Pemetrexed Mylan 25 mg/ml concentrate for solution for infusion – patient leaflet, side effects, dosage

1 What Pemetrexed Mylan is and what it is used for

Pemetrexed Mylan is a medicine used in the treatment of cancer.

Pemetrexed Mylan is given in combination with cisplatin, another anti-cancer medicine, as treatment for malignant pleural mesothelioma, a form of cancer that affects the lining of the lung, to patients who have not received prior chemotherapy.

Pemetrexed Mylan is also given in combination with cisplatin for the initial treatment of patients with advanced stage of lung cancer.

Pemetrexed Mylan can be prescribed to you if you have lung cancer at an advanced stage if your disease has responded to treatment or it remains largely unchanged after initial chemotherapy.

Pemetrexed Mylan is also a treatment for patients with advanced stage of lung cancer whose disease has progressed after other initial chemotherapy has been used.

2 What you need to know before you use Pemetrexed Mylan

Do not use Pemetrexed Mylan

• if you are allergic to pemetrexed or any of the other ingredients of this medicine (listed in section 6).
• if you are breast-feeding; you must discontinue breast-feeding during treatment with Pemetrexed Mylan.
• if you have recently received or are about to receive a vaccine against yellow fever.

Warnings and precautions

Talk to your doctor or hospital pharmacist before receiving Pemetrexed Mylan.

If you currently have or have previously had problems with your kidneys, talk to your doctor or hospital pharmacist as you may not be able to receive Pemetrexed Mylan.

Before each infusion you will have samples of your blood taken to evaluate if you have sufficient kidney and liver function and to check that you have enough blood cells to receive Pemetrexed Mylan.

Your doctor may decide to change the dose or delay treating you depending on your general condition and if your blood cell counts are too low. If you are also receiving cisplatin, your doctor will make sure that you are properly hydrated and receive appropriate treatment before and after receiving cisplatin to prevent vomiting.

If you have had or are going to have radiation therapy, please tell your doctor, as there may be an early or late radiation reaction with Pemetrexed Mylan.

If you have been recently vaccinated, please tell your doctor, as this can possibly cause bad effects with Pemetrexed Mylan.

If you have heart disease or a history of heart disease, please tell your doctor.

If you have an accumulation of fluid around your lungs, your doctor may decide to remove the fluid before giving you Pemetrexed Mylan.

Children and adolescents

This medicine should not be used in children or adolescents, since there is no experience with this medicine in children and adolescents under 18 years of age.

Other medicines and Pemetrexed Mylan

Tell your doctor or pharmacist if you are taking, have recently taken or might use any other medicines, including medicines obtained without a prescription.

Tell your doctor if you are taking any medicine for pain or inflammation (swelling), such as medicines called “nonsteroidal anti-inflammatory drugs” (NSAIDs), including medicines purchased without a doctor’s prescription (such as ibuprofen). There are many sorts of NSAIDs with different durations of activity. Based on the planned date of your infusion of Pemetrexed Mylan and/or on the status of your kidney function, your doctor needs to advise you on which medicines you can take and when you can take them. If you are unsure, ask your doctor or pharmacist if any of your medicines are NSAIDs.

Please inform your doctor if you are taking medicines called proton pump inhibitors (omeprazole, esomeprazole, lansoprazole, pantoprazole, and rabeprazole) used to treat heartburn and acid regurgitation.

Pregnancy, breast-feeding and fertility

Pregnancy

If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine. The use of Pemetrexed Mylan should be avoided during pregnancy. Your doctor will discuss with you the potential risk of taking Pemetrexed Mylan during pregnancy. Women must use effective contraception during treatment with Pemetrexed Mylan and for 6 months after receiving the last dose.

Breast-feeding

If you are breast-feeding, tell your doctor.

Breast-feeding must be discontinued during Pemetrexed Mylan treatment.

Fertility

Men are advised not to father a child during and up to 3 months following treatment with Pemetrexed Mylan and should therefore use effective contraception during treatment with Pemetrexed Mylan and for up to 3 months afterwards. If you would like to father a child during the treatment or in the 3 months following receipt of treatment, seek advice from your doctor or pharmacist. Pemetrexed Mylan can affect your ability to have children. Talk to your doctor to seek advice about sperm storage before starting your therapy.

