When This Medicine Should Not Be Used:
You should not receive this medicine if you have had an allergic reaction to pemetrexed, or if you are pregnant.

How to Use This Medicine:
Injectable

• Medicines used to treat cancer are very strong and can have many side effects. Before receiving this medicine, make sure you understand all the risks and benefits. It is important for you to work closely with your doctor during your treatment.
• You will receive this medicine while you are in a hospital or cancer treatment center. A nurse or other trained health professional will give you this medicine.
• Your doctor will prescribe your dose and schedule. This medicine is given through a needle placed in a vein.
• The medicine is usually given on day 1 of a treatment cycle. This treatment cycle is often 21 days, but it might be longer.
• If any of this medicine gets on your skin or in your eyes, nose, or mouth, tell your caregiver right away. You will need to wash off the medicine right away.
• You may need to do the following during treatment to help prevent gastrointestinal problems, skin rashes, anemia, and other side effects.
  
  • Take a folic acid supplement or a multivitamin that contains folic acid. Begin taking folic acid at least 5 days before your first injection, and continue to take it for at least 21 days after your final injection. Ask your doctor what dose to take.
  • Your doctor will give you a vitamin B12 injection in the week before your first treatment, and then about every 9 weeks while you receive treatment.
  • Your doctor will give you a steroid medicine to take the day before, the day of, and the day after each injection.
• Read and follow the patient instructions that come with this medicine. Talk to your doctor or pharmacist if you have any questions.

Drugs and Foods to Avoid:
Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

• Make sure your doctor knows if you are also using probenecid (Benemid®) or pain or arthritis medicine (such as aspirin, diclofenac, ibuprofen, indomethacin, meloxicam, nabumetone, naproxen, Advil®, Aleve®, Celebrex®, Voltaren®).

Warnings While Using This Medicine:

• It is not safe to take this medicine during pregnancy. It could harm an unborn baby. Tell your doctor right away if you become pregnant.
• Make sure your doctor knows if you are breastfeeding or have kidney disease, liver disease, or bone marrow problems (anemia).
• This medicine may make you bleed, bruise, or get infections more easily. Take precautions to prevent illness and injury. Wash your hands often.
• Your doctor will do lab tests at regular visits to check on the effects of this medicine. Keep all appointments.
• Cancer medicines can cause diarrhea, nausea, or vomiting in most people, sometimes even after receiving medicines to prevent it. Ask your doctor or nurse about other ways to control these side effects.

Possible Side Effects While Using This Medicine:
Call your doctor right away if you notice any of these side effects:

• Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
• Blistering, peeling, red skin rash
• Decrease in how much or how often you urinate
• Dry mouth or skin, increased thirst, lightheadedness, dizziness, fainting
• Fever, chills, cough, sore throat, and body aches
• Lower back or side pain
• Rapid weight gain, swelling in your hands, ankles, or feet
• Red or dark brown urine
• Unusual bleeding, bruising, weakness

If you notice these less serious side effects, talk with your doctor:

• Constipation, nausea, or vomiting
• Loss of appetite
• Sores or white patches on your lips, mouth, or throat

If you notice other side effects that you think are caused by this medicine, tell your doctor.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088