Drug General Information (ID: DDINAEZR2W)
  Drug Name Pemetrexed Drug Info Salicylic acid (sodium) Drug Info
  Drug Type Small molecule Small molecule
  Therapeutic Class Antineoplastics Antiinflammatory Agents
  Structure

 Mechanism of Pemetrexed-Salicylic acid (sodium) Interaction (Severity Level: Moderate)
     Decreased renal excretion due to nephrotoxicity Click to Show/Hide Mechanism Graph
Could Not Find 2D Structure
      Drug Name Pemetrexed Salicylic acid (sodium)
      Mechanism 1 Primarily eliminated by renal excretion Nephrotoxicity
      Key Mechanism Factor 1
Factor Name Nephrotoxicity
Factor Description Drug-induced nephrotoxicity is a common and potentially serious complication of medication use. The kidneys are the primary organ for drug excretion, and when they are damaged can lead to decreased drug excretion.
      Mechanism Description
  • Decreased renal excretion of Pemetrexed caused by Salicylic acid (sodium) mediated nephrotoxicity
      Mechanism 2 Primarily eliminated by renal excretion Nephrotoxicity
Decrease renal perfusion 
      Key Mechanism Factor 2
Factor Name Nephrotoxicity
Factor Description Drug-induced nephrotoxicity is a common and potentially serious complication of medication use. The kidneys are the primary organ for drug excretion, and when they are damaged can lead to decreased drug excretion.
      Mechanism Description
  • Decreased renal excretion of Pemetrexed caused by Salicylic acid (sodium) mediated nephrotoxicity
      Mechanism 3 Primarily eliminated by renal excretion Decrease renal perfusion/blood flow rate
      Key Mechanism Factor 3
Factor Name Nephrotoxicity
Factor Description Drug-induced nephrotoxicity is a common and potentially serious complication of medication use. The kidneys are the primary organ for drug excretion, and when they are damaged can lead to decreased drug excretion.
      Mechanism Description
  • Decreased renal excretion of Pemetrexed caused by Salicylic acid (sodium) mediated nephrotoxicity

Recommended Action
      Management Ibuprofen at 400 mg and aspirin at 325 mg four times a day, or less, may be used with pemetrexed in patients with normal renal function. However, caution is advised in patients with mild to moderate renal insufficiency (creatinine clearance 45 to 79 mL/min). These patients should avoid taking NSAIDs with short elimination half-lives (e.g., diclofenac, etodolac, fenoprofen, flurbiprofen, ibuprofen, indomethacin, ketoprofen, ketorolac, meclofenamate, mefenamic acid, sulindac, tolmetin, low dosages of salicylates) 2 days before to 2 days after pemetrexed administration. If concomitant administration is necessary, patients should be monitored closely for toxicity, especially myelosuppression, nephrotoxicity, and gastrointestinal toxicity.

References
1 Tietjen DP "Recurrence and specificity of nephrotic syndrome due to tolmetin." Am J Med 87 (1989): 354-5
2 Shand DG, Epstein C, Kinberg-Calhoun J, et al "The effect of etodolac administration on renal function in patients with arthritis." J Clin Pharmacol 26 (1986): 269-74
3 Turner GA, Walker RJ, Bailey RR, et al "Sulindac-induced acute interstitial nephritis." N Z Med J 97 (1984): 239-40