Drug Interaction Report

PEMEtrexed has a major potential interaction with Bone Marrow Depression/Low Blood Counts.

Pemetrexed can cause severe myelosuppression resulting in the need for transfusion and which may lead to neutropenic infection. The risk of myelosuppression is increased in patients who do not receive vitamin supplementation (including oral folic acid and IM vitamin B12). Patients with myelosuppression should be monitored carefully. A CBC should be obtained at the beginning of each cycle and as needed. Treatment should not be initiated unless the absolute neutrophil count is at least 1500 cells/mm3 and platelet count is at least 100,000 cells/mm3.

PEMEtrexed has a moderate potential interaction with History, Radiation Therapy.

Radiation recall can occur with pemetrexed in patients who have received radiation weeks to years previously. Patients should be monitored for inflammation/blistering in areas of previous radiation treatment; they should be advised to immediately contact their health care provider if inflammation/blisters develop in a previously irradiated area. Pemetrexed should be permanently discontinued for signs of radiation recall.

PEMEtrexed has a moderate potential interaction with Liver Disease.

No formal studies have been conducted to examine pemetrexed in patients with liver dysfunction. Caution is advised.

PRALAtrexate has a moderate potential interaction with Liver Disease.

The safety, efficacy and pharmacokinetics of pralatrexate have not been evaluated in patients with hepatic impairment. Additionally, this drug can cause hepatotoxicity and liver function test abnormalities, which might require dose modification or discontinuation. Caution and monitoring is advised.

PEMEtrexed has a major potential interaction with Pulmonary Impairment.

Serious interstitial pneumonitis (including fatal case) can occur with pemetrexed. Care should be exercised when using pemetrexed in patients with preexisting pulmonary impairment. Pemetrexed should be withheld for acute onset of new/progressive unexplained pulmonary symptoms; if pneumonitis is confirmed, pemetrexed should be permanently discontinued.

PEMEtrexed has a major potential interaction with Renal Dysfunction.

Pemetrexed can cause severe (and sometimes fatal) renal toxicity. Pemetrexed is primarily eliminated by the kidneys; decreased renal function results in decreased clearance and increased pemetrexed exposure compared with normal renal function. No dose is recommended for patients with CrCl less than 45 mL/min. CrCl should be determined before each dose and renal function should be monitored periodically during therapy. Pemetrexed should be withheld in patients with renal toxicity until CrCl is 45 mL/min or greater.

PRALAtrexate has a moderate potential interaction with Renal Dysfunction.

Patients with moderate to severe renal function impairment may be at greater risk of toxicity due to increased exposure. Patients should be monitored for renal function and toxicity and dosage should be adjusted accordingly. For patients with severe renal impairment (GFR 15 to <30), the recommended dose of pralatrexate is 15 mg/m2. Avoid the use of pralatrexate in patients with ESRD undergoing dialysis, unless the potential effect justifies the potential risk.