Driving and using machines

Pemetrexed Mylan may make you feel tired. Be careful when driving a car or using machines.

Pemetrexed Mylan contains propylene glycol

This medicine contains 140 mg propylene glycol in each 4 ml vial which is equivalent to 35 mg/ml.

This medicine contains 700 mg propylene glycol in each 20 ml vial which is equivalent to 35 mg/ml.

This medicine contains 1400 mg propylene glycol in each 40 ml vial which is equivalent to 35 mg/ml.

3 How to use Pemetrexed Mylan

The dose of Pemetrexed Mylan is 500 milligrams for every square metre of your body’s surface area. Your height and weight are measured to work out the surface area of your body. Your doctor will use this body surface area to work out the right dose for you. This dose may be adjusted, or treatment may be delayed depending on your blood cell counts and on your general condition. A hospital pharmacist, nurse or doctor will have mixed the Pemetrexed Mylan solution with 5% dextrose solution for injection or with 0.9% sodium chloride solution for injection before it is given to you.

You will always receive Pemetrexed Mylan by infusion into one of your veins. The infusion will last approximately 10 minutes.

When using Pemetrexed Mylan in combination with cisplatin

The doctor or hospital pharmacist will work out the dose you need based on your height and weight. Cisplatin is also given by infusion into one of your veins and is given approximately 30 minutes after the infusion of Pemetrexed Mylan has finished. The infusion of cisplatin will last approximately 2 hours.

You should usually receive your infusion once every 3 weeks.

Additional medicines

Corticosteroids:

Your doctor will prescribe you steroid tablets (equivalent to 4 milligram of dexamethasone twice a day) that you will need to take on the day before, on the day of, and the day after Pemetrexed Mylan treatment. This medicine is given to you to reduce the frequency and severity of skin reactions that you may experience during your anticancer treatment.

Vitamin supplementation:

Your doctor will prescribe you oral folic acid (vitamin) or a multivitamin containing folic acid (350 to 1000 micrograms) that you must take once a day while you are taking Pemetrexed Mylan. You must take at least 5 doses during the seven days before the first dose of Pemetrexed Mylan. You must continue taking the folic acid for 21 days after the last dose of Pemetrexed Mylan. You will also receive an injection of vitamin B₁₂ (1000 micrograms) in the week before administration of Pemetrexed Mylan and then approximately every 9 weeks (corresponding to 3 courses of Pemetrexed Mylan treatment). Vitamin B₁₂ and folic acid are given to you to reduce the possible toxic effects of the anticancer treatment.

If you have any further questions on the use of this medicine, ask your doctor or pharmacist.

4 Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.

You must contact your doctor immediately if you notice any of the following:

• Fever or infection (respectively, common or very common): if you have a temperature of 38ºC or greater, sweating or other signs of infection (since you might have less white blood cells than normal which is very common). Infection (sepsis) may be severe and could lead to death.
• If you start feeling chest pain (common) or having a fast heart rate (uncommon).
• If you have pain, redness, swelling or sores in your mouth (very common).
• Allergic reaction: if you develop skin rash (very common) / burning or prickling sensation (common), or fever (common). Rarely, skin reactions may be severe and could lead to death.
• Contact your doctor if you get a severe rash, or itching, or blistering (Stevens-Johnson Syndrome or Toxic epidermal necrolysis).
• If you experience tiredness, feeling faint, becoming easily breathless or if you look pale (since you might have less haemoglobin than normal which is very common).
• If you experience bleeding from the gums, nose or mouth or any bleeding that would not stop, reddish or pinkish urine, unexpected bruising (since you might have less platelets than normal which is common).
• If you experience sudden breathlessness, intense chest pain or cough with bloody sputum (uncommon) (may indicate a blood clot in the blood vessels of the lungs)

Side effects with Pemetrexed Mylan may include:

Very common (may affect more than 1 in 10 people)

Infection

Pharyngitis (a sore throat)

Low number of neutrophil granulocytes (a type of white blood cell)

