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Precautions and Warnings With Pemetrexed

Because the kidneys help clear pemetrexed from the blood, you should not receive it if your kidneys are not functioning well enough. Pemetrexed warnings and precautions also apply to people who are allergic to any of the ingredients used to make the medicine (including albumin). Women who are pregnant or breastfeeding should talk to their doctors before beginning treatment.

What Should I Tell My Healthcare Provider?

Prior to taking pemetrexed (Alimta®), talk to your healthcare provider if you have:
 
  • Kidney disease, such as kidney failure (renal failure)
  • Pleural effusion (accumulation of fluid in the lining of the lungs and chest cavity)
  • Ascites (accumulation of fluid in the abdominal cavity)
  • Any allergies, including to food, dyes, or preservatives.
     
Also, let your healthcare provider know if you are:
 
  • Pregnant or thinking of becoming pregnant
  • Breastfeeding.
     
You should also be sure to tell your healthcare provider about all other medications you are taking, including prescription and nonprescription medicines, vitamins, and herbal supplements.
 

Specific Pemetrexed Precautions and Warnings

Warnings and precautions to be aware of prior to taking pemetrexed include the following:
 
  • This medication can decrease the ability of bone marrow to produce blood cells. This can result in anemia and other serious conditions. Because your immune system depends on certain blood cells, you may be more susceptible to infections while taking pemetrexed (see Chemotherapy and Infections). 
You may also be at a higher risk for bleeding (see Blood Clotting Problems and Chemotherapy). You will need blood tests before each dose to make sure your blood counts are not too low.
  • If your blood counts become too low while on pemetrexed, your healthcare provider may need to reduce your pemetrexed dosage or delay future doses. In severe cases, you may have to stop taking this medicine altogether.
     
  • While taking pemetrexed, it is very important that you take folic acid supplements and get vitamin B12 injections as directed by your healthcare provider. This helps prevent (or reduce the severity of) some pemetrexed side effects. Your healthcare provider may also recommend that you take a corticosteroid, such as dexamethasone, as this reduces the risk and severity of skin rashes due to pemetrexed.
     
  • Your healthcare provider should monitor your kidney function (using a simple blood test) before each dose of this medication, as you should not receive pemetrexed if your kidneys are functioning too poorly (the kidneys help clear this medication from the blood).
     
  • At this time, it is not fully known how conditions involving excess fluid accumulation in the body -- such as with pleural effusion or ascites -- may affect this medication, especially in severe cases (mild to moderate cases do not seem to have a large effect). Your healthcare provider may need to drain the excess fluid before giving you a pemetrexed dosage (in severe cases of excess fluid).

 

  • Pemetrexed can interact with other medications (see Drug Interactions With Pemetrexed).
     
  • Pemetrexed is considered a pregnancy Category D medication. This means that it is probably not safe for use during pregnancy. Talk to your healthcare provider about the risks and benefits of using the drug when pregnant (see Alimta and Pregnancy).
     
  • It is not known if pemetrexed passes through breast milk. Therefore, if you are breastfeeding or plan to start, discuss this with your healthcare provider prior to taking the drug (see Alimta and Breastfeeding).
     
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Pemetrexed Drug Information

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