Pemetrexed (Intravenous)

Pemetrexed is used with Cisplatin in the treatment of a cancer of the lungs called malignant pleural mesothelioma.

Overview

Pemetrexed is an injected antineoplastic medication that is used in conjunction with Cisplatin to treat certain lung cancers. The treatment is used to attack malignant pleural mesothelioma (MPM), which develops in the inner lining of the chest cavity of the patient. It can also be used in the treatment of another form of lung cancer known as nosquamous non-small cell lung cancer.

Patients who are being treated with this medication will also need to be treated with other medications, in order to alleviate some of the side effects that will occur. Patients will need to take vitamin B12, folic acid and a corticosteroid treatment. Together, these will lower the chance of certain side effects, including skin reactions, from occurring.

This medication is only available for use when prescribed by a doctor and should be administered in a hospital. It is supplied as Alimta powder for solution and injected into the veins of the patient.

Condition treated

  • Malignant pleural mesothelioma (MPM)
  • Nonsquamous non-small cell lung cancer

Type Of Medicine

  • Antineoplastic
  • Chemotherapy

Side Effects

In addition to the desired effects that can occur from the use of Pemetrexed, other unwanted side effects may also occur. While not all side effects will occur, when some of them do, you will need to seek urgent medical attention.

You should consult your doctor immediately if you experience any of the following side effects from use:

Occurring more commonly:

  • Black stools with a tarry appearance
  • Bleeding from the gums
  • Chest pains
  • Chills when warm
  • Coughing
  • Feverishness
  • Loss of usual coordination
  • Lower back pain
  • Pain in the calves of the legs
  • Pain or difficulty experienced during urination
  • Pains in the chest, groin or legs
  • Paleness of the skin
  • Red spots appearing on the skin
  • Severe headaches that occur suddenly
  • Shortness of breath without exertion
  • Side pain
  • Soreness of the throat
  • Sudden occurrence of vision changes
  • Sudden slurring of speech
  • Swelling of glands
  • Trouble with breathing
  • Ulcers or sores around the mouth
  • Unusual bleeding
  • Unusual bruising
  • Unusual tiredness
  • Unusual weakness
  • White spots appearing in the mouth

Occurring less commonly:

  • Blood in the stools
  • Blood in the urine
  • Decrease in consciousness
  • Decreased in the frequency of urination
  • Decreased volume of urine
  • Fainting or faintness
  • Increased blood pressure
  • Increased rate of breathing
  • Increased thirst
  • Irregularity of breathing
  • Itching
  • Lack of hunger
  • Loss of appetite
  • Loss of consciousness
  • Nausea
  • Skin rash
  • Swelling of the eyelids
  • Swelling of the eyes
  • Swelling of the face
  • Swelling of the fingers
  • Swelling of the lower legs
  • Tightness across the chest
  • Vomiting
  • Weight gain
  • Wheezing

Frequency of occurrence not known:

  • Blistering of the skin
  • Irritated or red eyes
  • Joint pains
  • Loosening of the skin
  • Muscle pain
  • Pain and redness at site of a previous radiation treatment
  • Peeling of the skin
  • Skin lesions that may have a purple center
  • Stomach cramping
  • Stomach pains
  • Stomach tenderness
  • Watery diarrhea

Other side effects may occur from the use of Pemetrexed that would not normally require that you seek medical attention. Usually, these side effects will abate over time, will be mild and will not indicate wider medical problems that may be occurring. If these side effects are ongoing or become bothersome, then you can seek advice on how to alleviate them from your healthcare professional. The following side effects do not normally necessitate that you seek medical attention from a doctor:

Occurring more commonly:

  • Burning, numbness or tingling in the feet, legs, hands or arms
  • Changes in mood
  • Confusion or disorientation
  • Congested nose
  • Coughing
  • Decreased volume or frequency of urination
  • Diarrhea
  • Difficulty in passing a bowel movement
  • Difficulty when moving
  • Difficulty when swallowing
  • Discouragement or loss of motivation
  • Dizziness
  • Dryness of the mouth
  • Feeling sadness or emptiness
  • Hair thinning or hair loss
  • Headaches
  • Heartburn
  • Hoarseness
  • Increased heart rate
  • Inflammation or swelling in or around the mouth
  • Irritability or quickness to annoyance
  • Lightheadedness
  • Loss of interest
  • Loss of pleasure
  • Muscle aches
  • Muscle cramping
  • Muscle stiffness
  • Pain in the hands, arms, feet or legs
  • Pain or burning of the throat
  • Pain when swallowing
  • Pins and needles
  • Rapid breathing
  • Runny nose
  • Stabbing pains
  • Sunken eyes
  • Swelling
  • Swelling of the joints
  • Thinning of the hair
  • Thirstiness
  • Tiredness
  • Trouble with concentration
  • Troubled sleep
  • Weight loss
  • Wheezing
  • Wrinkling of the skin

Other side effects that have not been listed herein could also occur from your use of Pemetrexed. If you experience any other side effects, then you should contact your doctor for advice on what to do to alleviate them. If you believe your health to be at immediate risk, however, then you should always contact the emergency services.