Low white blood cells

Low haemoglobin level

Pain, redness, swelling or sores in your mouth

Loss of appetite

Vomiting

Diarrhoea

Nausea

Skin rash

Flaking skin

Abnormal blood tests showing reduced functionality of kidneys

Fatigue (tiredness)

Common (may affect up to 1 in 10 people)

Blood infection

Fever with low number of neutrophil granulocytes (a type of white blood cell)

Low platelet count

Allergic reaction

Loss of body fluids

Taste change

Damage to the motor nerves which may cause muscle weakness and atrophy (wasting) primary in the arms and legs)

Damage to the sensory nerves that may cause loss of sensation, burning pain and unsteady gait

Dizziness

Inflammation or swelling of the conjunctiva (the membrane that lines the eyelids and covers the white of the eye

Dry eye

Watery eyes

Dryness of the conjunctiva (the membrane that lines the eyelids and covers the white of the eye) and cornea (the clear layer in front of the iris and pupil)

Swelling of the eyelids

Eye disorder with dryness, tearing, irritation, and/or pain

Cardiac Failure (Condition that affects the pumping power of your heart muscles)

Irregular heart rhythm

Indigestion

Constipation

Abdominal pain

Liver: increases in the chemicals in the blood made by the liver

Increased skin pigmentation

Itchy skin

Rash on the body where each mark resembles a bullseye

Hair loss

Hives

Kidney stop working

Reduced functionality of kidney

Fever

Pain

Excess fluid in body tissue, causing swelling

Chest pain

Inflammation and ulceration of the mucous membranes lining the digestive tract

Uncommon (may affect up to 1 in 100 people)

Reduction in the number of red, white blood cells and platelets

Stroke

Type of stroke when an artery to the brain is blocked

Bleeding inside the skull

Angina (Chest pain caused by reduced blood flow to the heart)

Heart attack

Narrowing or blockage of the coronary arteries

Increased heart rhythm

Deficient blood distribution to the limbs

Blockage in one of the pulmonary arteries in your lungs

Inflammation and scarring of the lining of the lungs with breathing problems

Passage of bright red blood from the anus

Bleeding in the gastrointestinal tract

Ruptured bowel

Inflammation of the lining of the oesophagus

Inflammation of the lining of the large bowel, which may be accompanied by intestinal or rectal bleeding (seen only in combination with cisplatin)

Inflammation, edema, erythema, and erosion of the mucosal surface of the esophagus caused by radiation therapy

Inflammation of the lung caused by radiation therapy

Rare (may affect up to 1 in 1,000 people)

Destruction of red blood cells

Anaphylactic shock (severe allergic reaction)

Inflammatory condition of the liver

Redness of the skin

Skin rash that develops throughout a previously irradiated area

Very rare (may affect up to 1 of 10,000 people)

Infections of skin and soft tissues

Stevens-Johnson syndrome (a type of severe skin and mucous membranes reaction that may be life threatening)

Toxic epidermal necrolysis (a type of severe skin reaction that may be life threatening)

Autoimmune disorder that results in skin rashes and blistering on the legs, arms, and abdomen

Inflammation of the skin characterized by the presence of bullae which are filled with fluid

Skin fragility, blisters and erosions and skin scarring

Redness, pain and swelling mainly of the lower limbs

Inflammation of the skin and fat beneath the skin (pseudocellulitis)

Inflammation of the skin (dermatitis)

Skin to become inflamed, itchy, red, cracked, and rough

Intensely itchy spots

Not known: frequency cannot be estimated from the available data

Form of diabetes primarily due to pathology of the kidney

Disorder of the kidneys involving the death of tubular epithelial cells that form the renal tubules

You might have any of these symptoms and/or conditions. You must tell your doctor as soon as possible when you start experiencing any of these side effects.

If you are concerned about any side effects, talk to your doctor.

Reporting of side effects

If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via:

Yellow Card Scheme Website: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.

By reporting side effects you can help provide more information on the safety of this medicine.

5 How to store Pemetrexed Mylan

Keep this medicine out of the sight and reach of children.

Do not use this medicine after the expiry date which is stated on the label after ‘EXP’. The expiry date refers to the last day of that month.

