Classifications: antineoplastic agent; antimetabolite, antifolate; Therapeutic: antineoplastic; antimetabolite; antifolate
Pregnancy Category: D
500 mg powder for injection
Suppresses tumor growth by inhibiting both DNa synthesis and folate metabolism at multiple target enzymes.
Appears to arrest the cell cycle, thus inhibiting tumor growth.
Treatment of malignant pleural mesothelioma that is unresectable or in patients that are not surgery candidates in combination
with cisplatin; treatment of locally advanced or metastatic non-small cell lung cancer (NSCLC).
Solid tumors, including bladder, breast, colorectal, gastric, head and neck, pancreatic, and renal cell cancers.
Mannitol hypersensitivity; creatinine clearance is <45 mL/min, renal failure, moderate or severe renal impairment; active
infection; vaccines; children <18 y; pregnancy (category D); lactation.
Anemia, thrombocytopenia, neutropenia, dental disease; older adults; hepatic disease, hypoalbuminemia, hypovolemia, dehydration,
ascites, pleural effusion.
Route & Dosage
|Malignant Mesothelioma, Non-Small Cell Lung Cancer
Adult: IV 500 mg/m2 on day 1 of each 21-d cycle
Not recommended if Clcr <45 mL/min.
- Pre-/posttreatment with folic acid, vitamin B12, and dexamethasone are needed to reduce hematologic and gastrointestinal toxicity, and the possibility of severe cutaneous
reactions from pemetrexed.
PREPARE: IV Infusion: Reconstitute each 500 mg vial with 20 mL of preservative-free NS. Do not use any other diluent. Swirl gently to dissolve.
Each vial will contain 25 mg/mL. Withdraw the needed amount of reconstituted solution and add to 100 mL of preservative-free
NS. Discard any unused portion.
ADMINISTER: IV Infusion: Do NOT give a bolus dose. Infuse over 10 min.
INCOMPATIBILITIES Solution/additive: Solutions containing calcium, lactated Ringer's. Y-site: Amphotericin B, calcium, cefazolin, cefotaxime, cefotetan, cefoxitin, ceftazidime, chlorpromazine, ciprofloxacin,
dobutamine, doxorubicin, doxycycline, droperidol, gemcitabine, gentamicin, irinotecan, metronidazole,
minocycline, mitoxantrone, nalbuphine, ondansetron, prochlorperazine, tobramycin, topotecan.
- Store unopened single-use vials at room temperature between 15°30° C (59°86° F). The reconstituted
drug is stable for up to 24 h at 2°8° C (36°46° F) or at 25° C (77° F).
Adverse Effects (≥1%)Body as a Whole: Fatigue, fever,
hypersensitivity reaction, edema, myalgia, arthralgia. CNS:
Neuropathy, mood alteration, depression. CV:
Chest pain, thromboembolism. GI: Nausea, vomiting, constipation, anorexia, stomatitis, diarrhea,
dehydration, dysphagia, esophagitis, odynophagia, increased LFTs. Hematologic: Neutropenia, leukopenia, anemia, thrombocytopenia. Respiratory: Dyspnea. Skin: Rash, desquamation,
alopecia. Urogenital: Increases serum creatinine, renal
Increased risk of renal
toxicity with other nephrotoxic drugs (acyclovir, adefovir, amphotericin B, aminoglycosides
, carboplatin, cidofovir, cisplatin, cyclosporine, foscarnet, ganciclovir, sirolimus, tacrolimus, vancomycin); nsaid
s may increase risk of renal
toxicity in patients with preexisting renal
insufficiency; may cause additive risk of bleeding
with anticoagulants, platelet inhibitors
, aspirin, thrombolytic agents
Not extensively. Elimination:
Primarily in urine. Half-Life:
Assessment & Drug Effects
- Withhold drug and notify physician if the absolute neutrophil count (ANC) is <1500 cells/mm3 or the platelet count is less than at least 100,000 cells/mm3, or if the Clcr is <45 mL/min.
- Lab tests: Baseline and periodic CBC with differential; monitor for nadir and recovery before each dose (on day 8 and 15,
respectively, of each cycle); periodic LFTs, serum creatinine and BUN.
- Notify physician for S&S of neuropathy (paresthesia) or thromboembolism.
Patient & Family Education
- Report promptly any of the following to physician: symptoms of anemia (e.g., chest pain, unusual weakness or tiredness,
fainting spells, lightheadedness, shortness of breath); symptoms of poor blood clotting (e.g., bruising; red spots on skin;
black, tarry stools; blood in urine); symptoms of infection (e.g., fever or chills, cough, sore throat, pain or difficulty
passing urine); symptoms of liver problems (e.g., yellowing of skin).
- Do not take nonsteroidal antiinflammatory drugs (NSAIDs) without first consulting the physician.