Pemetrexed

Pemetrexed is a prescription medication used to treat mesothelioma (a form of cancer) and non-squamous non-small cell lung cancer. Pemetrexed belongs to a group of drugs called antifolate antineoplastic agents, which help stop cancer cells from multiplying.

This medication comes in an injectable form to be given directly into a vein (IV) over 10 minutes every 3 weeks by a healthcare provider.

Common side effects include fever, diarrhea, and nausea.

Pemetrexed is a prescription medicine used to treat mesothelioma, which is a cancer of the tissue that lines your lungs, stomach, heart, and other organs. Pemetrexed is also used to treat a certain kind of lung cancer called nonsquamous non-small cell lung cancer. This cancer occurs when malignant (cancer) cells form in the tissues of the lung.

This medication may be prescribed for other uses.  Ask your doctor or pharmacist for more information.

Pemetrexed may be found in some form under the following brand names:

• Alimta

Serious side effects have been reported with pemetrexed. See the “Drug Precautions” section.

Common side effects of pemetrexed include:

• nausea 
• vomiting
• diarrhea
• low blood cell counts including low red blood cells, low white blood cells, and low platelets
• tiredness
• mouth, throat, or lip sores
• loss of appetite
• hair loss
• rash

This is not a complete list of pemetrexed side effects. Ask your doctor or pharmacist for more information.

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

Tell your doctor about all the medicines you take including prescription and nonprescription medicines, vitamins, and herbal supplements. Especially, tell your doctor if you take:

• aspirin and other NSAIDs (non-steroidal anti-inflammatory drugs) such as:
  • celecoxib (Celebrex)
  • diclofenac (Cambia, Cataflam, Flector, Voltaren, Zipsor and others)
  • etodolac (Lodine)
  • ibuprofen (Advil, Motrin, Nuprin)
  • indomethacin (Indocin, Indocin SR)
  • ketoprofen (Orudis, Actron, Oruvail)
  • ketorolac (Toradol)
  • meloxicam (Mobic)
  • nabumetone (Relafen)
  • naproxen (Naprosyn)
  • naproxen sodium (Aleve, Anaprox, Naprelan)
  • oxaprozin (Daypro)
  • piroxicam (Feldene)

This is not a complete list of pemetrexed drug interactions. Ask your doctor or pharmacist for more information.

Serious side effects have been reported with pemetrexed including the following:

• lowered blood count. The number of blood cells in your bone marrow. This may cause certain symptoms and may increase the risk that you will develop a serious or life-threatening infection or bleeding. If you experience any of the following symptoms, call your doctor immediately: fever, chills, sore throat, ongoing cough and congestion, or other signs of infection; unusual bleeding or bruising; bloody or black, tarry stools; bloody vomit; or vomiting blood or brown material that resembles coffee grounds.

Do not take pemetrexed if you are allergic to any of its ingredients.

Medicines can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of pemetrexed there are no specific foods that you must exclude from your diet when receiving this medication.

Before taking pemetrexed, tell your doctor about all of your medical conditions. Especially tell your doctor if you:

• are allergic to pemetrexed or to any of its ingredients
• have kidney problems
• have blood problems
• are pregnant or are breastfeeding

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements.

Tell your doctor if you are pregnant or plan to become pregnant.

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.

Pemetrexed falls into category D. Pemetrexed can cause harm to the unborn baby. Women should use effective contraceptive measures to prevent pregnancy during treatment with pemetrexed.

Tell your doctor if you are breastfeeding or plan to breastfeed.

It is not known whether pemetrexed can pass into breastmilk. Many drugs can pass into human milk, and because of the potential for serious reactions in nursing infants from pemetrexed, a decision should be made to stop nursing or stop the use of this drug. The importance of the drug for the mother should be taken into account.

Take pemetrexed exactly as prescribed.

This medication is available in an injectable form to be given directly into a vein (IV) by a healthcare professional.

Pemetrexed is slowly infused (injected) into a vein by a healthcare professional. The injection or infusion will last about 10 minutes. You will usually receive pemetrexed once every 21 days (3 weeks).

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 400-1000 micrograms 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.

Your doctor will prescribe a medicine called a “corticosteroid” to take for 3 days during your treatment with pemetrexed.

You will have regular blood tests before and during your treatment with pemetrexed. Your doctor may adjust your dose of pemetrexed or delay treatment based on the results of your blood tests and on your general condition.

• Combination use in Non-Small Cell Lung Cancer and Mesothelioma:
  • Pemetrexed is given on Day 1 of each 21-day cycle. It will also be given with cisplatin beginning 30 minutes after pemetrexed is given.
• Single-Agent use in Non-Small Cell Lung Cancer:
  • Pemetrexed is given on Day 1 of each 21-day cycle.

Dose Reductions or discontinuation may be needed based on toxicities from the prior cycle of therapy.

Pemetrexed is usually administered by a healthcare provider in a medical setting making it unlikely for an overdose to occur. However, if an overdose is suspected, seek emergency medical attention.