This medicine does not require any special storage conditions.

Do not freeze.

Diluted solutions: the product should be used immediately. When prepared as directed, chemical and physical in-use stability of the diluted solutions of pemetrexed were demonstrated for 24 hours at refrigerated temperature. Store protected from light.

This medicine is for single use only; any unused solution must be disposed of in accordance with local requirement.

6 Contents of the pack and other information

What Pemetrexed Mylan contains

The active substance is pemetrexed.

One vial of 4 ml concentrate contains 100 mg pemetrexed (as pemetrexed diarginine).

One vial of 20 ml concentrate contains 500 mg pemetrexed (as pemetrexed diarginine).

One vial of 40 ml concentrate contains 1000 mg pemetrexed (as pemetrexed diarginine).

The solution contains 25 mg/ml of pemetrexed. Further dilution by a healthcare provider is required prior to administration.

The other ingredients are L-Arginine, L-Cysteine, propylene glycol, citric acid and water for injections.

What Pemetrexed Mylan looks like and contents of the pack

Pemetrexed Mylan is a clear, colourless to slightly yellow to brown, brown yellow or green yellow solution. It is provided in glass vials. Each pack contains:

1 x 4 ml vial (100 mg/4 ml)

1 x 20 ml vial (500 mg/ 20 ml)

1 x 40 ml vial (1000 mg/ 40 ml)

The vials are closed with a rubber stopper (bromobutyl), a cap and a flip-top.

Not all pack sizes may be marketed.

Marketing Authorisation Holder and Manufacturer

Marketing Authorisation Holder:

Generics [UK] Ltd t/a Mylan

Potters Bar

Hertfordshire EN6 1TL

United Kingdom

Manufacturer(s):

Synthon BV

Microweg 22

6545 CM Nijmegen

The Netherlands

Synthon Hispania S.L.

Castello, 1

Poligono Las Salinas

08830 Sant Boi de Llobregat

Spain

Synthon s.r.o.

Brnĕnská 32 /čp. 597

678 01 Blansko

Czech Republic

This leaflet was last revised in December 2024.

The following information is intended for medical or healthcare professionals only:

Instructions for use, handling and disposal.

1. 1. Use aseptic techniques during the dilution of pemetrexed for intravenous infusion administration.
2. 2. Calculate the dose and the number of Pemetrexed Mylan vials needed. Each vial contains an excess of pemetrexed to facilitate delivery of the label amount. Each vial contains a solution containing 25 mg/ml pemetrexed.
3. 3. The appropriate volume of the solution must be further diluted to 100 ml with 5% dextrose solution for injection or with 0.9 % sodium chloride solution for injection, without preservative, and administered as an intravenous infusion over 10 minutes.
4. 4.

   Pemetrexed infusion solutions prepared as directed above are compatible with polyvinyl chloride and polyolefin lined administration sets and infusion bags. Pemetrexed is incompatible with diluents containing calcium, including lactated Ringer’s Injection and Ringer’s Injection.

   Pemetrexed Mylan contains L-Arginine as an excipient. L-Arginine is incompatible with cisplatin resulting in degradation of cisplatin. This medicinal product must not be mixed with other medicinal products. Intravenous lines should be flushed after administration of Pemetrexed Mylan.

5. 5. Parenteral medicinal products should be inspected visually for particulate matter and discolouration prior to administration. If particulate matter is observed, do not administer.
6. 6. Pemetrexed solutions are for single use only. Any unused product or waste material should be disposed of in accordance with local requirements for cytotoxic agents.

Preparation and administration precautions: As with other potentially toxic anticancer agents, care should be exercised in the handling and preparation of pemetrexed infusion solutions. The use of gloves is recommended. If a pemetrexed solution contacts the skin, wash the skin immediately and thoroughly with soap and water. If pemetrexed solutions contact the mucous membranes, flush thoroughly with water. Pemetrexed is not a vesicant. There is not a specific antidote for extravasation of pemetrexed. There have been a few reported cases of pemetrexed extravasation, which were not assessed as serious by the investigator. Extravasation should be managed by local standard practice as with other non-vesicants.