Pemetrexed

CLINICAL USE

Treatment of chemotherapy naive patients with unresectable malignant pleural mesothelioma in combination with cisplatinMonotherapy for non-small cell lung cancer

DOSE IN NORMAL RENAL FUNCTION

500 mg/m2 on the first day of each 21 day cycle

PHARMACOKINETICS

Molecular weight :471.4 (as disodium)

%Protein binding :81

%Excreted unchanged in urine : 70–90

Volume of distribution (L/kg) :6–9 litres/m2

half-life – normal/ESRD (hrs) :2–4/Increased

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

45–50 Dose as in normal renal function20–45 Use with caution, at a lower dose. See ‘Other Information’<20 Use with caution, at a lower dose. See ‘Other Information’

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Unlikely to be dialysed. Dose as in GFR<20 mL/min

HD :Not dialysed.1 Dose as in GFR<20 mL/min

HDF/high flux :Unlikely to be dialysed. Dose as in GFR<20 mL/min

CAV/VVHD :Not dialysed.1 Dose as in GFR=20–45 mL/min

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugsNephrotoxic agents: may reduce clearance of pemetrexed – use with cautionLive vaccines: avoid use; YELLOW FEVER VACCINE ABSOLUTELY CONTRAINDICATED

ADMINISTRATION

Reconstition

20 mL sodium chloride 0.9% per 500 mg vial

Route

IV infusion

Rate of Administration

Over 10 minutes

Comments

Dilute in 100 mL preservative-free sodium chloride 0.9%Incompatible with calcium containing fluids

OTHER INFORMATION

To reduce the incidence and severity of skin reactions, a steroid (equivalent to 4 mg of dexamethasone) should be given the day before, the day of, and the day after pemetrexed therapy. Patients should also take a vitamin preparation containing folic acid and IM vitamin B1225% of patients get reversible mild renal dysfunctionThere has been a case report of a patient having severe rhabdomyolysis with pemetrexed in combination treatment with carboplatin.

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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