Pemetrexed

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Generic Name of Pemetrexed - Learn More

Pemetrexed

Pemetrexed Precaution - What You Need to Know

Before starting Pemetrexed, patients must consult their healthcare provider to ensure the medication is appropriate for their condition and medical history. Pemetrexed is typically used to treat non-small cell lung cancer (NSCLC) and mesothelioma, and its use requires careful consideration due to the following precautions:

- Renal Impairment: Pemetrexed is primarily excreted through the kidneys, so patients with renal insufficiency (e.g., creatinine clearance less than 45 mL/min) should receive careful dose adjustments. Kidney function should be monitored closely during treatment.
- Bone Marrow Suppression: Pemetrexed can cause hematologic toxicity, including neutropenia, thrombocytopenia, and anemia. Regular blood counts should be monitored before each cycle to detect any abnormalities early. Patients with existing bone marrow suppression should be carefully monitored.
- Liver Function: Although rare, hepatic toxicity can occur with Pemetrexed. Patients with liver dysfunction or abnormal liver tests should be assessed prior to and during treatment.
- Pregnancy and Breastfeeding: Pemetrexed is classified as Category D for pregnancy, meaning there is evidence of harm to the fetus. It should not be used during pregnancy unless absolutely necessary, and women should be advised not to become pregnant during treatment. It is unknown whether Pemetrexed passes into breast milk, so breastfeeding should be avoided.
- Folic Acid and Vitamin B12: Adequate supplementation with folic acid (400-1,000 mcg daily) and vitamin B12 (1,000 mcg intramuscularly every 3 weeks) is recommended to reduce the risk of hematologic toxicity, particularly in patients receiving Pemetrexed in combination with other chemotherapy agents.

Pemetrexed Indication - Uses and Benefits

Pemetrexed is indicated for the treatment of several cancers, including:

- Non-Small Cell Lung Cancer (NSCLC): Pemetrexed is commonly used in combination with cisplatin for the treatment of advanced or metastatic nonsquamous non-small cell lung cancer (NSCLC). It can also be used as a maintenance treatment after initial chemotherapy in patients with stable disease.
- Malignant Pleural Mesothelioma: It is used in combination with cisplatin for the treatment of malignant pleural mesothelioma, a rare cancer that affects the lining of the lungs, particularly in patients who are not candidates for surgery.
- Other Cancers: In some cases, Pemetrexed is used off-label to treat other cancers, including bladder cancer or head and neck cancers, though its primary indications remain lung cancer and mesothelioma.

Pemetrexed Contraindications - Important Warnings

Pemetrexed should not be used in the following circumstances:

- Hypersensitivity: Any patient with a known hypersensitivity or allergic reaction to Pemetrexed or any of its components should avoid its use.
- Severe Renal Impairment: Pemetrexed is contraindicated in patients with creatinine clearance less than 45 mL/min due to the risk of significant toxicity, particularly because it is cleared by the kidneys.
- Pregnancy: Pemetrexed is contraindicated during pregnancy due to the potential for harm to the fetus. It is crucial to perform a pregnancy test prior to starting treatment and to avoid pregnancy during and after therapy.
- Severe Bone Marrow Suppression: Pemetrexed is contraindicated in patients with severe bone marrow suppression (low white blood cells, red blood cells, or platelets) due to the risk of exacerbating hematologic toxicity.
- Severe Hepatic Impairment: Pemetrexed should be used with caution in patients with significant liver dysfunction, and its use is generally avoided in those with severe liver disease.

Pemetrexed Side Effects - What to Expect

Pemetrexed can cause a variety of side effects, from mild to severe. Patients should promptly report any unusual symptoms to their healthcare provider.

- Common Side Effects:
- Fatigue and weakness.
- Nausea and vomiting.
- Loss of appetite and weight loss.
- Diarrhea or constipation.
- Rash or skin reactions.
- Hair thinning or alopecia (hair loss).

