Pemetrexed injection is used in combination with other chemotherapy medications as a first treatment for a certain type of non-small cell lung cancer (NSCLC) that has spread to nearby tissues or to other parts of the body. Pemetrexed injection is also used alone to treat NSCLC as ongoing treatment in people who have already received certain chemotherapy medications and whose cancer has not worsened and in people who could not be treated successfully with other chemotherapy medications. Pemetrexed injection is also in combination with another chemotherapy medication as a first treatment for malignant pleural mesothelioma (a type of cancer that affects the inside lining of the chest cavity) in people who cannot be treated with surgery. Pemetrexed is in a class of medications called antifolate antineoplastic agents. It works by blocking the action of a certain substance in the body that may help cancer cells multiply.

Pemetrexed injection comes as a solution (liquid) and as a powder to be mixed with liquid to be injected into a vein over 10 minutes. Pemetrexed injection is administered by a doctor or nurse in a medical office or infusion center. It is usually given once every 21 days.

Your doctor will probably tell you to take other medications, such as folic acid (a vitamin), vitamin B₁₂, and a corticosteroid such as dexamethasone to decrease some of the side effects of this medication. Your doctor will give you directions for taking these medications. Follow your doctor's directions carefully. Ask your doctor or pharmacist to explain any part you do not understand. If you miss a dose of one of these medications, call your doctor.

Your doctor will tell you to have regular blood tests before and during treatment with pemetrexed injection. Your doctor may change your dose of pemetrexed injection, delay treatment, or permanently stop your treatment based on the results of the blood tests.

Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient.

Before receiving pemetrexed injection,

• tell your doctor and pharmacist if you are allergic to pemetrexed, mannitol (Osmitrol), any other medications, or any of the ingredients in pemetrexed injection. Ask your pharmacist or check the manufacturer's patient information for a list of the ingredients.
• tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• The following nonprescription or herbal products may interact with pemetrexed: ibuprofen (Advil, Motrin). Be sure to let your doctor and pharmacist know that you are taking this medication before you start receiving pemetrexed injection. Do not start this medication while receiving pemetrexed injection without discussing with your healthcare provider.
• tell your doctor if you have had radiation therapy or have or have ever had kidney disease.
• tell your doctor if you are pregnant or plan to become pregnant, or if you plan to father a child. If you are a female who can become pregnant, you will need to have a pregnancy test before you begin treatment, and you should use a reliable method of birth control while receiving pemetrexed injection and for at least 6 months after the final dose. If you are male, you and your female partner should use effective birth control while you are receiving pemetrexed injection and for 3 months after the final dose. If you or your partner becomes pregnant while using this medication, call your doctor. Pemetrexed injection may harm the fetus.
• tell your doctor if you are breastfeeding. You should not breastfeed during your treatment with pemetrexed injection and for 1 week after the final dose.
• you should know that pemetrexed injection may cause fertility problems in males that may affect your ability to father a child. It is not known if these effects are reversible. Talk to your doctor about the risks of receiving pemetrexed injection.

If you miss an appointment to receive a dose of pemetrexed injection, call your doctor as soon as possible.

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Unless your doctor tells you otherwise, continue your normal diet.

Pemetrexed injection may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• nausea
• vomiting
• diarrhea
• constipation
• loss of appetite
• change in ability to taste food
• hair loss
• rash
• itching
• tiredness
• joint pain

Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately or get emergency medical treatment :

• blisters, skin sores, skin peeling, or painful ulcers in your mouth, lips, nose, throat, or genital area
• swelling, blistering, or rash that looks like a sunburn in an area previously treated with radiation
• unusual bleeding or bruising
• sore throat, fever, chills, cough or other signs of infection
• chest pain
• fast heartbeat
• persistent cough or shortness of breath
• extreme tiredness or weakness
• dizziness or faintness
• weakness or numbness of an arm or leg
• pain, burning, numbness, or tingling in the hands or feet
• pale skin
• headache
• hives
• decreased urination

Pemetrexed injection may cause other side effects. Call your doctor if you have any unusual problems while receiving this medication.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your body's response to pemetrexed injection.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

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