Pemetrexed Disodium Solution for injection

What is this medicine?

PEMETREXED (PEM e TREX ed) is a chemotherapy drug. This medicine affects cells that are rapidly growing, such as cancer cells and cells in your mouth and stomach. It is usually used to treat lung cancers like non-small cell lung cancer and mesothelioma. It may also be used to treat other cancers.

This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

What should I tell my health care provider before I take this medicine?

They need to know if you have any of these conditions:

• if you frequently drink alcohol containing beverages

• infection (especially a virus infection such as chickenpox, cold sores, or herpes)

• kidney disease

• liver disease

• low blood counts, like low platelets, red bloods, or white blood cells

• an unusual or allergic reaction to pemetrexed, mannitol, other medicines, foods, dyes, or preservatives

• pregnant or trying to get pregnant

• breast-feeding

How should I use this medicine?

This drug is given as an infusion into a vein. It is administered in a hospital or clinic by a specially trained health care professional.

Talk to your pediatrician regarding the use of this medicine in children. Special care may be needed.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.

NOTE: This medicine is only for you. Do not share this medicine with others.

What if I miss a dose?

It is important not to miss your dose. Call your doctor or health care professional if you are unable to keep an appointment.

What may interact with this medicine?

• aspirin and aspirin-like medicines

• medicines to increase blood counts like filgrastim, pegfilgrastim, sargramostim

• methotrexate

• NSAIDS, medicines for pain and inflammation, like ibuprofen or naproxen

• probenecid

• pyrimethamine

• vaccines

Talk to your doctor or health care professional before taking any of these medicines:

• acetaminophen

• aspirin

• ibuprofen

• ketoprofen

• naproxen

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

What should I watch for while using this medicine?

Visit your doctor for checks on your progress. This drug may make you feel generally unwell. This is not uncommon, as chemotherapy can affect healthy cells as well as cancer cells. Report any side effects. Continue your course of treatment even though you feel ill unless your doctor tells you to stop.

In some cases, you may be given additional medicines to help with side effects. Follow all directions for their use.

Call your doctor or health care professional for advice if you get a fever, chills or sore throat, or other symptoms of a cold or flu. Do not treat yourself. This drug decreases your body's ability to fight infections. Try to avoid being around people who are sick.

This medicine may increase your risk to bruise or bleed. Call your doctor or health care professional if you notice any unusual bleeding.

Be careful brushing and flossing your teeth or using a toothpick because you may get an infection or bleed more easily. If you have any dental work done, tell your dentist you are receiving this medicine.

Avoid taking products that contain aspirin, acetaminophen, ibuprofen, naproxen, or ketoprofen unless instructed by your doctor. These medicines may hide a fever.

Call your doctor or health care professional if you get diarrhea or mouth sores. Do not treat yourself.

To protect your kidneys, drink water or other fluids as directed while you are taking this medicine.

Men and women must use effective birth control while taking this medicine. You may also need to continue using effective birth control for a time after stopping this medicine. Do not become pregnant while taking this medicine. Tell your doctor right away if you think that you or your partner might be pregnant. There is a potential for serious side effects to an unborn child. Talk to your health care professional or pharmacist for more information. Do not breast-feed an infant while taking this medicine. This medicine may lower sperm counts.

What side effects may I notice from receiving this medicine?

Side effects that you should report to your doctor or health care professional as soon as possible:

• allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue

• low blood counts - this medicine may decrease the number of white blood cells, red blood cells and platelets. You may be at increased risk for infections and bleeding.

• signs of infection - fever or chills, cough, sore throat, pain or difficulty passing urine

• signs of decreased platelets or bleeding - bruising, pinpoint red spots on the skin, black, tarry stools, blood in the urine

• signs of decreased red blood cells - unusually weak or tired, fainting spells, lightheadedness

• breathing problems, like a dry cough

• changes in emotions or moods

• chest pain

• confusion

• diarrhea

• high blood pressure

• mouth or throat sores or ulcers

• pain, swelling, warmth in the leg

• pain on swallowing

• swelling of the ankles, feet, hands

• trouble passing urine or change in the amount of urine

• vomiting

• yellowing of the eyes or skin

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):

• hair loss

• loss of appetite

• nausea

• stomach upset

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Where should I keep my medicine?

This drug is given in a hospital or clinic and will not be stored at home.