Pemetrexed


Generic Medicine Info
Indications and Dosage
Intravenous
Malignant pleural mesothelioma
Adult: In combination with cisplatin: 500 mg/m2 on day 1 of each 21-day cycle given via infusion over 10 minutes. Doses are individualised based on nadir haematologic counts or maximum non-haematologic toxicity. Refer to detailed product guidelines for dose adjustments according to toxicity.

Intravenous
Non-small cell lung cancer
Adult: As monotherapy or in combination with other antineoplastic agents: 500 mg/m2 on day 1 of each 21-day cycle given via infusion over 10 minutes. Doses are individualised based on nadir haematologic counts or maximum non-haematologic toxicity. Refer to detailed product guidelines for dose adjustments according to toxicity.
Renal Impairment
CrCl (mL/min) Dosage
<45 Not recommended.
Reconstitution
Reconstitute vials labelled as 100 mg and 500 mg with 4.2 mL and 20 mL of 0.9% NaCl (preservative free) respectively. Further dilute with 100 mL 0.9% NaCl.
Incompatibility
Incompatible with solutions containing Ca such as Ringer’s solution and lactated Ringer’s solution.
Contraindications
Hypersensitivity. Lactation. Concomitant use with yellow fever vaccine.
Special Precautions
Patient with hypertension, diabetes, dehydration, CV disorders. Patient who have received radiation therapy. Renal impairment.
Adverse Reactions
Significant: Hypersensitivity, severe myelosuppression (e.g. anaemia, neutropenia, thrombocytopenia, pancytopenia), gastrointestinal toxicity, radiation recall, dehydration, nephrogenic diabetes insipidus, renal tubular necrosis.
Eye disorders: Conjunctivitis.
Gastrointestinal disorders: Stomatitis, pharyngitis, nausea, vomiting, diarrhoea, anorexia, constipation, dyspepsia.
General disorders and administration site conditions: Fever, fatigue.
Investigations: Raised creatinine, tranasminases; decreased CrCl.
Nervous system disorders: Neuropathy, taste disturbance.
Skin and subcutaneous tissue disorders: Rash, desquamation, alopecia, pruritus.
Potentially Fatal: Stevens-Johnson syndrome, toxic epidermal necrolysis, nephrotoxicity, pulmonary toxicity.
Monitoring Parameters
Monitor CBC with differential and platelets prior to each cycle, on days 8 and 15, and as necessary; renal functions (e.g. serum creatinine, CrCl, and BUN); total bilirubin, ALT, AST. Assess for signs and symptoms of mucositis and diarrhoea, pulmonary toxicity, dermatologic reactions, and radiation recall.
Overdosage
Symptoms: Sensory polyneuropathy, mucositis, rash, anaemia, neutropenia, thrombocytopenia. Management: Supportive treatment.
Drug Interactions
Increased plasma concentrations with NSAIDs (e.g. ibuprofen) and aspirin. Delayed excretion with nephrotoxic drugs (e.g. aminoglycosides, loop diuretics, platinum compounds, ciclosporin), probenecid, and penicillin.
Action
Description: Pemetrexed, a folic acid antagonist, works by inhibiting the enzymes involved in folate metabolism and DNA synthesis such as thymidylate synthase, dihydrofolate reductase, glycinamide ribonucleotide formyltransferase, and aminoimidazole carboxamide ribonucleotide formyltransferase, thereby causing an inhibition of purine and thymidine nucleotide and protein synthesis.
Pharmacokinetics:
Distribution: Plasma protein binding: 81%.
Metabolism: Undergoes limited metabolism in the liver.
Excretion: Via urine (70-90% as unchanged drug). Elimination half-life: 3.5 hours.
Chemical Structure

Chemical Structure Image
Pemetrexed

Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 135410875, Pemetrexed. https://pubchem.ncbi.nlm.nih.gov/compound/Pemetrexed. Accessed Dec. 21, 2020.

Storage
Store intact vials at 25°C. Reconstituted solutions can be stored between 2-8°C for 24 hours. This is a cytotoxic drug. Follow applicable procedures for receiving handling, administration, and disposal.
ATC Classification
L01BA04 - pemetrexed ; Belongs to the class of antimetabolites, folic acid analogues. Used in the treatment of cancer.
References
Alimta Powder for Concentrate for Solution for Infusion (Eli Lilly and Company). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my/ . Accessed 02/10/2020.

Alimta Powder, Lyophilized, for Solution (Eli Lilly and Company). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 02/10/2020.

Anon. Pemetrexed. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 02/10/2020.

Anon. Pemetrexed. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 02/10/2020.

Buckingham R (ed). Pemetrexed Disodium. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 02/10/2020.

Joint Formulary Committee. Pemetrexed. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 02/10/2020.

Pemetrexed 500 mg Powder for Concentrate for Solution for Infusion (Reig Jofre UK Limited). MHRA. https://products.mhra.gov.uk/. Accessed 02/10/2020.

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 © 2021 MIMS. All rights reserved. Powered by MIMS.com
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