Pexate 100/Pexate 500

Pexate 100/Pexate 500 Drug Interactions







Full Prescribing Info
Drug Interactions
Pemetrexed is primarily eliminated unchanged by tubular secretion and to a lesser extent by glomerular filtration. In vitro studies indicate that Pemetrexed is actively secreted by OAT3 (organic anion transporter 3). Concomitant administration of nephrotoxic drugs (e.g. aminoglycoside, loop diuretics, platinum compounds, cyclosporin) could result in delayed clearance of Pemetrexed. This combination should be used with caution. If necessary, creatinine clearance should be closely monitored.
Concomitant administration of substances that are also tubularly secreted (e.g. probenecid, penicillin) could potentially result in delayed clearance of Pemetrexed. Caution should be made when these drugs are combined with Pemetrexed. If necessary, creatinine clearance should be closely monitored.
In patients with normal renal function (creatinine clearance ≥80 mL/min), high doses of non-steroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen >1,600 mg/day) and aspirin at higher dosage (≥1.3 g daily) may decrease Pemetrexed elimination and, consequently, increase the occurrence of Pemetrexed to patients with normal function (creatinine clearance ≥80 mL/min). In patients with mild to moderate renal insufficiency (creatinine clearance from 45 to 79 mL/min), the concomitant administration of Pemetrexed with NSAIDs (e.g. ibuprofen) or aspirin at higher dosage should be avoided for 2 days before, on the day of, and 2 days following Pemetrexed administration (see Precautions).
In the absence of data regarding potential interaction between Pemetrexed and NSAIDs with longer half-lives as piroxicam or rofecoxib in patients with mild to moderate renal insufficiency, patients with mild to moderate renal insufficiency taking these NSAIDs should interrupt dosing for at least 5 days before, o the day of, and at least 2 days after Pemetrexed administration (see Precautions). Pemetrexed undergoes limited hepatic metabolism. Results from in vitro studies with human liver microsomes indicated that Pemetrexed would not be predicted to cause clinically significant inhibition of the metabolic clearance of drugs metabolised by CYP3A, CYP2D6, CYP2D9 and CYP1A2.
Interactions Common to All Cytotoxics: Due to the increased thrombotic risk in patients with cancer, the use of coagulation treatment is frequent. The high intraindividual variability of the coagulation status during diseases and the possibility of interaction between oral anticoagulants and anticancer chemotherapy require increased frequency of INR (International Normalised Ratio) monitoring, if it is decided to treat the patient with oral anticoagulant.
Concomitant Use Contraindicated: Yellow fever vaccine. Risk of fatal generalised vaccinale disease (see Contraindications).
Concomitant Use Not Recommended: Live attenuated vaccines (except yellow fever). Risk of systemic, possibly fatal, disease. The risk is increased in subjects who are already immunosuppressed by their underlying disease. Use an inactivated vaccine where it exists (poliomyelitis) (see Precautions).
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