Patient Medication Information: uses, side effects, how to take - Pemetrexed for Injection
ABOUT THIS MEDICATION
What the medication is used for:
Pemetrexed for Injection is used in the treatment of the following types of cancers:
- Malignant pleural mesothelioma (cancer of the lining of the chest cavity) in combination with cisplatin (another anti-cancer drug).
Nonsquamous locally advanced or metastatic non-small cell lung cancer as:
- Initial treatment in combination with cisplatin.
- Maintenance treatment given alone immediately after four cycles of platinum-based first-line chemotherapy.
- Second line treatment given alone after prior chemotherapy.
What it does:
Pemetrexed for Injection is an antifolate anticancer agent that works by disrupting the metabolic processes that are essential for cell replication. It helps to stop the cancer cells from multiplying.
When it should not be used:
Do not take Pemetrexed for Injection if you:
- are allergic to pemetrexed disodium or any of the ingredients in Pemetrexed for Injection.
- have received or are going to receive the Yellow Fever vaccine.
What the medicinal ingredient is:
Pemetrexed for Injection contains the active ingredient called pemetrexed disodium.
What the important nonmedicinal ingredients are:
Pemetrexed for Injection contains citric acid, L-methionine, monothioglycerol, and water for injection. Hydrochloric acid and/or sodium hydroxide, may have been added to adjust pH.
What dosage forms it comes in:
Pemetrexed for Injection is supplied as sterile solution in single dose vials for intravenous infusion. Each single dose vial supplied in following strengths and fill volume.
| STRENGTH / FILL VOLUME | PACK STYLE |
| 100 mg/4 mL (25 mg/mL) | 1 single dose vial in a carton |
| 500 mg/20 mL (25 mg/mL) | 1 single dose vial in a carton |
| 850 mg/34 mL (25 mg/mL) | 1 single dose vial in a carton |
| 1000 mg/40 mL (25 mg/mL) | 1 single dose vial in a carton |
WARNINGS AND PRECAUTIONS
Serious Warnings and Precautions
- Pemetrexed for Injection should be administered under the supervision of a qualified physician experienced in the use of anticancer agents.
- Liver toxicity and rare cases of fatal liver failure have been reported in clinical trial patients treated with Pemetrexed for Injection alone or in combination with other anticancer drugs.
To lower your chances of side effects of Pemetrexed for Injection, you must also take folic acid and vitamin B12 injections prior to and during your treatment with Pemetrexed for Injection.
BEFORE you receive Pemetrexed for Injection talk to your doctor or pharmacist if:
- you have a severe hypersensitivity reaction to Pemetrexed for Injection or to any other ingredient used in the formulation.
you are pregnant or planning to get pregnant (Pemetrexed for Injection may cause harm to an unborn child).
- you plan to father a child. (Pemetrexed for Injection may cause irreversible infertility).
- you are breast feeding.
- you are under 18 years old.
- you have a kidney disease.
- you have a liver disease.
- you have a heart problem.
- you have ever had radiation therapy.
- you have recently received or are planning on receiving a
- vaccine against Yellow Fever or any live vaccines.
You should discuss effective birth control methods with your doctor. Male patients should not father a child during the treatment and up to 6 months after stopping the treatment.
INTERACTIONS WITH THIS MEDICATION
Tell your doctor or pharmacist if you are taking or have taken other medications, including prescription and nonprescription medicines, vitamins, and natural health products.
Drugs that may interact with Pemetrexed for Injection include:
- NSAIDs (nonsteroidal anti-inflammatory drugs, e.g. ibuprofen): you should stop taking them for at least 5 days before, the day of, and at least 2 days after Pemetrexed for Injection treatment. If it is necessary to take NSAIDs inform your doctor and you will be monitored accordingly.
PROPER USE OF THIS MEDICATION
Usual dose:
Pemetrexed for Injection is slowly infused (injected) into a vein. The injection or infusion will last about 10 minutes. You will usually receive Pemetrexed for Injection once every 21 days (3 weeks).
You may receive Pemetrexed for Injection alone or in combination with cisplatin, another anti-cancer agent. Your doctor will determine your treatment plan, be sure to ask your doctor or health care team if you have any questions.
If your doctor has prescribed cisplatin, it will be infused in your vein for about 2 hours starting about 30 minutes after your treatment with Pemetrexed for Injection.
Pre-Medications
To lower your chances of experiencing harmful side effects, it is important for you to take the following medication and vitamins prior to and/or during your treatment with Pemetrexed for Injection.
Corticosteroid
Your doctor will prescribe a medicine called a “corticosteroid” to take the day before, the day of, and the day after Pemetrexed for Injection treatment. Corticosteroid medicines lower your chances for getting skin reactions with Pemetrexed for Injection.
Folic Acid Tablets
You must start taking 350- 600 micrograms of folic acid every day for at least 5 days out of the 7 days before your first dose of Pemetrexed for Injection. You must keep taking folic acid every day during the time you are getting treatment with Pemetrexed for Injection and for 21 days after your last treatment.
You can get folic acid vitamins over-the-counter. Folic acid is also found in many multivitamin pills. Ask your doctor or pharmacist for help if you are not sure how to choose a folic acid product.
