Drug General Information (ID: DDIYSJG1HI)
Drug Name			Pemetrexed		Drug Info		Givosiran		Drug Info
Drug Type		Small molecule				Small interfering RNA
Therapeutic Class		Antineoplastics				Metabolic Agents
Structure

Mechanism of Pemetrexed-Givosiran Interaction (Severity Level: Moderate)
Decreased renal excretion due to nephrotoxicity Click to Show/Hide Mechanism Graph
Drug Name		Pemetrexed				Givosiran
Mechanism		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 Givosiran mediated nephrotoxicity

Recommended Action
Management		Caution is advised if pemetrexed is used in patients who have recently received or are receiving treatment with potentially nephrotoxic drugs (e.g., aminoglycosides polypeptide, glycopeptide, and polymyxin antibiotics amphotericin B adefovir cidofovir tenofovir foscarnet cisplatin deferasirox gallium nitrate lithium mesalamine certain immunosuppressants intravenous bisphosphonates intravenous pentamidine high intravenous dosages of methotrexate high dosages and/or chronic use of nonsteroidal anti-inflammatory agents). The potential for increased toxicity of pemetrexed such as bone marrow suppression should be considered. Renal function should be closely monitored during therapy.

References
1	Product Information. Alimta (pemetrexed). Lilly, Eli and Company, Indianapolis, IN.