• Country: Thymoorgan Pharmazie GmbH
• Brand: Germany 

1. What is Pemetrexed? 

Pemetrexed, also known by the common name Alimta, belongs to the folate antimetabolites class of chemotherapy drugs. The drug works by inhibiting three enzymes in the synthesis: purine and pyrimidine - thymidylate synthase (TS), dihydrofolate reductase (DHFR) and glycinamide ribonucleotide formyltransferase (GARFT).

Pemetrexed is a lyophilized powder for solution for infusion, lyophilized powder for solution for intravenous infusion.

2. Uses of Pemetrexed

Pemetrexed is used by doctors to treat certain types of cancer, such as non-small cell lung cancer and pleural mesothelioma.

Non-small cell lung cancer: Pemetrexed is indicated in combination with cisplatin, for use in locally advanced or metastatic non-small cell lung cancer. Pemetrexed is also used to treat certain other cancers, such as: metastatic cervical or bladder cancer, ovarian cancer, or metastatic thymic melanoma

3. Dosage - how to take Pemetrexed

3.1. How to use Pemetrexed?

Pemetrexed drug is used to inject directly into the patient's vein for 10 minutes, the injection time is 3 weeks.

To limit unwanted side effects, doctors will often recommend that patients take folic acid and vitamin B12 supplements before and during treatment with pemetrexed.

For folic acid: Take folic acid daily and should be taken 5 to 7 days before the first dose of pemetrexed is given.
For vitamin B12: Use the injectable form, injected into the muscle 1 week before the patient receives pemetrexed injection. Note, patients must not arbitrarily replace vitamin B12 from oral to injectable form, before changing, must consult a doctor.
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3.2. Amount

Dosage for patients with malignant pleural mesothelioma:
When used in combination with cisplatin, pemetrexed will be injected at a dose of about 500 mg/m2 over 10 minutes on the first day, used in a 21-day cycle.

After about 30 minutes, when pemetrexed infusion is finished, an additional 75mg/m2 of cisplatin is given over 2 hours.

The usual adult dose for non-small cell lung cancer is used in the same way as for patients with malignant pleural mesothelioma.
For patients with metastatic bladder cancer: 500 mg/m2 BSA is applied on the first day of each 21-day treatment cycle.
For ovarian cancer patients: Apply the first dose of 500 mg/m2 BSA on the first day of each 21-day treatment cycle.
For patients with cervical cancer or recurrence: The dose is 500 mg/m2 BSA or 900 mg/m2 BSA on the first day of each 21-day treatment cycle.
For patients with metastatic thymic malignancies: 500 mg/m2 BSA should be applied on the first day of each 6-day treatment cycle.
Special note with:

For children, pregnant women and lactating women, there is currently no specific general dosage, so when using it, it is necessary to consult a doctor.

4. Drug interactions

Pemetrexed may change the way other medicines work or increase side effects. To avoid drug interactions when using Pemetrexed you need to tell your doctor about the list of drugs you are currently taking including prescription drugs, nonprescription drugs or supplements. Specifically like:

Care should be taken when co-administering with drugs containing Aminoglycosides, diuretics, probenecid compounds, penicillins, anticoagulants.
Do not use concurrently with yellow fever vaccine: it can cause death.
Do not use Pemetrexed with live attenuated vaccines, it may cause systemic adverse reactions.
When used with Lansoprazole, Aspartame, Pravastatin, Liothyronine, Lansoprazole: Decreased excretion of Pemetrexed.

5. Unwanted side effects

Pemetrexed, whether used alone or in combination with cisplatin, will bring unwanted side effects to patients.

5.1. Some common side effects

Constipation
Rash: To prevent a rash, your doctor will usually prescribe a steroid dose the day before and the day of Pemetrexed.
Not eating well
Inflammation of the oral mucosa such as sore throat, mouth ulcers, lips. To reduce this situation, patients should clean their teeth by rinsing their mouth with salt water after eating or drinking
Diarrhea
Nausea or vomiting: An antiemetic can be used to minimize this side effect
Mental fatigue, or feeling sleepy
Decreased blood cell count

5.2. More serious reactions

When using Pemetrexed will affect fertility in men, so before using it, consult your doctor.
If you experience more severe symptoms such as swollen ankles/swelling of the feet/hands or signs of kidney problems (change in the amount of urine), signs of liver disease (consisting abdominal pain, yellowing of the skin/eyes) , dark urine) should immediately call a doctor for timely advice.
Pemetrexed also causes a serious allergic skin reaction, if you feel your skin is swollen, peeling, or blistering, you should go to the hospital as soon as possible.