Dosage

Patients must take the prescribed doses of vitamin B12 during treatment. Failure to do so will dramatically increase the chances that severe side effects may occur.

You must also take a dose of 400-1000mcg of folic acid daily for at least five days in the week preceding your first use of Pemetrexed. You will then need to continue taking folic acid while you are being treated with Pemetrexed and for the following 21 days after your last dose of the medication.

Both vitamin B12 and folic acid are available over the counter. You should consult your doctor for advice on how best to take folic acid and you will receive injections of vitamin B12. These will usually be given at the same time as your injection with Pemetrexed. The first dose of vitamin B12 should be given at least a week before treatment starts.

This medication will be administered in a hospital or in a treatment center for cancer. It will only ever be given by a trained healthcare professional under the supervision of a doctor and should not be used at any other time for any reason. You will be administered with the medication through a needle that is placed into the vein.

Pemetrexed will be administered along with other medications in a lot of cases. You should take all of these other medications at the correct time, so that you can avoid any unwanted side reactions from occurring. If you are taking some of these other medications orally, your doctor will give you a treatment schedule that you should follow exactly.

You should never take any more of a medication than you have been prescribed, nor should you use it more frequently or for longer than prescribed. To do so can cause severe medical complications when you are using Pemetrexed. If you miss a dose of any medication that you are due to take, you should contact your doctor to see what you should do.

You will also be prescribed treatment with corticosteroid with this medication. This will be used to prevent the occurrence of skin conditions that may develop when using Pemetrexed. You will be treated with corticosteroid for the first three days of treatment with Pemetrexed to help the body avoid this reaction.

Before you begin use of Pemetrexed, you will be given a medication guide with all of the information that you need to know before you begin treatment. It is vital that you read and fully understand this so that you are prepared for all of the side effects of the treatment that may occur. If you have any questions after reading this booklet, you should consult your doctor.

Interactions

Pemetrexed can interact with a range of medications. While it is used in conjunction with a lot of treatments, there are also many treatments that it should not be used in conjunction with. This is because medications can interact in the body and, in some cases, serious medical conditions and problems can result from incorrect use. Other medications may prevent Pemetrexed from working and may increase the risk of certain side effects occurring.

To prevent any interactions occurring with the use of Pemetrexed, you should inform your doctor of all medications that you are taking before you begin use. This includes all substances that you take, whether they were prescribed or bought over the counter or otherwise.

The use of Pemetrexed is not recommended in conjunction with the following treatments. Your doctor may decide not to administer these treatments with Pemetrexed:

The use of Pemetrexed with the following medications would not normally be recommended. In some cases, treatment with both may be necessary, but your doctor may need to make changes to the dose that is given or to the frequency of use:

  • Yellow Fever vaccine
  • Valdecoxib
  • Typhoid vaccine
  • Tolmetin
  • Tolfenamic acid
  • Tiaprofenic acid
  • Tenoxicam
  • Sulindac
  • Sodium Salicylate
  • Smallpox vaccine
  • Salsalate
  • Salicylic acid
  • Rofecoxib
  • Proquazone
  • Propyphenazone
  • Proglumetacin
  • Poliovirus vaccine, live
  • Piroxicam
  • Piketoprofen
  • Phenylbutazone
  • Parecoxib
  • Oxyphenbutazone
  • Oxaprozin
  • Nimesulide Beta Cyclodextrin
  • Nimesulide
  • Niflumic acid
  • Nepafenac
  • Naproxen
  • Nabumetone
  • Morniflumate
  • Meloxicam
  • Mefenamic acid
  • Meclofenamate
  • Lumiracoxib
  • Loxoprofen
  • Lornoxicam
  • Ketorolac
  • Ketoprofen
  • Influenza virus vaccine, live
  • Indomethacin
  • Ibuprofen
  • Flurbiprofen
  • Flufenamic acid
  • Floctafenine
  • Feprazone
  • Fepradinol
  • Fenoprofen
  • Felbinac
  • Etoricoxib
  • Etofenamate
  • Etodolac
  • Droxicam
  • Dipyrone
  • Diflunisal
  • Diclofenac
  • Dexketoprofen
  • Dexibuprofen
  • Clonixin
  • Choline Salicylate
  • Cholera vaccine, live
  • Celecoxib
  • Bufexamac
  • Bromfenac
  • Bacillus of Calmette and Guerin vaccine, live
  • Aspirin
  • Amtolmetin Guacil
  • Adenovirus vaccine
  • Acemetacin
  • Aceclofenac

Pemetrexed may also interact with other medications that have not been listed here. This list has been compiled for severity and is not necessarily all inclusive. Inform your doctor of all conditions from which you suffer before using this treatment to avoid interactions.

