Posted on December 3rd, 2008 by
Generic Name: Pemetrexed (pe-me-TRECKS-ate) sodium
Trade Name: Alimta®
How is this drug used? Pemetrexed is FDA approved for treatment of inoperable malignant pleural mesothelioma in combination with the chemotherapy agent cisplatin, and for the treatment of non-small cell lung cancer. It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.
What is the mechanism of action? Pemetrexed belongs to a class of drugs called anti-folates. Pemetrexed produces its anti-cancer effects by disrupting metabolic processes of a cell that are dependent upon folate. By disruption of folate-dependent pathways, development of new DNA is inhibited, and cellular replication is not able to take place.
How is pemetrexed given (administered)? Pemetrexed is administered into a vein (intravenous) and the dose depends on several factors, including the condition being treated, the size of the patient, the particular regimen being used, and the overall health of the patient. Patients also receive daily injections of vitamin B12 as well as daily oral doses of folic acid to reduce side effects caused by pemetrexed. Corticosteroids may be given a few days prior to treatment with pemetrexed to reduce the incidence or severity of side effects to the skin caused by treatment.
How are patients monitored? Patients will usually have scheduled meetings with their healthcare provider while they are being treated with pemetrexed. Typically, blood will be drawn to check levels of blood cells and to monitor functions of some organ systems, such as the kidneys or liver. Patients may also undergo physical examinations, scans or other measures to assess side effects and response to therapy. Patients will also be monitored for blood clots. Patients experiencing swelling, pain or redness in one extremity and not the other, sudden difficulty or pain in breathing, sudden and severe headache or visual disturbances should tell their healthcare provider immediately.
What are the common (occur in 30% or more of patients) side effects of treatment with pemetrexed?
• Low levels of white blood cells - increases risk of infection
• Low levels of red blood cells - increases risk of anemia
• Low levels of platelets - increases risk of bleeding
• Inflammation, irritation or sores of the lining of the mouth or lips
• Inflammation or sores of the throat
• Scaly or peeling skin
• Loss of appetite accompanied by weight loss
• Nausea and vomiting
What are the less common (occur in 10% to 29% of patients) side effects of treatment with pemetrexed?
• Shortness of breath, difficulty breathing
• Chest pain
• Mood alteration or depression
• Changes in kidney function levels as determined by blood tests
This is not a complete list of side effects. Some patients may experience other side effects that are not listed here. Patients may wish to discuss with their physician the other less common side effects of this drug, some of which may be serious.
Some side effects may require medical attention. Other side effects do not require medical attention and may go away during treatment. Patients should check with their physician about any side effects that continue or are bothersome.
What can patients do to help alleviate or prevent discomfort and side effects?
• Pay careful attention to the physician’s instructions and inform the physician of any side effects.
• Maintain adequate rest and nutrition.
• Wear sunscreen and protective clothing and try to minimize sun exposure.
• Drink plenty of fluids. (Patients should ask their physician about the amount of liquid to consume during a day.)
• If possible, patients should avoid large crowds or persons who are sick or not feeling well, as this drug may leave some patients susceptible to infection.
• Wash hands often to reduce the risk of infection.
• Avoid activities that may cause injury or bruising.
• Use a soft toothbrush and an electric razor to prevent cuts on the mouth or skin.
• Eat small meals frequently to help alleviate nausea
Are there any special precautions patients should be aware of before starting treatment?
• Patients should inform their physician if they are pregnant, breastfeeding or planning a family in the near future. This drug may cause birth defects. It is important to use some kind of birth control while undergoing treatment. Also, patients may want to talk to their physician if they are considering having children in the future, since some drugs may cause fertility problems.
• It is important that patients inform their physician of any pre-existing conditions (chicken pox, heart disease, kidney disease, liver disease, lung disease, etc.) as they may worsen with this drug.
• Patients should inform their physician of any other medication they are taking (whether prescription or over-the-counter, including vitamins, herbs, etc.) as they may interfere with treatment.
• Patients should check with their physician before starting any new drug or nutritional supplement.
• Patients should inform their physician of any known drug or food allergies or any reactions to medications they have experienced in the past.
• It is recommended that pemetrexed be taken with daily supplementation of folic acid and injections of B12 about every 9 weeks. Patients should adhere to the schedule recommended to them by their physician and should not skip doses even if they are tolerating therapy well.
• If a dose of folic acid is missed, patients should not double up on their next dose, but should contact their healthcare provider.
When should patients notify their physician?
• Fever, chills
• Sore throat
• Areas of redness, swelling, pus, pain
• Extreme or persistent fatigue
• Unexplained or prolonged bleeding or bruising
• Blood in the urine
• Black, tarry stools
• Sores or severe pain in the mouth, lips or throat
• Severe or persistent diarrhea
• Severe or persistent nausea or vomiting
• Severe or persistent constipation
• Swelling of the feet and ankles
• Sudden weight gain
• Extreme weight loss
• Chest pain
• Difficulty breathing or shortness of breath
• Swelling, redness or pain in one extremity and not the other
• Severe or prolonged rash or itching
What is a package insert?
A package insert is required by the FDA and contains a summary of the essential scientific information needed for the safe and effective use of the drug for healthcare providers and consumers. A package insert typically includes information regarding specific indications, administration schedules, dosing, side effects, contraindications, results from some clinical trials, chemical structure, pharmacokinetics and metabolism of the specific drug. By carefully reviewing the package insert, you will get the most complete and current information about how to safely use this drug. If you do not have the package insert for the drug you are using, your pharmacist or physician may be able to provide you with a copy.
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