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Allipem 500mg is commonly used to treat patients with locally advanced non-small cell lung cancer or metastases to other areas of the body. The drug can be combined with Cisplatin to increase the effectiveness of treatment, but it is necessary to use it according to the instructions of the doctor to ensure safety.1. What is Allipem 500mg?
Allipem 500mg is an infusion drug, used in combination with Cisplatin to treat cases of locally advanced or metastatic non-small cell lung cancer. In addition, Allipem is also used to treat patients with malignant pleural mesothelioma that cannot be surgically removed.
Allipem is a chemotherapy drug from Eli Lilly and Company, available as a lyophilized powder for injection, white or slightly yellow/yellow green, each vial contains the following ingredients:
Active ingredient: Pemetrexed 500 (in the form of Pemetrexed Disodium 2.5 Hydrate). Other excipients: Hydrochloric Acid, nitrogen gas, D-Mannitol and Sodium Hydroxide.
2. Indications and uses of Allipem 500mg
2.1. Indications for use of Allipem 500mg
Allipem 500mg is indicated for use in the following cases:
Using Allipem in combination with platinum chemotherapy and Pembrolizumab (Keytruda) for the initial treatment of non-small cell lung cancer (NSCLC). no ALK or EGFR gene tumor aberrations. Use Allipem in combination with cisplatin for the initial treatment of locally advanced or metastatic non-small cell lung cancer. Maintenance treatment for people with non-small cell lung cancer that has not spread/metastasized whose disease has shown no signs of progress through 4 cycles of platinum-based first-line chemotherapy. Treatment of patients with metastatic non-small cell lung cancer that has recurred after prior chemotherapy. Indications Allipem 500mg in combination with Cisplatin for the initial treatment of malignant lung mesothelioma (MPM) that cannot be cured by surgical resection.
2.2. Uses of Allipem 500mg
*Pharmacodynamics
Active ingredient pemetrexed is a pyrrolo-pyrimidine-containing antibiotic, known for its anti-cancer activity by its mechanism of disrupting folate-based metabolic pathways in favor of folate. cell proliferation.
Several in vitro studies have found that the active ingredient pemetrexed in the drug has the ability to inhibit dihydrofolate reductase (DHFR), thymidylate synthase (TS), glycinamide ribonucleotide formyltransferase (GARFT), folate-dependent enzymes involved in folate. involved in the de novo biosynthesis of purine nucleotides as well as thymidine.
The active ingredient pemetrexed is transported into cells by the transmembrane folate-binding protein transport system and the reduced folate-binding protein transport system. In the cells, pemetrexed is metabolized to polyglutamate by the enzyme folylpolyglutamate synthetase.
*Pharmacokinetics
Absorption: Pemetrexed has pharmacokinetic properties after a single intravenous infusion over 10 minutes, ranging from 0.2 to 838 mg/m2. The maximum Cmax plasma concentration and total area of the curve (AUC) for pemetrexed will increase with the dose administered. According to the review, the pharmacokinetic profile of pemetrexed is unlikely to change after multiple cycles of treatment. Distribution: The active substance pemetrexed has a volume of distribution of 16.1 liters at steady state. In vitro studies have shown that the binding of pemetrexed to plasma proteins is close to 81% and is not affected by renal impairment. Metabolism and Elimination: The pemetrexed component in Allipem is not significantly metabolized, the main route of elimination is via the urine. Within 24 hours of dosing, about 70-90% of an allipem dose is recovered in the urine. When renal function declines, the AUC index increases, while the clearance of the drug decreases. The estimated systemic clearance of pemetrexed is 91.8 mL/min with a mean half-life of 3.5 hours in subjects with normal renal function.
3. Dosage and how to use Allipem 500mg
3.1. Dosage of Allipem 500mg * Dosage of Allipem in combination with Cisplatin:
The doctor's recommended dose of Allipem is 500 mg / m2, administered intravenously over 10 minutes on the first day of each day. The treatment cycle lasts 21 days. The recommended dose for Cisplatin is 75 mg/m2, administered intravenously > 2 hours, starting approximately 30 minutes after the patient has finished the Allipem infusion. Before or after treatment with Cisplatin, the patient should take some appropriate rehydration measures.
*Dosage of Allipem monotherapy:
When Allipem is used as monotherapy for NSCLC, patients can receive an intravenous infusion of pemetrexed equivalent to 500 mg/m2 over 10 minutes on day 2 of each 21-day treatment cycle.
*Prophylactic dose of Allipem:
In order to reduce the severity of skin reactions, patients can use Corticosteroids one day before, during and after one day of drug treatment. Allipem. The recommended dose of corticosteroids is equivalent to 4 mg of oral dexamethasone, administered approximately twice daily.
During treatment with Allipem, patients should take vitamin supplements to reduce the toxicity of the active ingredient pemetrexed. Patients can take folic acid or a multivitamin containing folic acid (from 350μg - 1mg). Within 7 days prior to Allipem therapy, patients should take a minimum of 5 doses of folic acid, continuing throughout the course of treatment and for 21 days after the last intravenous dose of Allipem.
In addition, patients should also inject about 1mg of vitamin B12 before the first dose of Allipem and 1 time after every 3 treatment cycles. Vitamin B12 injections can also be administered on the same day as the Allipem dose.
