Pemetrexed medac - Pemetrexed uses, dose and side effects

Pemetrexed medac is given together with cisplatin, another anti-cancer medicine, for the treatment of malignant pleural mesothelioma, a form of lung cancer, to patients who have not previously received anticancer medicine.

Pemetrexed medac is also used with cisplatin in the initial treatment of advanced lung cancer.

Pemetrexed can be prescribed to you if you have advanced lung cancer and your disease has responded to treatment or if it is largely unchanged after initial drug treatment.

In addition, Pemetrexed medac is used to treating advanced lung cancer whose disease has progressed after other previous drug treatments have been used.

What you need to know before using Pemetrexed medac

Do not use Pemetrexed medac:

if you are allergic to pemetrexed or any of the other ingredients of this medicine (listed in section 6).
if you are breastfeeding. You should stop breastfeeding during treatment with Pemetrexed medac.
if you have recently been vaccinated or are just about to be vaccinated against yellow fever.

Warnings and cautions

Before using Pemetrexed medac, talk to your doctor or pharmacist about:

you have or have had kidney problems, as you may not be able to get Pemetrexed medac. Before each infusion , blood samples will be taken to determine if the function of the kidneys and liver is sufficient and to check that the amount of blood cells is sufficient to obtain Pemetrexed medac. Your doctor may choose to change the dose or postpone your treatment depending on your general condition and if your blood levels are too low. If you are also taking cisplatin, your doctor will make sure that you have been given enough fluids and that you will receive appropriate treatment before and after the cisplatin treatment to prevent vomiting.
you have received radiation therapy or if such treatment is planned, like radiation therapy and Pemetrexed medac may cause immediate or late side effects .
you have recently been vaccinated, as Pemetrexed medac in connection with vaccination may give rise to undesirable reactions.
if you have or have previously had, heart disease.
you have fluid accumulation around your lung as your doctor may decide to remove the fluid before treatment with Pemetrexed medac.

Children and young people

This medicine should not be used by children or adolescents as there is no experience with the medicine in children and adolescents under 18 years of age.

Other medicines and Pemetrexed medac

Tell your doctor or pharmacist if you are taking or have recently taken any other medicines, including medicines obtained without a prescription.

In particular, tell your doctor if you are taking any medicine for pain or inflammation (swelling), such as so-called non-steroidal anti-inflammatory drugs ( NSAIDs ), including over-the-counter medicines (such as ibuprofen ). There are many different types of these drugs with varying duration of action. Knowing the date of the planned infusion of Pemetrexed medac and / or renal function status, your doctor will need to advise you on which medicines to take and when to take them. If you are not sure, ask your doctor or pharmacist if any of your medicines are NSAIDs .

Pregnancy, breastfeeding, and fertility

Pregnancy

If you are pregnant, breastfeeding or think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine. Treatment with Pemetrexed medac should be avoided during pregnancy. Your doctor will discuss any possible risks when Pemetrexed medac is given during pregnancy. Women should use effective contraception during treatment with Pemetrexed medac.

Breast-feeding

You should not breastfeed during treatment with Pemetrexed medac. Ask your doctor when it is safe to start breastfeeding again after stopping treatment.

Fertility

Men are advised not to have children during and up to 6 months after Pemetrexed medac treatment and should therefore use an effective method of contraception during Pemetrexed medac treatment and up to 6 months after stopping treatment. If you plan to have children during treatment or the following 6 months after treatment, consult your doctor or pharmacist . You may want to seek advice on sperm preservation before starting treatment.

Driving and using machines

Treatment with Pemetrexed medac may make you feel tired. Be careful when driving or using machines.

Pemetrexed medac contains sodium

Pemetrexed medac 100 mg

This medicine contains less than 1 mmol (23 mg) sodium per 100 mg vial , ie is essential ‘sodium-free’.

Pemetrexed medac 500 mg

This medicine contains 54 mg of sodium (the main ingredient in table salt / table salt) per 500 mg vial . This corresponds to 2.70% of the maximum recommended daily sodium intake for adults.

Pemetrexed medac 1,000 mg

This medicine contains 108 mg of sodium (the main ingredient in common salt / table salt) per 1,000 mg vial . This corresponds to 5.40% of the maximum recommended daily intake of sodium for adults.

