Pemex Drug Interactions

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Ibuprofen: Although ibuprofen (400 mg, four times a day) can decrease the clearance of Pemetrexed, it can be administered with Pemetrexed in patients with normal renal function (creatinine clearance ≥80 mL/min). Caution should be taken when administering high dose of Ibuprofen (>1600 mg/day). Caution should be taken when administering Ibuprofen concurrently with Pemetrexed to patients with mild to moderate renal insufficiency (creatinine clearance from 45 to 79 mL/min). (see Pharmacology: Pharmacokinetics under Actions).
Other NSAIDs: Caution should be taken when high dose of NSAIDs or Aspirin combination with Pemetrexed on patients with normal renal function (creatinine clearance ≥80 mL/min).
NSAIDs with short elimination half-lives should be avoided for a period of 2 days before, the day of, and 2 days following administration of Pemetrexed on patients with mild and moderate function insufficient.
In the absence of data regarding potential interaction between Pemetrexed and NSAIDs with longer half-lives, patients taking these NSAIDs should interrupt dosing for at least 5 days before, the day of, and 2 days following Pemetrexed administration. If concomitant administration of NSAIDs is necessary, patients should be monitored closely for toxicity, especially myelosuppression, renal, and gastrointestinal toxicity.
Nephrotoxic Drugs: Pemetrexed is primarily eliminated unchanged renally as a result of glomerular filtration and tubular secretion. Concomitant administration of nephrotoxic drugs (such as aminoglycoside, loop diuretics, platinum compounds, cyclosporine) could result in delayed clearance of Pemetrexed. Concomitant administration of substances that are also tubularly secreted (e.g., probenecid) could potentially result in delayed clearance of Pemetrexed. Caution should be taken when co-administration of previously mentioned drugs, it is necessary to monitor creatinine clearance.
Normal interaction of all cytotoxic drug: Because of risk of thrombus in cancer patients increasing, anticoagulant agent is often used. When patients use oral anticoagulant agent, variability of individual anticoagulant is high and oral anticoagulant has interaction with anti-cancer agent, so the INR monitoring frequency should increase.
Attenuated live vaccine: Immunosuppressive states are common in cancer patients, therefore, except for forbidden yellow fever vaccine, it is not recommended receiving attenuated live vaccine, because it may cause the fatal general disease risk.