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Concomitant administration of nephrotoxic drugs (e.g. aminoglycosides, loop diuretics, platinum compounds, cyclosporin) could potentially result in delayed clearance of pemetrexed.
Concomitant administration of substances that are also tubularly secreted (e.g. probenecid, penicillin) could potentially result in delayed clearance of pemetrexed.
In patients with normal renal function (creatinine clearance ≥80 mL/min), high doses of non-steroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen >1600 mg/day) and aspirin at higher doses (≥1.3 g daily) may decrease pemetrexed elimination and, consequently, increase the occurrence of pemetrexed adverse events.
If concomitant administration of NSAIDs is necessary, patients should be monitored closely to toxicity, especially myelosuppression and gastrointestinal toxicity.
Due to the increased thrombotic risk in patients with cancer, the use of anticoagulation treatment is frequent. Require increased frequency of INR (International Normalised Ratio) monitoring, if it is decided to treat the patient with oral anticoagulants.
Yellow fever vaccine: Risk of fatal generalised vaccine disease.
Live attenuated vaccines (except yellow fever, for which concomitant use is contraindicated): Risk of systemic, possibly fatal disease. The risk is increased in subjects who are already immunosuppressed by their underlying disease. Use an inactivated vaccine where it exists (poliomyelitis).
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