Pemetrexed is used to treat certain types of cancer (such as lung cancer, mesothelioma). It is a chemotherapy drug that works by slowing or stopping the growth of cancer cells.

Read the Patient Information Leaflet if available from your pharmacist before you start receiving pemetrexed and each time you receive a dose. If you have any questions, ask your doctor or pharmacist.

This medication is given by injection into a vein by a healthcare professional. It is given over 10 minutes as directed by your doctor, usually once every 3 weeks. The dosage is based on your medical condition, body size, and response to treatment. To lower your chance of having a skin reaction while using pemetrexed, your doctor will prescribe a corticosteroid medicine (such as dexamethasone) to take for a short period around the time of each treatment. Consult your doctor or pharmacist for more details.

To lower your chance of other side effects, it is very important that you take folic acid vitamins and receive vitamin B12 shots before and during treatment with pemetrexed. Folic acid vitamins are available over-the-counter without a prescription, and folic acid can be found in many multivitamin products. Make sure your vitamin contains between 400 to 1000 micrograms (0.4 to 1 milligram) of folic acid. Take folic acid daily starting 1 week before your first dose of pemetrexed, during treatment, and for 3 weeks after your last dose of pemetrexed. If you need help choosing a folic acid vitamin, ask your doctor or pharmacist. Your doctor will give you a vitamin B12 shot into the muscle, usually 1 week before your first dose of pemetrexed and then once every 9 weeks during your treatment. Do not substitute vitamin B12 taken by mouth for the vitamin B12 shots. Consult your doctor or pharmacist for more details.

Nausea, vomiting, loss of appetite, diarrhea, stomach upset, changes in taste, constipation, mouth sores, and tiredness may occur. Nausea, vomiting, and diarrhea can be severe. In some cases, your doctor may prescribe medication to prevent or relieve nausea, vomiting, and diarrhea. Eating several small meals, not eating before treatment, or limiting activity may help lessen nausea and vomiting. If any of these effects last or get worse, tell your doctor or pharmacist promptly.

Temporary hair loss may occur. Normal hair growth should return after treatment has ended.

People using this medication may have serious side effects. However, you have been prescribed this drug because your doctor has judged that the benefit to you is greater than the risk of side effects. Careful monitoring by your doctor may decrease your risk.

Tell your doctor right away if you have any serious side effects, including:

• numbness/tingling skin
• swelling ankles/feet/hands
• signs of kidney problems (such as change in the amount of urine)
• signs of liver disease (such as nausea/vomiting that doesn't stop, stomach/abdominal pain, yellowing eyes/skin, dark urine)

This medication may decrease bone marrow function, an effect that may lead to a low number of blood cells such as red cells, white cells, and platelets. This effect can cause anemia, decrease your body's ability to fight an infection, or cause easy bruising/bleeding. Tell your doctor right away if you develop any of the following symptoms:

• unusual tiredness
• pale skin
• signs of infection (such as sore throat that doesn't go away, fever, chills)
• easy bruising/bleeding

Get medical help right away if you have any very serious side effects, including:

• blisters or sores
• signs of lung problems (such as new or worsening shortness of breath, cough)

Pemetrexed may cause a serious skin reaction that looks like a severe sunburn (radiation recall) on any area that has been treated with radiation weeks to years before. Get medical help right away if you have skin redness, pain, tenderness, swelling, peeling, or blisters.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including:

• rash
• itching/swelling (especially of the face/tongue/throat)
• severe dizziness
• trouble breathing

Pemetrexed can commonly cause a rash that is usually not serious and that can be prevented by taking corticosteroid medication (see How to Use section). However, you may not be able to tell the rash apart from a rare rash that could be a sign of a severe reaction. Get medical help right away if you develop any rash.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US - Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Before using pemetrexed, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of:

• kidney disease
• liver disease
• radiation treatment

Pemetrexed can make you more likely to get infections or may make current infections worse. Stay away from anyone who has an infection that may easily spread (such as chickenpox, COVID-19, measles, flu). Talk to your doctor if you have been exposed to an infection or for more details.

Tell your health care professional that you are using pemetrexed before having any immunizations/vaccinations. Avoid contact with people who have recently received live vaccines (such as flu vaccine inhaled through the nose).

To lower the chance of getting cut, bruised, or injured, use caution with sharp objects like razors and nail cutters, and avoid activities such as contact sports.

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

This medication can affect fertility in males. Ask your doctor for more details.

Tell your doctor if you are pregnant or plan to become pregnant. You should not become pregnant while using pemetrexed. Pemetrexed may harm an unborn baby. Your doctor should order a pregnancy test before you start this medication. Women using this medication should ask about reliable forms of birth control during treatment and for 6 months after the last dose. Men using this medication should ask about reliable forms of birth control during treatment and for 3 months after the last dose. If you or your partner becomes pregnant, talk to your doctor right away about the risks and benefits of this medication.

It is unknown if this drug passes into breast milk. Because of the possible risk to the infant, breastfeeding is not recommended while using this drug and for 1 week after the last dose. Consult your doctor before breastfeeding.

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call 1-800-222-1222. Canada residents can call 1-844-764-7669.

Lab and/or medical tests (such as complete blood count, liver/kidney function) should be done while you are taking this medication. Keep all medical and lab appointments. Consult your doctor for more details.

It is important to get each dose of this medication as scheduled. If you miss a dose, ask your doctor or pharmacist right away for a new dosing schedule.

Not applicable. This medication is given in a clinic and will not be stored at home.

Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).