Pemetrexed (patient information)

# Why is this medication prescribed
Pemetrexed is used with another chemotherapy (anti-cancer) medication to treat malignant pleural mesothelioma (a type of cancer that affects the inside lining of the chest cavity). Pemetrexed is also used to treat non-small cell lung cancer. Pemetrexed is in a class of medications called antifolate antineoplastic agents. It works by blocking the action of a certain substance in the body that may help cancer cells multiply.

# How should this medicine be used
Pemetrexed comes as a solution (liquid) to be injected into a vein. Pemetrexed is administered by a doctor or nurse in a medical office or infusion center. It is usually given once every 21 days.
Your doctor will probably tell you to take other medications, such as folic acid (a vitamin), vitamin B12, and a corticosteroid such as dexamethasone (Decadron) to decrease some of the side effects of this medication. Your doctor will give you directions for taking these medications. Follow your doctor's directions carefully. Ask your doctor or pharmacist to explain any part you do not understand. If you miss a dose of one of these medications, call your doctor.
Your doctor will ask you to have regular blood tests before and during treatment with pemetrexed. Your doctor may change your dose of pemetrexed or delay treatment based on the results of the blood tests.
Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient.

# Other uses for this medicine
This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

# What special precautions should I follow
Before taking pemetrexed:
- tell your doctor and pharmacist if you are allergic to pemetrexed, mannitol,or any other medications.
- tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: aspirin and other nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn), or probenecid. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
- tell your doctor if you have a pleural effusion (excess fluid between the linings around the lung), ascites (excess fluid in the abdomen); or have or have ever had kidney or liver disease.
- tell your doctor if you are pregnant or plan to become pregnant. You should use birth control to prevent pregnancy during your treatment with pemetrexed. If you become pregnant while using this medication, call your doctor. Pemetrexed may harm the fetus.
- tell your doctor if you are breast-feeding. You should not breast-feed during your treatment with pemetrexed.

# What special dietary instructions should I follow
Unless your doctor tells you otherwise, continue your normal diet.

# What should I do if I forget a dose
If you miss an appointment to receive a dose of pemetrexed, call your doctor as soon as possible.

# Side effects

## Mild side effects
Pemetrexed may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
- nausea
- vomiting
- constipation
- loss of appetite
- weight loss
- tiredness
- weakness
- pale skin
- headache
- dizziness
- confusion
- fast heartbeat
- difficulty falling asleep or staying asleep
- changes in mood
- depression
- joint or muscle pain

## Severe side effects
Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately:
- diarrhea
- sores and/or redness in the mouth or throat or on the lips
- unusual bleeding or bruising
- sore throat, fever, chills, cough or other signs of infection
- chest pain
- difficulty breathing or swallowing
- slow or difficult speech
- dizziness or faintness
- weakness or numbness of an arm or leg
- pain, burning, numbness, or tingling in the hands or feet
- hives
- rash
- itching
- decreased urination
Pemetrexed may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

# 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.
Symptoms of overdose may include:
- rash
- sores and/or redness in the mouth or throat or on the lips
- unusual bleeding or bruising
- sore throat, fever, chills, cough or other signs of infection
- extreme tiredness
- weakness
- pale skin
- headache
- dizziness
- confusion
- fast heartbeat
- difficulty falling asleep or staying asleep

# What other information should I know
Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your body's response to pemetrexed.

# Brand names
- Alimta