Drug Interaction Report

Imipenem may increase the blood levels of PEMEtrexed. You may be more likely to develop serious side effects such as anemia, bleeding problems, infections, and nerve damage when these medications are used together. Contact your doctor if you experience severe nausea and vomiting, diarrhea, paleness of skin, fatigue, dizziness, fainting, unusual bleeding or bruising, fever, chills, body aches, flu-like symptoms, mouth ulcers or sores, and/or numbness, burning or tingling in your hands and feet. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Consumer information for this interaction is not currently available.

MONITOR: Coadministration with drugs that are eliminated by active tubular secretion may delay and/or decrease the clearance of pemetrexed. The mechanism is competitive inhibition of the renal excretion of pemetrexed, which is primarily eliminated unchanged via glomerular filtration and active tubular secretion. Drugs (and/or their metabolites) that are thought to undergo active tubular secretion include acyclovir, allopurinol, aminosalicylic acid, cidofovir, cimetidine, creatine, dyphylline, famciclovir, famotidine, flecainide, ganciclovir, levetiracetam, metformin, methotrexate, midodrine, mycophenolic acid, oseltamivir, pralatrexate, probenecid, procainamide, quinidine, ranitidine, tenofovir, triamterene, trimethoprim, valacyclovir, valganciclovir, zalcitabine, zidovudine, and many of the beta-lactam and quinolone antibiotics.

MANAGEMENT: Patients receiving pemetrexed in combination with other drugs that undergo active tubular secretion should be monitored for excessive pharmacologic effects of one or both drugs, and the dosages of the drugs adjusted if necessary. The potential for increased toxicity of pemetrexed such as bone marrow suppression should be considered. Renal function should be closely monitored during therapy. Pemetrexed should not be administered to patients whose creatinine clearance is below 45 mL/min.