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What is Alimta?
Alimta (pemetrexed disodium) is a new chemotherapy drug made by Eli Lilly and Company. The FDA first approved it in 2004. Alimta comes in 100 mg and 500 mg vials for injection.
How does Alimta work?
Alimta is a folate analog metabolic inhibitor. It works by interfering or blocking three specific enzymes that allow cancer cells to reproduce and spread.
Alimta is used in the treatment of two types of cancer: metastatic nonsquamous non-small cell lung cancer and a rare cancer called malignant pleural mesothelioma.
Warnings and Precautions
- Patients are typically premedicated with folic acid and vitamin B12. Pretreatment with dexamethasone or equivalent reduces cutaneous reaction.
- Alimta can suppress bone marrow function.
- Alimta affects renal function and is contraindicated when CrCl less than 45 mL/min.
- NSAIDs with renal insufficiency: Use caution in patients with mild to moderate renal insufficiency (CrCl 45-79 mL/min).
- Lab monitoring is required with this drug to monitor platelets.
- Pregnancy Category D: Alimta can cause fetal harm when administered to a pregnant woman. Women should be advised to use effective contraception measures to prevent pregnancy during treatment with Alimta.
Alimta Side Effects
Studies show that Alimta typically does not cause serious side effects. The most common side effects with single-agent use are as follows:
Additional common adverse reactions when used in combination with cisplatin include the following:
- Fatigue (25%)
- Nausea (19%)
- Anorexia (19%)
- Anemia (15%)
- Rash and itching (10%)
- Sensory neuropathy (9%)
- Vomiting (9%)
- Mucositis/stomatitis (7%)
- Neutropenia (6%)
- Leukopenia (6%)
- Diarrhea (5%)
- Infection (5%)
The above side effects have been reported to last about 10 days after the first treatment. Side effects after subsequent treatments have been reported to last from 3 to 5 days. Post marketing reports of side effects include cough, flu-like symptoms, dizziness, shortness of breath, fever, and excessive sweating.
Use caution with ibuprofen or other NSAIDs for those with mild to moderate renal insufficiency. The use of ibuprofen (400 mg four times a day) is typically not a problem for those with normal renal function.
Concomitant use of Nephrotoxic drugs and/or substances which are tubularly secreted may result in delayed clearance.
Alimta is contraindicated for those with a history of severe hypersensitivity reaction to pemetrexed.
Skin rash has been reported more frequently in those patients who were not pretreated with a corticosteroid. A pretreatment of dexamethasone (or equivalent) reduced the incidence and severity of cutaneous reaction. In the clinical trials, 4 mg of dexamethasone was given by mouth twice daily on the day before, the day of, and the day after the administration of Alimta.
Vitamin supplementation reduces toxicity in patients treated with Alimta. During the 7-day period preceding the first dose of Alimta a regimen of at least 5 daily doses of folic acid or multivitamin with folic acid must be taken. Dosing is continued during the full course of therapy and for 21 days after the last dose of Alimta.
It is unknown whether Alimta is excreted in human milk. Because of the potential for serious adverse reactions in nursing infants from Alimta, a decision should be made to discontinue nursing or discontinue the drug, taking into account the importance of the drug for the mother's health.
The safety and effectiveness of Alimta in pediatric patients have not been established.
Note: This page is a summary report on Alimta and does not include all information needed to use Alimta safely and effectively.
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