Monitor patients for myelosuppression; should not be given in patients w/ absolute neutrophil count <1,500 cells/mm3
& platelet count <100,000 cells/mm3
. Pre-treatment w/ dexamethasone (or equivalent) & co-administration w/ folic acid & vit B12
while under treatment is recommended. Reports of serious renal events (eg, acute renal failure). Regularly monitor patients for acute tubular necrosis, decreased renal function & signs & symptoms of nephrogenic diabetes insipidus. Uncommon reports of serious CV events (eg, MI & CVA) usually in combination w/ another cytotoxic agent & in patients w/ pre-existing CV risk factors. Reports of radiation pneumonitis in patients treated w/ radiation prior, during or subsequent to pemetrexed therapy. Radiosensitising agents must be used w/ caution. Reports of radiation recall in patients who received radiotherapy wk or yr previously. Concomitant use w/ live attenuated vaccine is not recommended. May affect ability to drive & operate machines. Avoid high-dose NSAIDs in patients w/ mild to moderate renal insufficiency (CrCl 45-79 mL/min) 2 days before, on the day of, & 2 days following pemetrexed administration. Concomitant administration w/ NSAIDs having longer t½
(eg, piroxicam or rofecoxib) should be interrupted in patients w/ mild to moderate renal insufficiency for at least 5 days prior to, on the day of, & at least 2 days following pemetrexed administration. Not recommended in patients w/ CrCl <45 mL/min. Contraceptive measures or abstinence are recommended in males during treatment & up to 6 mth thereafter; counselling on sperm storage prior to treatment initiation is recommended. Women of childbearing potential must use effective contraception during treatment. Pregnancy. Discontinue breast-feeding while under therapy. 500-mg:
May affect patients on controlled Na diet.