• If you are allergic to anything, including medicines, dyes, additives, or foods.

• If you have any medical conditions such as kidney disease, liver disease (including hepatitis), heart disease, congestive heart failure, diabetes, gout, or infections. These conditions may require that your medicine dose, regimen, or timing be changed.

• If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. This drug may cause birth defects if either the male or female is taking it at the time of conception or during pregnancy. Men and women who are taking this drug need to use some kind of birth control. It is important to check with your doctor about what kinds of birth control can be used with this medicine.

• If you are breast-feeding. It is not known whether this drug passes into breast milk. If it does, it could harm the baby.

• If you think you might want to have children in the future. Some drugs can cause sterility. Talk with your doctor about the possible risk with this drug and the options that may preserve your ability to have children.

• About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs.

Since there are many types of non-steroidal anti-inflammatory drugs (NSAIDs), check with your doctor, nurse, or pharmacist to find out if any of the medicines you are taking are NSAIDs. Most of these medicines must be stopped several days before you get pemetrexed, and cannot be resumed until the third day after the dose is given.

Check with your doctor, nurse, or pharmacist about other medicines, vitamins, herbs, and supplements, and whether alcohol can cause problems with this medicine.

Your doctor will give you a prescription for a steroid medicine (like dexamethasone) to take twice a day for 3 days starting the day before treatment. This lowers the chance that you will get skin reactions.

You will need to take folic acid (a vitamin) and vitamin B12 starting the week before your treatment with pemetrexed. You must take 350 to 1000 micrograms of folic acid every day for at least 5 days out of the 7 days before you start your first treatment with pemetrexed. Then, once you start treatment, you need to take folic acid every day, and continue this for 21 days after you get your final treatment. This protects your body's normal cells from the effects of the chemotherapy. You can buy folic acid over-the-counter. If you have any questions, or need help in deciding which folic acid product to use, ask your nurse, pharmacist, or doctor. Your doctor and nurse will give you your first vitamin B12 shot the week before your first pemetrexed treatment, and then about every 9 weeks during treatment.

When treating mesothelioma, pemetrexed is given along with cisplatin, another chemotherapy drug. Cisplatin is given over 2 hours starting about 30 minutes after the pemetrexed injection ends. You will need to drink as much fluid as you can before and after the cisplatin to keep your kidneys working well, and will probably get extra fluid by vein during the treatment (see also cisplatin).

This drug can lower your white blood cell count, especially in the weeks after the drug is given. This can increase your chance of getting an infection. Be sure to let your doctor or nurse know right away if you have any signs of infection, such as fever (100.5° F or higher), chills, diarrhea, mouth sores, pain when passing urine, a new cough, or bringing up sputum.

This drug may lower your platelet count in the weeks after it is given, which can increase your risk of bleeding. Speak with your doctor before taking any drugs or supplements that might affect your body's ability to stop bleeding, such as aspirin or aspirin-containing medicines, warfarin (Coumadin), or vitamin E. Tell your doctor right away if you have unusual bruising, or bleeding such as nosebleeds, bleeding gums when you brush your teeth, or black, tarry stools.

This drug may lower your red blood cell count. If this occurs, it is usually a few months after starting treatment. A low red blood cell count (known as anemia) can cause shortness of breath, or make you to feel weak or tired all the time. Your doctor may give you medicines to help prevent or treat this condition, or you may need to get blood transfusions.

Do not get any immunizations (vaccinations), either during or after treatment with this drug, without your doctor's OK. This drug may affect your immune system, which could make vaccinations ineffective, or could even lead to serious infections. Try to avoid contact with people who have recently received a live virus vaccine, such as the oral polio vaccine or smallpox vaccine. Check with your doctor about this.

Pemetrexed can cause you to feel tired. You may feel tired and weak for a few days after your treatment. Tell your doctor or nurse if you have severe weakness or tiredness.

This drug may cause sores in the mouth or on the lips, which often occur within the first few weeks after starting treatment. This can cause mouth pain, bleeding, or even trouble eating. Your doctor or nurse can suggest ways to reduce this, such as changing the way you eat or how you brush your teeth. If needed, your doctor can prescribe medicine to help with the pain.

You may have nausea and vomiting on the day you receive this drug or in the first few days afterward. Your doctor may give you medicine before your treatment to help prevent nausea and vomiting. You will likely also get a prescription for an anti-nausea medicine that you can take at home. It is important to have these medicines on hand and to take them as prescribed by your doctor.

Pemetrexed can cause a rash or itching, which usually starts after a treatment and goes away before the next treatment. Tell your nurse or doctor if you have severe rash or itching.

• decreased white blood cell count with increased risk of infection*
• decreased platelet count with increased risk of bleeding*
• decreased red blood cell count with increased risk of fatigue and shortness of breath*
• nausea*
• vomiting*
• diarrhea
• constipation
• sores in the mouth or on the lips*
• loss of appetite
• rash, skin peeling, or itching*
• difficulty breathing

• abnormal blood tests which suggest that the drug is affecting the liver (Your doctor will discuss the importance of this finding, if any.)
• hair loss

• blood clots
• severe allergic reaction

*See the "Precautions" section for more detailed information.