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Pemetrexed (Alimta ) 


Brand name: Alimta  


Generic name:Pemetrexed     

Therapeutic Class: antifolate antineoplastic agent 

Manufacturer / Distributor:   Eli Lilly and Co 

Availability:  Pemetrexed is available by prescription only  

FDA Approval - Pemetrexed was approved in February 2004 by the US FDA (Food and Drug Administration) for treatment of malignant pleural mesothelioma, in combination with cisplatin. Thereafter, in September 2008, the FDA approved the drug as a first-line treatment, in combination with cisplatin, of locally-advanced and metastatic non-small cell lung cancer (NSCLC) in patients with non-squamous histology.  

Indications: Pemetrexed is used to treat the following malignancies: 

  • pleural mesothelioma that was not previously treated with other chemotherapy drugs. Most of the times, Pemetrexed is used in combination with another chemotherapy drug called cisplatin.  
  • Advanced or metastatic non-small cell lung cancer that was treated with monochemotherapy. 

Your doctor can use Pemetrexed to treat other medical conditions non-mentioned in this article if he believes it may be helpful.  

Dosage form: Pemetrexed is taken by injection into a vein (intravenous, IV), usually associated with cisplatin. In addition, you can be prescribed folic acid and vitamin B12 to supplement your diet in order to reduce the development of side effects.  

Dosage:  l  ike any chemotherapy drug, Pemetrexed must be administered only by medical professionals experienced in the use of anticancer chemotherapy. The instructions recommended should be respected. In other words, PEMETREXED solution must be prepared and administered according to the FDA approved indications 

When Pemetrexed is used in combination with cisplatin, the dosage is usually 500 mg / m² Body Surface Area (BSA). The drug is recommended to be taken by intravenous infusion during a period of 10 minutes, once every 21 days. The recommended dose of cisplatin is 75 mg / m² body surface area (BSA) injected   over 2 hours. It is recommended to start the injection about 30 minutes after the Pemetrexed injection. To increase the curative effects and decrease the side effects of Pemetrexed, the therapy must be accompanied by an antiemetic treatment (against vomiting and nausea) and adequate hydration before and after the injection of cisplatin.  

Overdose:   Pemetrexed is given by intravenous injection, usually in combination with other drugs. The drug is given by a specialist in oncology, hematology, or by a competent physician that has experience in giving chemotherapy medications; this reduces any chance of overdose. However, in cases of overdose symptoms, your doctor may reduce the dosage or stopping the treatment completely. Therefore, if you experience signs or symptoms of complications (see side effects), contact your doctor immediately.  

Missing dose: since Pemetrexed is administered in hospital, missing dose is basically difficult if you are present for your appointment. If for some reasons you cannot go to the hospital for the treatment, contact your doctor before the date schedule for the injection.  

Contraindication:  PEMETREXED is contraindicated in the following conditions: 

  • children or adolescent below 18 years   
  • in association with vaccine against yellow fever   
  • allergy to mannitol, Pemetrexed or any of its ingredients   
  • kidney or liver disease   
  • Breastfeeding - Pemetrexed increased the risk of adverse reactions in breastfed infant; therefore, breastfeeding should be discontinued during treatment with Pemetrexed;  
  • Pregnancy - Pemetrexed can cause birth defects when administered during pregnancy. It is recommended that all women of childbearing age, and who are sexually active to follow an effective contraceptive method during treatment with Pemetrexed to avoid pregnancy. It is also recommended that men do not conceive after 6 months of taking Pemetrexed.   

Mechanism of Action (MOA)  : Pemetrexed acts by inhibiting several metabolic processes involved in the synthesis of DNA, and therefore prevents multiplication of cancer cells. 

Interactions:  If you are taking Pemetrexed, talk to your doctor before taking any prescription or nonprescription medications: Advil, Motrin, Aleve, Naprosyn, and others. Other than folic acid and vitamin 12, you should not take vitamins, nutritional supplements or/and herbal products without the recommendation of your doctor.  

Side effects: to reduce the occurrence and severity of skin reactions, a corticosteroid is recommended to be administered the day before, the same day and the day after taking Pemetrexed. In general, the dosage is 4 mg of dexamethasone (Decadron) taken by mouth twice a day. In addition, your doctor may recommend you to take folic acid or a multivitamin containing folic acid daily. At least five doses of folic acid must be taken within 7 days before the first dose of Pemetrexed. You should continue taking the supplement during the duration of the treatment and for 21 days following the last day of the therapy.  

You may also be prescribed an intramuscular injection of vitamin B12 in the week preceding the first dose of Pemetrexed and once every three cycles. Subsequent injections of vitamin B12 can take place the same day as the therapy.   

Taking Pemetrexed tends to damage the bone marrow, which causes a deficiency of white blood cells, red blood cells and platelets. In addition, the toxicity of the drug may cause adverse reaction in most patients. Most common Pemetrexed side effects include:  

  • diarrhea   
  • Vomiting  
  • confusion  
  • insomnia   
  • nausea  
  • abdominal pain 
  • loss of appetite  
  • loss of taste (dysgeusia) 
  • weight loss  
  • fatigue 
  • pale skin or/and skin rashes 
  • hair loss 
  • headache   
  • rapid heart beat 
  • changes in mood  
  • depression  
  • joint or muscle pain  
  • Bowel problems (diarrhea or constipation  ).   

Contact your health care provider right away if you experience at least one of the following:  

  • dizziness or faintness   
  • chest pain and/or cough  
  • unreasonable bleeding or bruising   
  • difficulty breathing and/or swallowing  
  • difficultor altered speech (dysphonia) 
  • weakness or numbness of an arm or leg 
  • Pain, numbness, or tingling in the hands or feet.