|The name of the preparation||Character; dose; package||Manufacturer||Price 100%||Price after refund||In which pharmacy?|
|Alimta||powder for concentrate for solution for infusion; 100 mg; 1 fiol||Eli Lilly||b / d||Check|
|Alimta||powder for concentrate for solution for infusion; 500 mg; 1 fiol||Eli Lilly||b / d||Check|
Note: reimbursed drug prices are in line with the regulations in force from July 1, 2018.
It is an anticancer drug used in cancer Chemotherapy .
The active substance is pemetrexed. It is an organic compound, a folic acid derivative. The chemical similarity causes pemetrexed to replace folic acid in biochemical reactions. In this way, it blocks the action of enzymes necessary for metabolic transformations of folic acid. Because of this mode of action pemetrexed belongs to a group of anticancer drugs called antimetabolites (it is an antimetabolite of folic acid). By inhibiting metabolic pathways, it prevents the synthesis of purine and pyrimidine bases, elements necessary in the structure of DNA. The consequence is a disruption in the synthesis of DNA as well as RNA and proteins, which leads to inhibition of cell division and apoptotic cell death. The effects of pemetrexed are particularly relevant to rapidly dividing cells, which are cancer cells. Used in the treatment of non-small cell lung cancer and rare pleural mesothelioma, often associated with exposure to asbestos.
The preparation is indicated for the treatment of the following types of cancer:
• inoperable malignant pleural mesothelioma (combination therapy with Cisplatin in patients who have not undergone chemotherapy)
• non-small cell lung cancer in a locally advanced stage or with metastases other than mainly squamous histology (combined treatment with cisplatin as a first line treatment, monotherapy as maintenance treatment in people who have not progressed immediately after the completion of platinum-based chemotherapy, monotherapy as second-line treatment).
Unfortunately, even if there are indications to use the preparation, it can not always be used. You can not use the preparation if you are allergic (you are hypersensitive) to any of the ingredients. Do not use during pregnancy. The use of the preparation is contraindicated during breast-feeding. Do not use yellow fever vaccines in parallel. It is not recommended for use in people under 18 years of age.
Certain diseases and other circumstances may constitute a contraindication to use or indication to change the dosage of the preparation. In certain situations, it may be necessary to carry out specific check-ups. Treatment may only be carried out under the supervision of an oncologist who has experience in the use of cancer chemotherapy.
During your treatment your doctor will recommend regular hematological examinations because there is a risk of bone marrow suppression. It is possible that neutropenia (decrease in neutrophil counts in blood counts), thrombocytopenia, anemia and pancytopenia (deficiency of all blood morphology) may occur. If the number of white blood cells or platelets decreases significantly, your doctor will adjust the dosage or recommend discontinuation of the preparation until the test results improve.The preparation should not be used if the neutrophil count is less than 1,500 / microliter and the platelet count is less than 100,000 / microliter. If any symptoms of infection occur, immediately consult a doctor who will recommend a blood test and appropriate treatment depending on the results of the examination.
To reduce the incidence and severity of side effects of the preparation, it is recommended to prophylactically use folic acid and vitamin B12 before starting treatment. Additionally, to minimize skin reactions, the doctor may recommend prophylactic corticosteroid use (eg Dexamethasone ).
Before each administration of pemetrexed, your doctor will prescribe tests to assess liver function (blood bilirubin, liver enzymes) and kidney (creatinine clearance). The use of the preparation is possible only after obtaining the required parameters.
Patients with severe renal impairment (creatinine clearance less than 45 ml / min) are not recommended. Caution should be exercised in patients with mild or moderate renal impairment. These people should avoid taking non-steroidal anti-inflammatory drugs (eg Ibuprofen , Acetylsalicylic acid ) 2 days before, on the day of administration and 2 days after administration. All patients scheduled for pemetrexed therapy should avoid the use of non-steroidal anti-inflammatory drugs with a long half-life (eg Piroxicam , rofecoxib) for at least 5 days before, on the day of administration and for at least 2 days after administration.
The use of the preparation may be associated with the occurrence of severe renal dysfunction (including acute renal failure ). This risk is increased in people with risk factors such as dehydration, hypertension or in patients with diabetes.
If there is pulmonary embolism or ascites with a significant accumulation of fluid, it is recommended to remove the fluid (decrease exudate) before starting treatment.
Use of the preparation in combination with cisplatin is associated with the possibility of toxic effects on the digestive system. In order to reduce vomiting and their effect, which may be a significant dehydration of the body, the doctor may recommend taking anti-sickness medication before taking the preparation. It is important to take adequate amounts of fluids to ensure adequate hydration of the body.
Use of the drug, especially in combination with other cytotoxic agents, may increase the risk of severe cardiovascular dysfunction including myocardial infarction and cerebrovascular events. This risk is increased in people with risk factors for cardiovascular disease.
If the symptoms of neurotoxic (nervous system damaging) effects of the preparation occur, the doctor will stop the treatment.
Due to the reduction of the immune response (reduction of immunity), live vaccines should not be used during the treatment period due to the risk of generalized post-vaccination disease that may cause death.
The preparation may increase the sensitivity to irradiation. In patients who have undergone radiotherapy within a few weeks before the start of treatment, recurrence of radiation symptoms may occur. If radiation has been used before, during or after the application, pneumonia may occur.
Treatment with pemetrexed may cause irreversible infertility. Therefore, men who intend to become fathers in the future should consult a physician regarding the possibility of collecting and storing semen collected before starting treatment.
