Pemetrexed


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult : IV Non-small cell lung cancer; Malignant pleural mesothelioma 500 mg/m2 on day 1 of each 21-day cycle. After the 1st treatment cycle, adjust subsequent doses based on nadir haematologic counts and max non-haematologic toxicity. Malignant pleural mesothelioma: Used w/ cisplatin
Dosage Details
Intravenous
Non-small cell lung cancer
Adult: 500 mg/m2 on day 1 of each 21-day cycle; dose to be given over 10 minutes via IV infusion. After the 1st treatment cycle, adjust subsequent doses based on nadir haematologic counts and max non-haematologic toxicity. Refer to full prescribing information on dose modifications according to toxicity.

Intravenous
Malignant pleural mesothelioma
Adult: 500 mg/m2 on day 1 of each 21-day cycle. Dose to be given as IV infusion over 10 minutes. To be used in combination with cisplatin which is given 30 minutes after completion of pemetrexed infusion. Ensure adequate hydration before and after cisplatin. After the 1st treatment cycle, adjust subsequent doses based on nadir haematologic counts and max non-haematologic toxicity. Refer to full prescribing information on dose modifications according to toxicity.
Renal Impairment
CrClDosage
<45Usage is not recommended.
Incompatibility
Physically incompatible with calcium-containing products. Y-site admin: Incompatible with amphotericin B, calcium gluconate, cefazolin sodium, cefotaxime sodium, cefotetan disodium, cefoxitin sodium, ceftazidime, chlorpromazine hydrochloride, ciprofloxacin, dobutamine hydrochloride, doxorubicin hydrochloride, doxycycline hyclate, droperidol, gemcitabine hydrochloride, gentamicin sulfate, irinotecan hydrochloride, metronidazole, minocycline hydrochloride, mitoxantrone hydrochloride, nalbuphine hydrochloride, ondansetron hydrochloride, prochlorperazine edisylate, tobramycin sulfate and topotecan hydrochloride.
Special Precautions
Monitor CBC. Premedication with folate and vitamin B12 are recommended as prophylaxis against haematological and GI toxicity during treatment. Pre-treatment with a corticosteroid also reduces the incidence and severity of skin reactions. Caution when used in renal or hepatic impairment. Not recommended for use in pregnancy and lactation.
Adverse Reactions
Stomatitis, pharyngitis, dyspnoea and neuropathy. Chest pain, oedema, hypertension, fatigue, fever, anorexia, nausea, vomiting, constipation, depression. Rash/desquamation and alopecia. Anaemia, leukopenia and neutropenia. Neuropathy and myalgia.
Potentially Fatal: Acute renal failure.
IV/Parenteral: D
Overdosage
Overdosage may lead to neutropenia, anaemia, thrombocytopenia, mucositis and rash. Other complications include bone marrow suppression. Treatment includes general supportive measures.
Drug Interactions
High doses of NSAIDs and aspirin may reduce the elimination of pemetrexed; avoid usage 2 days (5 days for longer-acting NSAIDs) before, during and 2 days after treatment with pemetrexed in patients with impaired renal function. Additive GI side effects when used with SSRIs, acetylcholinesterase inhibitors, aripiprazole or ziprasidone. Additive sedation when used with psychotropics. Concurrent use with nephrotoxic drugs (e.g. aminoglycosides, loop diuretics, platinum compounds and ciclosporin) may decrease pemetrexed clearance, thus increasing the risk of toxicity. Clearance may be reduced when used with drugs that are cleared by tubular secretion e.g. probenecid and penicillin.
Action
Description: Pemetrexed is a thymidylate synthase inhibitor. It works by inhibiting thymidylate synthase, dihydrofolate reductase, glycinamide ribonucleotide formyltransferase and aminoimidazole carboxamide ribonucleotide formyltransferase, the enzymes involved in folate metabolism and DNA synthesis, thus inhibiting purine and thymidine nucleotide and protein synthesis.
Pharmacokinetics:
Distribution: Protein binding: 81%.
Metabolism: Limited hepatic metabolism.
Excretion: Elimination half-life: 3.5 hr. Approximately 70-90% of a dose is eliminated unchanged in the urine within 24 hr.
Storage
Store between 15-30°C.
Disclaimer: This information is independently developed by MIMS based on Pemetrexed from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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