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Pemetrexed Dosage

Applies to the following strength(s): 500 mg ; 100 mg

The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.

Usual Adult Dose for:

Additional dosage information:

Usual Adult Dose for Malignant Pleural Mesothelioma

500 mg/m2 IV over 10 minutes on day 1 of each 21 day cycle along with cisplatin

Cisplatin 75 mg/m2 infused over 2 hours beginning approximately 30 minutes after the end of the pemetrexed administration. Patients should receive hydration consistent with local practice prior to and/or after receiving cisplatin.

PREMEDICATION REGIMEN AND CONCURRENT MEDICATIONS:
-Vitamin Supplementation: Patients should initiate folic acid 400 to 1000 mcg orally once daily beginning 7 days before the first dose of chemotherapy. Folic acid should be continued during the full course of therapy and for 21 days after the last dose.
-Vitamin B12 1 mg should be administered IM 1 week prior to the first dose of chemotherapy and every 3 cycles thereafter.
-Subsequent vitamin B12 injections may be given the same day as treatment.
-Corticosteroids: Dexamethasone 4 mg orally 2 times a day the day before, the day of, and the day after chemotherapy administration.

Comments:
-See the manufacturer product information for cisplatin dosing.

Use: For the treatment of patients with malignant pleural mesothelioma whose disease is unresectable or who are otherwise not candidates for curative surgery in combination with cisplatin

Usual Adult Dose for Non-Small Cell Lung Cancer

COMBINATION USE WITH CISPLATIN FOR NONSQUAMOUS NON-SMALL CELL LUNG CANCER: 500 mg/m2 IV over 10 minutes on day 1 of each 21 day cycle along with cisplatin:
-Cisplatin 75 mg/m2 infused over 2 hours beginning approximately 30 minutes after the end of the pemetrexed administration. Patients should receive hydration consistent with local practice prior to and/or after receiving cisplatin.

AS A SINGLE AGENT FOR NONSQUAMOUS NON-SMALL CELL LUNG CANCER MAINTENANCE AND NONSQUAMOUS NON-SMALL LUNG CANCER AFTER PRIOR CHEMOTHERAPY: 500 mg/m2 IV over 10 minutes on day 1 of each 21 day cycle

PREMEDICATION REGIMEN AND CONCURRENT MEDICATIONS:
-Vitamin Supplementation: Patients should initiate folic acid 400 to 1000 mcg orally once daily beginning 7 days before the first dose of chemotherapy. Folic acid should be continued during the full course of therapy and for 21 days after the last dose.
-Vitamin B12 1 mg should be administered IM 1 week prior to the first dose of chemotherapy and every 3 cycles thereafter.
-Subsequent vitamin B12 injections may be given the same day as treatment.
-Corticosteroids: Dexamethasone 4 mg orally 2 times a day the day before, the day of, and the day after chemotherapy administration.

Renal Dose Adjustments

CrCl 45 mL/min or greater: No adjustment recommended
CrCl less than 45 mL/min: Use is not recommended

Liver Dose Adjustments

Data not available

Dose Adjustments

DOSE REDUCTION FOR PEMETREXED (SINGLE-AGENT OR IN COMBINATION) AND CISPLATIN:
HEMATOLOGIC TOXICITIES:
-Nadir absolute neutrophil count (ANC) less than 500/mm3 and nadir platelets 50,000/mm3 or more: Use 75% of the previous dose for pemetrexed and cisplatin
-Nadir platelets less than 50,000/mm3 without bleeding regardless of nadir ANC: Use 75% of the previous dose for pemetrexed and cisplatin
-Nadir platelets less than 50,000/mm3 with bleeding, regardless of nadir ANC: Use 50% of the previous dose for pemetrexed and cisplatin

NONHEMATOLOGIC TOXICITIES (excluding neurotoxicity) Grade 3 or higher, treatment should be withheld until resolution to less than or equal to the patient pretherapy value. Treatment should be resumed as shown:
-Any Grade 3 or 4 toxicities except mucositis: Use 75% of the previous dose for pemetrexed and cisplatin
-Any diarrhea requiring hospitalization (irrespective of Grade) or Grade 3 or 4 diarrhea: Use 75% of the previous dose for pemetrexed and cisplatin
-Grade 3 or 4 mucositis: Use 50 % of the previous dose for pemetrexed and 100% of the previous dose for cisplatin

NEUROTOXICITY:
-Common Toxicity Criteria (CTC) Grade 0 to 1: Use 100 % of the previous dose for pemetrexed and 100% of the previous dose for cisplatin
-Common Toxicity Criteria (CTC) Grade 2: Use 100 % of the previous dose for pemetrexed and 50% of the previous dose for cisplatin

DISCONTINUATION RECOMMENDATION:
-Therapy should be discontinued if a patient experiences any hematologic or nonhematologic Grade 3 or 4 toxicity after 2 dose reductions or immediately if Grade 3 or 4 neurotoxicity is observed.

Precautions

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:
-This drug should be administered under the supervision of a qualified physician experienced in the use of antineoplastic agents. Appropriate management of complications is possible only when adequate diagnostic and treatment facilities are readily available.

Storage requirements:
-Refer to the manufacturer product information.

Reconstitution/preparation techniques:
-Refer to the manufacturer product information.

IV compatibility:
-This drug is incompatible with calcium containing solutions such as lactated Ringers injection and Ringers injection.

General:
-This drug is not indicated for the treatment of patients with squamous cell non-small cell lung cancer.

Monitoring:
-Complete blood cell counts, including platelet counts, should be performed on all patients receiving this drug.
-Patients should be monitored for nadir and recovery, which were tested in the clinical study before each dose and on days 8 and 15 of each cycle. Patients should not begin a new cycle of treatment unless the ANC is 1500 cells/mm3 or greater, the platelet count is 100,000 cells/mm3 or greater, and CrCl is 45 mL/min or greater.
-Periodic chemistry tests should be performed to evaluate renal and hepatic function.

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