Pemetrexed

Uses	Non-Small Cell Lung Cancer And Mesothelioma
Therapy	Anti-Neoplastic
Side Effects	Tiredness, Low Blood Counts, Nausea, Mouth Ulcers

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Molecule Description

Pemetrexed is an anti-cancer medicine that belongs to the folate analogue metabolic inhibitors group. It is used in the maintenance treatment of locally advanced or metastatic Non-Small Cell Lung Cancer (other than predominantly squamous cell histology) whose disease has not progressed immediately following platinum-based chemotherapy. Pemetrexed works by blocking certain enzymes that cancer cells need to make new DNA and multiply. Pemetrexed is given as an intravenous (IV) infusion by a doctor or nurse in a hospital or clinic. Pemetrexed can affect the bone marrow, lowering the number of white blood cells, red blood cells, and platelets. It increases the risk of infection and bleeding and causes tiredness and breathlessness. Your doctor will regularly check your blood counts and kidney function before and during treatment, and treatment. A key warning during treatment is a significant drop in urine output, which may indicate a kidney issue needing urgent medical care. Pemetrexed can cause side effects like mouth sores, appetite loss, nausea, and vomiting. Before treatment begins, tell your doctor about any kidney problems, any past radiation therapy, and whether you are pregnant, planning a pregnancy, or breastfeeding.

Uses

Management of Non Small Cell Lung Cancer.

Contraindications

When should one not use Pemetrexed

Known history of a severe allergic (hypersensitivity) reaction to Pemetrexed or any of its ingredients.

Side effects

Common side effects of this drug are:

Tiredness or weakness
Nausea
Loss of appetite
Constipation
Low blood cell counts
Skin rash
Taste changes
Numbness or tingling in hands or feet
Hair thinning
Mild swelling
Indigestion
Vomiting
Diarrhea
Mouth sores or inflammation
Fever, chills, sore throat, or other signs of infection; unusual bruising or bleeding; severe tiredness or paleness
A significant reduction in urine output or other signs of kidney problems .
New or worsening breathlessness, dry cough, or fever
Swelling, blistering, or a sunburn-like rash in an area that previously received radiation therapy

Precautions and Warnings

Pregnancy

No, Pemetrexed is not recommended during pregnancy as it can cause serious harm to an unborn baby. Women who can become pregnant should use effective contraception during and for some time post-treatment, after discussing it with your doctor.

Breast Feeding

It is not known whether Pemetrexed passes into breast milk, but because of the potential for serious side effects in a breastfeeding infant, women are advised not to breastfeed during treatment.

Driving

Pemetrexed treatment can cause tiredness, weakness, dizziness, or other side effects that may affect your alertness and coordination. If you experience these symptoms after your infusion, avoid driving or operating machinery until you feel well enough to do so safely.

Alcohol

There is no specific established alcohol interaction with pemetrexed. However, alcohol may worsen symptoms such as nausea, vomiting, or fatigue. Discuss alcohol consumption with your doctor.

Other General Warnings

Talk to your doctor if

You have kidney impairment, as pemetrexed is mainly eliminated by the kidneys and impaired kidney function can increase toxicity.
You have a history of bone marrow problems or are taking other medicines that affect blood counts
You have previously received radiation therapy, especially to the chest.
You are taking NSAIDs such as ibuprofen, particularly if you have reduced kidney function.
You are male and concerned about future fertility
You have a history of severe skin reactions to any medicine
You experience severe vomiting or diarrhoea during treatment
Attend all scheduled blood tests to confirm blood counts and kidney function are safe before each cycle.
Take the pre-medication as directed by your doctor.
Contact your doctor immediately if you notice fever, signs of infection, unusual bleeding or bruising, a marked drop in urine output, new breathlessness or cough, or any skin blistering or peeling.
If you or your partner could become pregnant, use effective contraception during treatment and follow your doctor's advice about contraception after treatment. .
Pemetrexed is a hospital-administered medicine, so the pharmacy normally handles storage and disposal.
Pemetrexed and related infusion supplies are kept safely out of reach of children within the clinical area.

Mode of Action

How Does It Work?

Pemetrexed belongs to a class of medicines called folate analogue metabolic inhibitors. Folate (a B-vitamin) is needed by cells to make the building blocks required for DNA and RNA. Pemetrexed blocks several enzymes that depend on folate and are needed to make DNA and RNA. This makes it difficult for cancer cells to copy their genetic material and divide, which slows their growth and can eventually cause them to die.

Interactions

Interactions with other medicines

Non-steroidal anti-inflammatory drugs (NSAIDs), including ibuprofen, may affect how quickly the kidneys clear pemetrexed and can increase the risk of toxicity, particularly in patients with impaired kidney function. Your doctor may advise you to avoid certain NSAIDs around the time of treatment.
Other medicines that affect kidney function may also increase the risk of pemetrexed toxicity.
Always tell your doctor about every prescription medicine, over-the-counter medicine, vitamin, and herbal or dietary supplement you are taking to plan your treatment safely.

Interactions with food items

No specific food interactions have been established for Pemetrexed. Follow any dietary advice given by your doctor or pharmacist during treatment.

Dosage

Overdose

There is no specific antidote for Pemetrexed overdose. Because Pemetrexed is always administered and monitored in a healthcare setting by trained staff, the chance of overdose is very low. If an overdose occurs, supportive treatment and close monitoring are required.

Missed a Dose

If you miss a planned infusion or need to reschedule, contact your doctor as soon as possible.

Frequently Asked Questions (FAQs)

These vitamins are given specifically to reduce the risk and severity of certain side effects from pemetrexed, including effects on blood counts and the digestive system. They should be taken exactly as prescribed.

Ask your doctor before taking any pain or fever medicine. NSAIDs such as ibuprofen may require special precautions around pemetrexed treatment, particularly if kidney function is reduced.

Tell your doctor, as mouth sores (mucositis) are a recognised side effect. Your doctor may recommend supportive measures and, if severe, may need to adjust your dose.

Tiredness (fatigue) is one of the most common side effects of Pemetrexed. Rest when needed, but tell your doctor if fatigue is severe or worsening, as this should be evaluated.

Because Pemetrexed can lower your white blood cell count and increase infection risk, avoid close contact with people who have infections and follow your healthcare team's advice, especially when your blood counts are low.