Drug interactions
Indomethacin + Pemetrexed
Severity: Major
Indomethacin and Pemetrexed: major interaction.
Last updated Sources: US FDA label
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
NSAIDs can reduce the renal clearance of pemetrexed, leading to higher exposure and increased myelosuppression, renal and gastrointestinal toxicity. The risk is greatest in patients with mild to moderate renal impairment.
What this interaction means in plain words
Indomethacin and Pemetrexed can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Indomethacin belongs to Musculoskeletal; Pemetrexed belongs to Oncology.
Why it happens
Reduced renal elimination of pemetrexed, likely through NSAID effects on renal perfusion and tubular handling.
What to do
Avoid indomethacin in the days around pemetrexed dosing, following labeling guidance on NSAID interruption. If it must be used, monitor blood counts and renal function closely.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
Other interactions of Indomethacin
- Indomethacin + Ketorolac Contraindicated
- Indomethacin + Ketorolac intranasal Contraindicated
- Aceclofenac + Indomethacin Major
- Acemetacin + Indomethacin Major
- Acetylsalicylic acid + Indomethacin Major
- Alteplase + Indomethacin Major
Other interactions of Pemetrexed
Frequently asked questions
Can I take Indomethacin with Pemetrexed?
MediHelp rates the interaction as major. Indomethacin and Pemetrexed can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. NSAIDs can reduce the renal clearance of pemetrexed, leading to higher exposure and increased myelosuppression, renal and gastrointestinal toxicity. The risk is greatest in patients with mild to moderate renal impairment.
How serious is the interaction between Indomethacin and Pemetrexed?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid indomethacin in the days around pemetrexed dosing, following labeling guidance on NSAID interruption. If it must be used, monitor blood counts and renal function closely.
What other medicines interact with Indomethacin?
MediHelp also lists interactions of Indomethacin with, for example, Ketorolac, Ketorolac intranasal, Aceclofenac. The full list is on the Indomethacin page.
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