Pemetrexed

Indications
 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.
CrCl (ml/min)Dosage Recommendation
<45Usage is not recommended.

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.
CrCl (ml/min)Dosage Recommendation
<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.
Warnings / 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.
Overdose Reactions
 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.
See Below for More pemetrexed Drug Interactions
Mechanism of Actions
 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.
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 Conditions
 Intravenous: Store between 15-30°C.
ATC Classification
 L01BA04 - pemetrexed ; Belongs to the class of antimetabolites, folic acid analogues. Used in the treatment of cancer.
Storage
 Intravenous: Store between 15-30°C.
Available As
  • Pemetrexed 100 mg
  • Pemetrexed 500 mg

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