Alimta (pemetrexed)

ALIMTA (pemetrexed disodium) – a folate analog metabolic inhibitor commonly used to treat certain types of lung cancer and mesothelioma. Alimta exerts its action by disrupting folate-dependent metabolic processes essential for cell replication.

FDA approved uses: Alimta is indicated for Locally Advanced or Metastatic Nonsquamous Non-Small Cell Lung Cancer -Initial treatment in combination with cisplatin; Maintenance treatment of patients whose disease has not progressed after four cycles of platinum-based first-line chemotherapy; After prior chemotherapy as a single-agent. Mesothelioma – in combination with cisplatin. Limitations of Use – Alimta is not indicated for the treatment of patients with squamous cell non-small cell lung cancer.

Available dosage forms Injection – 100 mg vial, 500 mg vial.

Usual dosage: Combination use in Non-Small Cell Lung Cancer and Mesothelioma – Recommended dose of Alimta is 500 mg/m2 i.v. on Day 1 of each 21-day cycle in combination with cisplatin 75 mg/m2 i.v. beginning 30 minutes after Alimta administration. Single-Agent use in Non-Small Cell Lung Cancer – Recommended dose of Alimta is 500 mg/m2 i.v. on Day 1 of each 21-day cycle. Prior to initiating Alimta, initiate supplementation with oral folic acid and intramuscular vitamin B12. Continue folic acid and vitamin B12 supplementation throughout treatment. Administer corticosteroids the day before, the day of, and the day after Alimta administration.

Contraindications: Patients with history of severe hypersensitivity to reaction pemetrexed.

Special warnings: Premedication regimen – Prior to treatment with Alimta, initiate supplementation with oral folic acid and intramuscular vitamin B12 to reduce the severity of hematologic and gastrointestinal toxicity of Alimta. Bone marrow suppression – Reduce doses for subsequent cycles based on hematologic and nonhematologic toxicities.
Renal function: Do not administer when CrCl <45 mL/min. NSAIDs with renal insufficiency - Use caution in patients with mild to moderate renal insufficiency (CrCl 45-79 mL/min). Lab monitoring - Do not initiate a cycle unless ANC ≥1500 cells/mm3, platelets ≥100,000 cells/mm3, and CrCl ≥45 mL/min. Pregnancy - Fetal harm can occur when administered to a pregnant woman. Adverse reactions (side effects) of these medications: The most common side effects of Alimta with single-agent use are fatigue, nausea, and anorexia. Additional common adverse reactions when used in combination with cisplatin include vomiting, neutropenia, leukopenia, anemia, stomatitis/pharyngitis, thrombocytopenia, and constipation.

Common drug interactions: Use caution when administering with nonsteroidal anti-inflammatory drugs (NSAIDS). Concomitant use with nephrotoxic drugs and/or substances which are tubularly secreted may result in delayed clearance.

Special instructions for patients: Tell your doctor if you are pregnant or planning to become pregnant, are breastfeeding, or if you are taking any other medications, including prescription and nonprescription medications and supplements. Call your doctor right away if you have any of the following: fever, chills, diarrhea, or mouth sores.

Full prescribing information may be found at the manufacturer‘s official website Alimta.com or at the U.S. Food and Drug Administration’s website at Alimta Info at Drugs@FDA

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