Trimetrexate Glucuronate (patient information)

# IMPORTANT WARNING:
It is important to remember to take trimetrexate with leucovorin as directed by your doctor. If you miss a dose, take it as soon as you remember. If it is almost time for the next dose, skip the missed dose and continue with your regular dosing schedule. Call your doctor if you miss a dose.

# About your treatment
Your doctor has ordered the drug trimetrexate to help treat your illness. The drug can be given by injection into a vein.
This medication is used to treat:
- infections caused by the bacteria Pneumocystis carinii in patients that do not have a fully functioning immune system
This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.
Trimetrexate resembles a normal nutrient needed for cell growth. The Pneumocystis bacteria and cancer cells take up trimetrexate, which then interferes with their growth. You also will be given the drug leucovorin with each trimetrexate treatment. Leucovorin replaces the same needed nutrient in normal cells. Pneumocystis bacteria and cancer cells cannot use leucovorin. Take leucovorin exactly as prescribed by your doctor.

# Precautions
Before taking trimetrexate:
- tell your doctor and pharmacist if you are allergic to trimetrexate or any other drugs.
- tell your doctor and pharmacist what prescription and nonprescription medications you are taking, especially acetaminophen (Tylenol), aspirin, clotrimazole (Mycelex), erythromycin, fluconazole (Diflucan), ketoconazole (Nizoral), miconazole(Monistat), rifabutin (Mycobutin), rifampin (Rifadin), zidovudine (AZT, Retrovir), and vitamins.
- tell your doctor if you have or have ever had kidney or liver disease, stomach ulcers, or intestinal disease.
- you should know that trimetrexate may interfere with the normal menstrual cycle (period) in women and may stop sperm production in men. However, you should not assume that you cannot get pregnant or that you cannot get someone else pregnant. *Women who are pregnant or breast-feeding should tell their doctors before they begin taking this drug. You should not plan to have children while receiving chemotherapy or for a while after treatments. (Talk to your doctor for further details.) Use a reliable method of birth control to prevent pregnancy. Trimetrexate may harm the fetus.
- do not have any vaccinations (e.g., measles or flu shots) without talking to your doctor.

# Side effects

## Mild side effects
Side effects from trimetrexate are common and include:
- nausea
- loss of appetite or weight
Tell your doctor if either of these symptoms is severe or lasts for several hours:
- mouth blistering
- fatigue

## Severe side effects
If you experience any of the following symptoms, call your doctor immediately:
- painful urination or red urine
- black, tarry stools
- diarrhea
- unusual bruising or bleeding
- fever
- cough
- difficulty swallowing
- dizziness
- chills
- shortness of breath
- severe vomiting
- rash
- yellowing of the skin or eyes
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online  or by phone .

# In case of emergency/overdose
In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

# Special instructions
The most common side effect of trimetrexate is a decrease in the number of blood cells. Your doctor may order tests before, during, and after your treatment to see if your blood cells are affected by the drug.

# Brand names
- Neutrexin