Drug interactions
Pemetrexed + Sulindac
Severity: Major
Pemetrexed and Sulindac: 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 reduce the renal clearance of pemetrexed, raising its exposure and the risk of myelosuppression, renal toxicity and gastrointestinal toxicity. The risk is greatest in patients with mild to moderate renal impairment.
What this interaction means in plain words
Pemetrexed and Sulindac 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; Sulindac belongs to Musculoskeletal.
Why it happens
NSAID-related reduction in renal blood flow and competition for tubular secretion decrease pemetrexed elimination, which is mainly renal.
What to do
Avoid NSAIDs around pemetrexed dosing where possible; labeling advises holding longer-acting NSAIDs for several days before and a couple of days after the dose. If they 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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Other interactions of Sulindac
- Ketorolac intranasal + Sulindac Contraindicated
- Ketorolac + Sulindac Contraindicated
- Aceclofenac + Sulindac Major
- Acetylsalicylic acid + Sulindac Major
- Alteplase + Sulindac Major
- Amiloride + Sulindac Major
Other interactions of Pemetrexed
Frequently asked questions
Can I take Pemetrexed with Sulindac?
MediHelp rates the interaction as major. Pemetrexed and Sulindac 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, raising its exposure and the risk of myelosuppression, renal toxicity and gastrointestinal toxicity. The risk is greatest in patients with mild to moderate renal impairment.
How serious is the interaction between Pemetrexed and Sulindac?
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 NSAIDs around pemetrexed dosing where possible; labeling advises holding longer-acting NSAIDs for several days before and a couple of days after the dose. If they must be used, monitor blood counts and renal function closely.
What other medicines interact with Sulindac?
MediHelp also lists interactions of Sulindac with, for example, Ketorolac intranasal, Ketorolac, Aceclofenac. The full list is on the Sulindac page.
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