Persons being treated with the preparation (both men and women) should absolutely consult a doctor about the use of effective contraception to prevent pregnancy during the treatment period and in addition for 6 months after its completion.
Does this preparation affect the ability to drive vehicles?
The preparation may cause side effects (eg fatigue) that may impair your ability to drive or use machines / machines. Take care and do not drive or operate machines if this symptom occurs.
The preparation is a powder for concentrate for solution for intravenous infusion. The preparation, after proper preparation and dilution, may be administered only by qualified medical personnel. If you have any doubts regarding the use of the preparation, consult a physician.The doctor will select the dosage individually depending on the indication, the expected result, the clinical situation, and whether the preparation will be used as a monotherapy or as part of a multi-drug chemotherapy. During the treatment, the doctor will adjust the dosage depending on the results of hematological examinations and the severity of side effects. Usually:
-Treatment associated with cisplatin or monotherapy: 500 mg / m2 of body surface area, in a 10-minute intravenous infusion on day 1 of each 3-week cycle.
To reduce side effects (vomiting, dehydration), it is recommended to use antiemetics and adequate fluid intake. To minimize skin reactions, your doctor may recommend taking corticosteroids. Parallel intake of folic acid or multivitamins containing folic acid reduces the risk of pemetrexed toxicity. Folic acid (350-1000 micrograms) should be taken within 7 days of treatment, during the entire treatment period and for 3 weeks after its completion. In addition, the doctor will recommend vitamin B12 administered intramuscularly.
To start and conduct treatment, the results of hematology and liver and kidney function tests are required to meet certain criteria. Otherwise, the doctor will reduce the dosage or recommend discontinuation of treatment until the parameters are improved.
There are no specific recommendations on the use of the preparation in the elderly (after the age of 65). It is not recommended for use in people under 18 years of age.
No dosage adjustment is necessary for people with renal impairment whose creatinine clearance is greater than 45 ml / min. It is not recommended for people whose creatinine clearance is less than 45 ml / min.
During pregnancy, do not use any medicine without consulting your doctor!
It is very important that before using any medicine during pregnancy or breastfeeding, consult a physician and explain beyond any doubt the potential risks and benefits associated with the use of the drug. If you are pregnant or plan to become pregnant, please inform the doctor prescribing the prescription for this medicine. Also, see the warnings in the "Take special care with the preparation" section.
Do not use the preparation during pregnancy. The use of the preparation is only allowed if the doctor considers it absolutely necessary after considering the benefits for the mother and the risks to the fetus.
The preparation is contraindicated during breast-feeding.
Tell your doctor about all medicines you have recently taken, including those that are over the counter.
Drugs affecting the rate of excretion of pemetrexed by the kidneys (eg penicillin, probenecid, aminoglycoside antibiotics, some diuretics, e.g. Furosemide , platinum compounds, cyclosporin) may delay the excretion of the preparation and increase its toxicity. If it is necessary to use them in parallel, be careful.
Non-steroidal anti-inflammatory drugs (e.g., ibuprofen) and acetylsalicylic acid, especially those used at high doses, may lead to increased adverse effects of the preparation in people with normal renal function. People with mild or moderate renal impairment should avoid taking non-steroidal anti-inflammatory drugs (eg ibuprofen) and acetylsalicylic acid 2 days before, on the day of administration and 2 days after administration. All patients scheduled for pemetrexed therapy should avoid the use of non-steroidal anti-inflammatory drugs with a long half-life (eg piroxicam, rofecoxib) for at least 5 days before, on the day of administration and for at least 2 days after administration.
If anticoagulants are used, monitoring of blood coagulation parameters and possible dose adjustments is recommended.
The use of a vaccine against yellow fever is contraindicated; generalized vaccine reaction can lead to death. During the treatment period, live vaccines should not be used because of the risk of generalized post-vaccination disease that can cause death. This risk is increased in people with immune system disabilities caused by the underlying disease.
Like all medicines, Alimta can cause side effects, although it will not occur in all patients who use this medicine.Remember that the expected benefits of using the drug are usually greater than the damage resulting from the occurrence of side effects. The severity of the side effects of the preparation may be greater if it is given in combination with other chemotherapeutics.
Very often hematological disorders are possible: leukopenia (reduction in the number of white blood cells [leukocytes] in blood counts), neutropenia (decrease in neutrophil counts in blood counts), anemia, thrombocytopenia, and infection; fever may be less frequent, septicemia. Often or very often possible: dehydration, dysgeusia, nausea, diarrhea, vomiting, indigestion, stomatitis and / or pharyngitis, anorexia, constipation, rash, exfoliation, alopecia, pruritis, neuropathy (tingling and numbness), inflammation conjunctivitis, fatigue, abnormal liver function (increased bilirubin, increased liver enzymes), impaired renal function (reduced rate of creatinine excretion). Uncommonly or rarely possible: urticaria, chest pain, myocardial infarction, cerebrovascular events, edema, abdominal pain, erythema multiforme, colitis, intestinal bleeding, intestinal perforation, intestinal necrosis, interstitial pneumonia that may lead to death . Very rarely possible dangerous Anaphylactic reactions , arrhythmia, motor neuropathy, hepatitis.
Peripheral ischemia leading to necrosis of the extremities, pneumonia after irradiation, recurrence of radiation symptoms, acute renal failure is also possible.
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