Other medical problems from which you suffer can also affect the use of this treatment. This is because some medical conditions will be worsened by use and because they can slow the removal of the medication from the body. Before you begin use you should inform your doctor of all medical conditions that you suffer from. This is especially important in the following cases

Pemetrexed should be used with caution in patients with the following conditions. These conditions may be worsened by use:

The following condition can increase the side effects of Pemetrexed by slowing the removal of the medication from the body. Doses used may need to be adjusted:

  • Kidney disease

Other medication conditions that have not been listed could also interact with Pemetrexed. You should inform your doctor of your full medical history before you use this treatment, to avoid the occurrence of side effects.

Warnings

Before making the decision to use any medication you should weigh the benefits against the risks with your doctor. For Pemetrexed, you should ensure that you have considered all of the following factors before using the treatments:

Allergies

You must inform your doctor of all allergies from which you suffer before use. This includes any unusual reactions you have ever had to any medications and allergies to dyes, preservatives, foods, animals or other substances. Allergies to medications could prohibit the use of these treatments.

Pediatric

The use of this medication in children has not been tested for safety and efficiency. Discuss use with your doctor.

Geriatric

There are no known limitations to the use of Pemetrexed in elderly patients. Elderly patients are, however, more likely to suffer from age-related kidney complications that may limit the use of this treatment. Be cautious of other existing medical problems that may limit use in the elderly.

Pregnancy

You must inform your doctor if you are pregnant before beginning use. The use of this medication while you are pregnant is likely to harm your unborn child. Women who are of childbearing age should use two forms of birth control during treatment to ensure that pregnancy does not occur. You must inform your doctor immediately if you believe that you have become pregnant during use. The risk is categorized as category D risk by the FDA.

Fertility

Men may be advised to seek counseling and to store sperm before undergoing this treatment.

Breastfeeding

There have been no studies carried out on the use of this medication when breastfeeding. Chemotherapy treatments are, however, known to pass into the breastmilk. You must inform your doctor if you are breastfeeding and should discuss this with them. You must weigh the risks of use against the benefits of use before beginning treatment.

You will need to have regular check ups with your doctor while you are receiving this treatment. Doing so will enable you to be checked for unwanted side effects, as well as for progress. Blood tests are likely to be taken during these check ups.

If you develop any signs of infection, then you need to consult your doctor immediately. These will need to be treated with a higher priority than normal when you are being treated with Pemetrexed, to prevent them from worsening.

Skin conditions could develop during use of the treatment and these can be very serious. If you notice any changes to the skin at all, then you should report them to your doctor, particularly if you are suffering from rashes.

You may become sick or nauseous during use of this treatment. It is vital that you continue using all of the treatments that you have been prescribed in this case. You should not stop treatment because it is making your sick.

You may not wish to eat during treatment and some weight loss may occur. If you are under-weight already, then you should discuss this with your doctor, and you may need to take nutrition supplements.

Your immune system will be temporarily lowered during use of this treatment. This is because the white blood cell count in your body will be reduced. You may also have a lower level of platelets in the blood, exposing you to a risk of bleeding problems. You should follow these steps to avoid any complications from infection or bleeding:

  • Avoid people with infections and enclosed public spaces.
  • Report any signs of infection as soon as you notice them.
  • Take extra care with oral hygiene, as brushing, flossing and picking can all cause bleeding. Discuss other options for oral care with your dentist.
  • Wash your hands and face with soap before touching your eyes, the inside of your nose or your ears.
  • Take extra care with sharp implements, such as knives or razors.
  • Avoid dangerous situations where injury may occur and do not participate in contact sports.

Do not take any other medications in conjunction with Pemetrexed unless directed to by your doctor.

Storage

Pemetrexed should be stored at 2-8 °C. Once prepared for injection, it should be used within 24 hours when stored at 2-8 °C.

Summary

Pemetrexed is used in conjunction with Cisplatin for the treatment of certain lung cancers and is used alone in the treatment of other lung cancers.

Pemetrexed is injected directly into the vein and should only ever be administered in a hospital environment. The treatment is an aggressive antineoplastic chemotherapy treatment that can have severe side effects, so you will need to be monitored immediately after treatment.

There are a wide range of side effects that may occur from the use of this medication and other medications will need to be taken to alleviate these side effects. Before beginning treatment, you should ensure that you understand the risks of doing so and have read and understood the medication guide issued with it. If you have any questions then you should consult your doctor.

Males may be advised to store sperm before use and females should not become pregnant during use. There is a severe risk to unborn children if used during pregnancy.