3.2. How to use Allipem 500mg Allipem 500mg is used through intravenous infusion. During the treatment of non-small cell lung cancer with Allipem, patients should note a few things about the correct use of the drug:
Apply aseptic technique when reconstitution and dilution of the active ingredient pemetrexed for injection. intravenous infusion to the patient. Reconstitute the 500 mg vial of pemetrexed with 20.4 ml of 0.9% sodium chloride injection for injection without preservatives to obtain a suspension containing 25 mg/ml pemetrexed. After reconstitution, stir gently until the powder for injection is completely dissolved, so that a clear white or slightly yellow-green solution is obtained. The pH of the drug solution should be from 6.6 - 7.8, even more diluted in case of need. Take an adequate amount of reconstituted pemetrexed solution and dilute it with 100ml of 0.9% sodium chloride for injection (without preservatives) and use it by intravenous infusion for more than 10 minutes. Allipem solution for infusion, after being prepared as directed, should be compatible with PVC bags, infusion tubes and polyolefins. In addition, the solution should be visually examined for particles as well as color change prior to intravenous infusion. If the particles are not observed through observation, the drug is not allowed to be used. It is recommended that pemetrexed solution for injection should be used only once and unused medication should be discarded as prescribed. Similar to other potentially toxic anticancer drugs, care should be taken in preparing and using pemetrexed solution. Ideally, wear gloves when handling the drug, if pemetrexed gets on the mucous membranes, the patient should immediately rinse with water.
3.3. Treatment of an overdose of Allipem 500mg
When intravenous overdosage Allipem 500mg, patients may experience symptoms such as:
Anemia; Mucositis; Thrombocytopenia; Sensory polyneuropathy; skin rash; Myelosuppression (neutropenia, anemia, thrombocytopenia); Infection without fever; Diarrhea. When there are signs of suspected overdose, the patient should immediately notify the doctor so that the blood cell count can be checked and appropriate supportive measures taken. Alternatively, the physician may also consider treating the patient with an overdose with folinic acid or calcium folinate.
4. Side effects of Allipem 500mg During the use of Allipem, patients may experience the following side effects:
Common side effects: Gastritis, fatigue, shortness of breath, sore throat , neuralgia and chest pain. Rare side effects: Colitis, hepatitis, pneumonia, acute kidney failure, hypertension, diabetes, dehydration, myocardial infarction, cerebrovascular accident,...
5. Some things to be careful about when using Allipem 500mg
5.1. What should be noted before and during the use of Allipem?
When treated with Allipem 500mg, patients should note some of the following:
Allipem can inhibit the function of bone marrow, leading to conditions such as thrombocytopenia, neutropenia, pancytopenia or anemia. Therefore, patients should be closely monitored for myelosuppression during treatment and should be discontinued immediately until the platelet count returns to ≥100000 cells/mm3 and the neutrophil count returns to ≥ 1500 cells/mm3. People being treated with Allipem should be instructed on the use of vitamin B12 and folic acid to reduce the toxicity of the drug. People who are not receiving corticosteroid prophylaxis may experience skin reactions. In addition, prophylactic treatment with dexamethasone can reduce the severity and frequency of skin reactions. For patients with creatinine clearance < 45 ml/min, the use of Allipem should be avoided. Patients with moderate to mild renal impairment should avoid the use of NSAIDs such as Aspirin and Ibuprofen before, during, and after about 2 days of Allipem treatment. Stop taking NSAIDs at least 5 days before taking Allipem. People with heart or kidney problems should use caution when infusion with Allipem. Cancer patients should not receive Allipem with live attenuated vaccines. Men while taking Allipem should not have children for at least 6 months after allipem treatment because the drug can damage genes or even cause irreversible infertility. Patients receiving radiation therapy should be careful when using Allipem.
5.2. Allipem 500mg drug interactions
The following are drugs that may interact with Allipem 500mg, including: Nephrotoxic drugs (eg Aminoglycosides).
Loop diuretics ; Certain platinum compounds; Drugs that can be excreted by the renal tubules, such as penicillin and probenecid, when co-administered with Allipem may prolong the clearance of the active ingredient pemetrexed. If use is necessary, patients should be closely monitored for creatinine clearance. Use of Allipem may cause clinical inhibition of drugs metabolised by CYP2D6, CYP3A, CYP1A2, and CYP2C9. Absolutely do not take Allipem with yellow fever vaccine because it can cause death. Concomitant use of live attenuated vaccines with Allipem may increase the risk of systemic infection and death in immunocompromised patients. Instead, the patient should receive an inactivated vaccine. 5.3. Cases of contraindications to the use of Allipem 500mg Here are some cases where Allipem should not be used without a doctor's prescription:
Pregnant women / nursing mothers. People who are allergic to pemetrexed or any of the other ingredients in the medicine. People who have had or are about to be vaccinated against yellow fever. Because pemetrexed has the potential to cause genetic harm, adult males should not father children during treatment with Allipem and for 6 months thereafter. Ideally, patients should abstain from sex or use contraception because pemetrexed therapy can cause irreversible infertility in men. Children under 18 years of age should not receive an intravenous infusion of Allipem. In summary, Allipem is used to treat patients with non-small cell lung cancer that is locally advanced or has spread to other areas of the body.
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