How to use Pemetrexed medac

Pemetrexed medac is given at a recommended dose of 500 mg per square meter of body surface area. Your height and weight are used to calculate the body surface area. Your doctor will use the measurement of your body surface area to calculate the correct dose for you. This dose can be adjusted or the treatment can be postponed depending on blood levels and your general condition. A hospital pharmacist, nurse, or doctor will have mixed the Pemetrexed medac powder in sterile sodium chloride 9 mg / ml (0.9%) solution before giving it to you.

Pemetrexed medac is always given as an infusion into a friend. Infusion one lasts for about 10 minutes.

Then Pemetrexed medac is given in combination with cisplatin

Your doctor or hospital pharmacist will have calculated the required dose using your height and weight. Cisplatin is also given as an infusion into a vein and is given approximately 30 minutes after the end of the Pemetrexed medac infusion. Infusion one of cisplatin lasts for about 2 hours.

You usually receive an infusion once every three weeks.

Other drugs

Corticosteroid is

Your doctor will prescribe steroid tablets (equivalent to 4 mg dexamethasone twice daily). You should take these tablets the day before, on the day of treatment, and the day after treatment with Pemetrexed medac. The tablets are given to reduce the frequency and severity of the skin reactions that may occur during treatment for cancer.

Vitamin supplement

Your doctor will prescribe a preparation of folic acid ( vitamin ) to be taken by mouth or a multivitamin preparation containing folic acid (350-1000 µg) that you should take once a day during treatment with Pemetrexed medac. You should take at least 5 doses during the seven days before the first dose of one of the Pemetrexed medac. You should continue to take folic acid for 21 days after the last Pemetrexed medication . You will also receive a vitamin B 12 injection ( 1,000 µg) the week before Pemetrexed medac infusion one and then approximately every 9 weeks (equivalent to 3 courses of treatment with Pemetrexed medac). Vitamin B ₁₂ and folic acid are given to reduce the possible harmful effects of cancer treatment.

If you have any further questions on the use of this product, ask your doctor or pharmacist.

Possible side effects

Like all medicines, this medicine can cause side effects , although not everybody gets them.

You should contact your doctor immediately if you notice any of the following side effects:

Fever or infection (common or very common): if you have a temperature of 38 ° C or more, sweating, or other signs of an infection (because you may have a lower white blood cell count than normal, which is very common). Infection one (blood poisoning) can be serious and lead to death.
If you start to feel chest pain (common) or have a fast heart rate (less common).
If you feel pain, redness , swelling, or soreness in your mouth (very common).
Allergic reaction: if you get a rash (very common) / burning or stinging sensation (common) or fever (common). Skin reactions can be serious and lead to death (rare). Contact your doctor if you get a lot of rash, itching, or blisters ( Stevens-Johnson syndrome or toxic epidermal necrolysis ).
If you get tired, feel weak, get short of breath easily, or if you look pale (because you may have less hemoglobin than normal, which is very common).
If there is bleeding from the gums, nose, or mouth or you get any bleeding that does not want to stop, reddish or pinkish urine, unexpected bruising (because you may have fewer platelets than normal, which is common).
If you experience sudden shortness of breath, intense chest pain, or cough with bloody cough (less common) (may indicate a blockage in the blood vessels of the lungs).

The following side effects may occur during treatment with pemetrexed:

Very common (may affect more than 1 user in 10)

Infection

Sore throat

Low neutrophil count ( white blood cell type )

Low white blood cell count

Low hemoglobin ( anemia )

Pain, redness , swelling, or soreness in the mouth

Decreased appetite

Vomiting

Diarrhea

Nausea

Rash

Flaking skin

Abnormal blood counts showing reduced kidney function

Fatigue (fatigue)

Common (may affect up to 1 in 10 people)

Blood infection

Fever with low neutrophil count ( white blood cell type )

Reduced platelet count

Allergic reaction

Dehydration

Taste changes

Muscle weakness due to damage to motor nerves, especially in the arms and legs

Loss of sensation, burning pain, and unsteady gait due to damage to sensory nerves

Dizziness

Inflammation or swelling of the conjunctiva ( membrane at the end of the eyelids and covering the eyes white)

Dry eyes

Tear-filled eyes

Dried conjunctiva ( membrane on the outer part of the eyelids and covering the eyes white and cornea (the clear layer that protects the iris and pupil )

Swollen eyelids

Eye problems, such as dryness, tearing, irritation, and / or pain.

