Drug interactions
Pemetrexed + Piroxicam
Severity: Major
Pemetrexed and Piroxicam: major interaction.
Last updated
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 raise pemetrexed exposure by reducing its renal clearance, increasing the risk of myelosuppression, renal toxicity and gastrointestinal toxicity. Piroxicam has a very long half-life, so its effect persists for many days after the last dose.
What this interaction means in plain words
Pemetrexed and Piroxicam 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.
Pemetrexed belongs to Oncology; Piroxicam belongs to Musculoskeletal.
Why it happens
NSAID-related reduction in renal blood flow and tubular handling decreases renal elimination of pemetrexed.
What to do
Where possible, withhold piroxicam for at least several days before, on the day of, and for a couple of days after pemetrexed, following product labeling. If it must continue, 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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Other interactions of Piroxicam
- Ketorolac intranasal + Piroxicam Contraindicated
- Ketorolac + Piroxicam Contraindicated
- Aceclofenac + Piroxicam Major
- Acemetacin + Piroxicam Major
- Acetylsalicylic acid + Piroxicam Major
- Alteplase + Piroxicam Major
Other interactions of Pemetrexed
Frequently asked questions
Can I take Pemetrexed with Piroxicam?
MediHelp rates the interaction as major. Pemetrexed and Piroxicam 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 raise pemetrexed exposure by reducing its renal clearance, increasing the risk of myelosuppression, renal toxicity and gastrointestinal toxicity. Piroxicam has a very long half-life, so its effect persists for many days after the last dose.
How serious is the interaction between Pemetrexed and Piroxicam?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Where possible, withhold piroxicam for at least several days before, on the day of, and for a couple of days after pemetrexed, following product labeling. If it must continue, monitor blood counts and renal function closely.
What other medicines interact with Piroxicam?
MediHelp also lists interactions of Piroxicam with, for example, Ketorolac intranasal, Ketorolac, Aceclofenac. The full list is on the Piroxicam page.
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