- Severe Side Effects:
- Hematologic Toxicity: Severe reductions in blood counts, including neutropenia, thrombocytopenia, and anemia, which can lead to increased risk of infections, bleeding, and fatigue.
- Liver Toxicity: Pemetrexed can cause liver problems, including elevated liver enzymes or jaundice, which may require dose adjustment or discontinuation.
- Kidney Toxicity: Impaired renal function can result from Pemetrexed, particularly in patients with pre-existing renal issues.
- Respiratory Toxicity: Pneumonitis (inflammation of lung tissue) has been reported, though rare. Symptoms include cough, difficulty breathing, and fever.
- Severe Skin Reactions: Rarely, blistering, peeling, or severe skin rash may occur.
- Neurological Effects: Neuropathy and confusion, although uncommon, can occur, particularly with extended use.

Pemetrexed Pregnancy Category ID - Safety Information

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Pemetrexed Mode of Action - How It Works

Pemetrexed is classified as an antimetabolite chemotherapy drug. Its mechanism of action involves interfering with DNA and RNA synthesis in rapidly dividing cells, which is crucial for the treatment of cancer.

- Folate Antagonist: Pemetrexed is a folate analogue that inhibits the enzyme thymidylate synthase and other enzymes involved in purine and pyrimidine metabolism. These enzymes are necessary for DNA synthesis, and by blocking their activity, Pemetrexed prevents cancer cells from dividing and growing.
- Cell Cycle Arrest: The inhibition of these enzymes leads to cell cycle arrest and subsequent apoptosis (programmed cell death) in rapidly dividing tumor cells, particularly in mesothelioma and NSCLC.

Pemetrexed Drug Interactions - What to Avoid

Pemetrexed may interact with several other medications and substances, potentially affecting its efficacy or increasing the risk of adverse effects:

- Cisplatin: When used in combination with cisplatin (a chemotherapy agent), the combination is well-established in treating lung cancer and mesothelioma. However, careful monitoring of kidney function is necessary because both drugs can cause renal toxicity.
- NSAIDs (Non-Steroidal Anti-Inflammatory Drugs): NSAIDs, especially those with long half-lives (e.g., ibuprofen, indomethacin), should be avoided prior to and after Pemetrexed administration due to the potential for renal toxicity. If NSAIDs must be used, they should be stopped 2 days before and after treatment with Pemetrexed.
- Folic Acid and Vitamin B12 Supplements: As mentioned above, folic acid and vitamin B12 supplements are recommended to reduce hematologic toxicity, but high doses should not exceed recommended levels, as they might affect Pemetrexed's mechanism.
- Other Chemotherapy Agents: Pemetrexed should be used cautiously with other chemotherapy agents. Combination therapy requires monitoring for overlapping toxicities such as bone marrow suppression, gastrointestinal toxicity, and organ damage.
- Live Vaccines: Pemetrexed can weaken the immune system, so patients should avoid live vaccines while receiving treatment, as these vaccines could cause infections in immunocompromised individuals.

Pemetrexed Adult Dose - Recommended Dosage

The dosing of Pemetrexed in adults depends on the specific cancer being treated:

- Non-Small Cell Lung Cancer (NSCLC): The typical dose is 500 mg/m² intravenously once every 21 days in combination with cisplatin.
- Malignant Pleural Mesothelioma: The usual dose is also 500 mg/m² intravenously once every 21 days in combination with cisplatin.
- Other Indications: The dose may vary depending on the specific type of cancer and the patient's overall health.

Pemetrexed Child Dose - Dosage for Children

Pemetrexed is not typically used in pediatric patients, and its safety and efficacy in children have not been established. Use in pediatric patients should be considered only in clinical trials or for specific oncological conditions under the supervision of an oncologist.

Pemetrexed Renal Dose - Dosage for Kidney Conditions

For patients with mild renal impairment (creatinine clearance 45-79 mL/min), no dose adjustment is required. However, for moderate renal impairment (creatinine clearance 30-44 mL/min), a dose reduction is recommended. In patients with severe renal impairment (creatinine clearance less than 30 mL/min), Pemetrexed should generally be avoided due to the risk of increased toxicity, and dose adjustments are required in consultation with an oncologist.