Heart failure (a condition that affects the pumping power of your heart muscle)

Irregular heartbeat

Indigestion

Constipation

Abdominal pain

Liver: increase in the substances in the blood produced by the liver

Increased skin pigmentation

Itching

Rash on the body therewith red marks

Hair loss

Hives

Kidney failure

Decreased renal function

Fever

Pain

Excess fluid in body tissue, which causes swelling

Chest pain

Inflammation and ulceration of the mucous membranes that line the digestive tract

Uncommon (may affect up to 1 in 100 people)

Reduction in the number of red and white blood cells and platelets

Stroke

Type of stroke when an artery to the brain is blocked

Bleeding inside the skull

Angina (Chest pain caused by decreased blood flow to the heart)

Myocardial infarction

Narrowing or blockage of the coronary arteries

Elevated heart rate

Reduced blood distribution to the limbs

Blood clots in the pulmonary blood vessels ( pulmonary embolism )

Inflammation and scarring of the lungs with respiratory problems

Passage of bright red blood from the anus

Bleeding in the gastrointestinal tract

Broken intestine

Inflammation of the esophageal mucosa (esophagus)

Colitis ( inflammation of the wall of the colon, which may be accompanied by bleeding from the intestines or rectum (seen only in combination with cisplatin)

Inflammation , edema , erythema, and erosion of the mucosal surface of the esophagus caused by radiation therapy

Inflammation of the lung caused by radiation therapy

Rare (may affect up to 1 in 1,000 people)

Destruction of red blood cells

Anaphylactic shock (severe allergic reaction )

Inflammatory conditions of the liver

Redness of the skin

Skin rash that may occur on skin that has previously been exposed to radiation therapy.

Very rare (may affect up to 1 in 10,000 people)

Infection of skin and soft tissue

Stevens-Johnson syndrome (a type of severe reaction to skin and mucous membranes that can be life-threatening)

Toxic epidermal necrolysis (a type of severe skin reaction that can be life-threatening)

An autoimmune condition that results in skin rashes and blisters on legs, arms, and abdomen

Inflammation of the skin characterized by the presence of bullous conditions with fluid-filled blistering)

Fragile skin, blisters, and erosion as well as scarring of the skin

Redness , pain, and swelling mainly in the lower legs

Inflammation of the skin and fat under the skin (pseudocellulitis)

Inflammation of the skin ( dermatitis )

Skin that becomes inflamed, itchy, red, cracked and rough

Intense itchy spots

Has been reported (occurs in an unknown number of users)

A form of diabetes that is primarily based on kidney pathology

Kidney disorder involving tubular epithelial cells (which form renal tubules) death.

How to store Pemetrexed medac

Keep this medicine out of the sight and reach of children.

Do not use this medicine after the expiry date which is stated on the label and carton after EXP.

No special storage instructions.

Dissolved drug and infusion solution: The drug should be used immediately. Chemical and physical shelf life for 24 hours in a refrigerator (2-8 ° C) has been demonstrated for the reconstituted stock solution and the infusion solution of pemetrexed, if reconstituted according to the instructions.

This medicine is for single use only. Any unused solution should be disposed of in accordance with local requirements.

Contents of the pack and other information

Content declaration

The active substance is pemetrexed.

Pemetrexed medac 100 mg: One vial contains 100 mg pemetrexed (as disodium pemetrexedhemipentahydrate).

Pemetrexed medac 500 mg: One vial contains 500 mg of pemetrexed (as disodium pemetrexedhemipentahydrate).

Pemetrexed medac 1,000 mg: One vial contains 1,000 mg of pemetrexed (as disodium pemetrexedhemipentahydrate).

After reconstitution, the solution contains 25 mg / ml pemetrexed.

The other ingredients are mannitol, hydrochloric acid and sodium hydroxide, see section 2 “Pemetrexed medac contains sodium”.

What the medicine looks like and contents of the pack

Pemetrexed medac is a powder for concentrate for solution for infusion in a rubber stopper vial .

It is a white to light yellow powder.

The pack contains a vial of 100, 500 or 1,000 mg pemetrexed.

Marketing Authorisation Holder

medac

Society for Clinical Specialties mbH

Theaterstr. 6

22880 Wedel

Germany

tel .: +49 4103 8006-0

fax: +49 4103 8006-100

Manufacturer

Synthon Hispania SLC / Castelló n ° 1, Pol. Las Salinas

08830 Sant Boi de Llobregat

Barcelona

Spain

tel .: +34 936401516

fax: +34 936401146

Synthon, sro

Brnĕnská 32 / čp. 597

67801 Blansko

Czech Republic

tel .: +420 516 427 311

fax: +420 516 417 350