea and vomiting. However, it is very important that you continue to receive the medicine, even if you begin to feel ill. You can get medicines to help control the nausea and vomiting. Talk with your doctor if you get any of these symptoms.

You may lose your appetite and some weight during your treatment. Talk to your doctor if this is a problem for you.

Pemetrexed can temporarily affect your blood counts and your doctor will do blood tests to check your blood counts before and during treatment with pemetrexed. Low red blood cells may make you feel tired, get tired easily, appear pale, and become short of breath. Low white blood cells may give you a greater chance for infection. If you have a fever (temperature above 100.4 degrees F) or other signs of infection, call your doctor right away. Low platelets give you a greater chance for bleeding. If this occurs, there are certain precautions you can take, especially when your blood count is low, to reduce the risk of infection or bleeding:

  • If you can, avoid people with infections. Check with your doctor immediately if you think you are getting an infection or if you get a fever or chills, cough or hoarseness, diarrhea, lower back or side pain, mouth sores, or painful or difficult urination.
  • Check with your doctor immediately if you notice any unusual bleeding or bruising; black, tarry stools; blood in the urine or stools; or pinpoint red spots on your skin.
  • Be careful when using a regular toothbrush, dental floss, or toothpick. Your medical doctor, dentist, or nurse may recommend other ways to clean your teeth and gums. Check with your medical doctor before having any dental work done.
  • Do not touch your eyes or the inside of your nose unless you have just washed your hands and have not touched anything else in the meantime.
  • Be careful not to cut yourself when you are using sharp objects such as a safety razor or fingernail or toenail cutters.
  • Avoid contact sports or other situations where bruising or injury could occur.

If you have kidney problems, make sure your doctor knows if you are using an NSAID medicine for pain or arthritis (e.g., diclofenac, ibuprofen, naproxen, Advil®, Aleve®, Celebrex®, Voltaren®).

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Side Effects of This Medicine:

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur:

More common
Black, tarry stools
bleeding gums
chest pain
chills
cough
fever
loss of coordination
lower back or side pain
painful or difficult urination
pains in the chest, groin, or legs, especially calves of the legs
pale skin
pinpoint red spots on the skin
severe headaches of sudden onset
shortness of breath
sore throat
sudden onset of slurred speech
sudden vision changes
swollen glands
troubled breathing
ulcers, sores, or white spots in the mouth
unusual bleeding or bruising
unusual tiredness or weakness
Less common
Bloody urine or bloody stools
decreased frequency or amount of urine
fainting or loss of consciousness
fast or irregular breathing
increased blood pressure
increased thirst
itching
loss of appetite
nausea
skin rash
swelling of the eyes or eyelids
swelling of the face, fingers, or lower legs
tightness in the chest or wheezing
vomiting
weight gain
Incidence not known
Blistering, peeling, or loosening of the skin
joint or muscle pain
pain and redness of the skin in the area of earlier radiation treatment
red skin lesions, often with a purple center
red, irritated eyes
stomach cramps, tenderness, or pain
watery diarrhea

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
Burning, tingling, numbness, or pain in the hands, arms, feet, or legs
confusion
cough or hoarseness
decreased urination
diarrhea
difficulty having a bowel movement (stool)
difficulty with moving
difficulty with swallowing
discouragement
dizziness
dry mouth
feeling sad or empty
hair loss
headache
heartburn
increase in heart rate
irritability
lightheadedness
loss of interest or pleasure
mood changes
muscle aches or cramping
muscle stiffness
pain or burning in the throat
pain produced by swallowing
rapid breathing
sensation of pins and needles
stabbing pain
stuffy or runny nose
sunken eyes
swelling
swelling or inflammation of the mouth
swollen joints
thinning of the hair
thirst
tiredness
trouble concentrating
trouble sleeping
weight loss
wheezing
wrinkled skin

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.


Last Updated: 7/4/2017
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