Vitamin B12 Injection
Your doctor will give you vitamin B12 injections while you are getting treatment with Pemetrexed for Injection. You will get your first vitamin B12 injection during the week before your first dose of Pemetrexed for Injection, and then about every 9 weeks during treatment until 3 weeks after the last dose of Pemetrexed for Injection.
Contact your doctor if you forget to take your pre-medications.
You will have regular blood tests before and during your treatment with Pemetrexed for Injection. Your doctor may adjust your dose of Pemetrexed for Injection or delay treatment based on the results of your blood tests and on your general condition.
Overdose:
| If you think you have taken too much Pemetrexed for Injection, contact your healthcare professional, hospital emergency department or regional poison control centre immediately, even if there are no symptoms. |
Missed Dose:
Contact your physician immediately for further instructions.
SIDE EFFECTS AND WHAT TO DO ABOUT THEM
Most patients taking Pemetrexed for Injection will have side effects. Sometimes it is not possible to tell whether Pemetrexed for Injection, another medicine, or the cancer itself is causing these side effects. Call your doctor right away if you have a fever, chills, diarrhea, or mouth sores. These symptoms could mean you have an infection.
The most common side effects of Pemetrexed for Injection when taken alone or with cisplatin are:
- Stomach upset, including nausea, vomiting, diarrhea, and constipation.
Low blood cell counts
- Low red blood cells may make you feel tired, get tired easily, appear pale, and become short of breath.
- Low white blood cells may give you a greater chance for infection. If you have a fever (temperature above 38°C) or other signs of infection, call your doctor right away.
- Low platelets give you a greater chance for bleeding. Your doctor will do blood tests to check your blood counts before and during treatment with Pemetrexed for Injection.
- Tiredness. You may feel tired or weak for a few days after your Pemetrexed for Injection treatments. If you have severe weakness or tiredness, call your doctor.
- Mouth, throat, or lip sores (stomatitis, pharyngitis). You may get redness or sores in your mouth, throat, or on your lips. These symptoms may happen a few days after Pemetrexed for Injection treatment. Talk with your doctor about proper mouth and throat care.
- Loss of appetite. You may lose your appetite and lose weight during your treatment.
- Kidney. Your kidney function may be decreased, sometimes seriously, which may make you feel unwell. Your doctor may do blood tests to monitor your kidney function.
- Rash. You may get a rash or itching during treatment. These usually appear between treatments with Pemetrexed for Injection and usually go away before the next treatment. Sometimes you may get severe skin reactions. Call your doctor if you get a severe rash or itching.
- Fever.
Effects on heart and brain have been reported uncommonly in clinical studies. Severe effects on stomach and intestine including bleeding has been uncommonly reported in clinical studies. Sometimes the effect on intestine are worse after radiation. In clinical studies, severe effects on lung and breathing have been reported. Blood flow disturbance leading to tissue damage has been reported.
Rare cases of unusual swelling in the legs or the face (edema) have been reported.
A small number of patients have reported changes in mood/ depression.
Be sure to tell your doctor if your breathing gets worse while you are on Pemetrexed for Injection.
Talk with your doctor, nurse, or pharmacist about any side effect that bothers you or that doesn't go away. It is important that you continue to take your folic acid and vitamin B12 supplements even if you experience serious side effects.
| SERIOUS SIDE EFFECTS, HOW OFTEN THEY HAPPEN AND WHAT TO DO ABOUT THEM | ||||
|---|---|---|---|---|
| Symptom / effect | Talk with your doctor or pharmacist | Stop taking drug and call your doctor or pharmacist* | ||
| Only if severe | In all cases | |||
| Co m m o n | Allergic reaction | √ | ||
| Bleeding | √ | |||
| Breathing (Any change) | √ | |||
| Chest pain (new or worsening) | √ | |||
| Diarrhea | √ | |||
| Fever | √ | |||
| Mouth, throat or lip sores | √ | |||
| Nausea | √ | |||
| Skin rash | √ | |||
| Swallowing difficulty | √ | |||
| Tiredness | √ | |||
| Vomiting | √ | |||
*Continue taking your folic acid and vitamin B12 injections even if you have serious side effects. Common = 1% to <10%
This is not a complete list of side effects. For any unexpected effects while taking Pemetrexed for Injection, contact your doctor or pharmacist.
HOW TO STORE IT
PEMETREXED FOR INJECTION should be stored at 20 - 25°C, excursions permitted between 15°C and 30°C. Keep vial in the carton until use and protect from light.
Keep out of reach and sight of children.
REPORTING SIDE EFFECTS
You can report any suspected side effects associated with the use of health products to Health Canada by:
NOTE: Contact your health professional if you need information about how to manage your side effects. The Canada Vigilance Program does not provide medical advice. |
MORE INFORMATION
If you want more information about Pemetrexed for Injection:
- Talk to your healthcare professional
- Find the full product monograph that is prepared for healthcare professionals and includes this Consumer Information by visiting the Health Canada website (https://health-products.canada.ca/dpd-bdpp/index-eng.jsp); or by calling the sponsor Accord Healthcare Inc. at 1-866-296-0354.
Accord Healthcare, Inc.,
3535 boul. St. Charles, Suite 704
Kirkland, QC, H9H 5B9
Canada