Home Drug Guide Pralatrexate

Drug Guide

Generic Name

Pralatrexate

Brand Names Folotyn

Classification

Therapeutic: Antineoplastic, Antimetabolite

Pharmacological: Folate analogue metabolic inhibitor

FDA Approved Indications

  • Relapsed or refractory peripheral T-cell lymphoma (PTCL)

Mechanism of Action

Pralatrexate is a folate analogue metabolic inhibitor that selectively inhibits dihydrofolate reductase (DHFR), leading to inhibition of DNA synthesis, repair, and cellular replication, primarily affecting rapidly dividing cancer cells.

Dosage and Administration

Adult: Dose: 30 mg/m² IV weekly for 6 weeks followed by 1 week of rest (total 7-week cycles). Premedicate with folic acid and vitamin B12 before starting therapy and during treatment to reduce toxicity.

Pediatric: Not typically used in pediatric patients; safety and efficacy not established.

Geriatric: Use with caution; monitor for toxicity, especially in patients with decreased renal function.

Renal Impairment: Dose modification may be necessary; consult specific guidelines.

Hepatic Impairment: No specific dose adjustment recommended; monitor hepatic function.

Pharmacokinetics

Absorption: Administered intravenously, rapid and complete absorption is not applicable.

Distribution: Widely distributed; high affinity for tissues.

Metabolism: Metabolized minimally; primarily excreted unchanged.

Excretion: Primarily renal excretion.

Half Life: Approximate half-life of 13 hours.

Contraindications

  • Hypersensitivity to pralatrexate or its components.

Precautions

  • Risk of myelosuppression, mucositis, infections, renal toxicity, hepatotoxicity, and pulmonary toxicity. Use with caution in pregnant or breastfeeding women. Monitor blood counts, renal and hepatic function regularly.

Adverse Reactions - Common

  • Myelosuppression (neutropenia, anemia, thrombocytopenia) (Very common)
  • Stomatitis/mucositis (Common)
  • Nausea, vomiting (Common)
  • Fatigue (Common)

Adverse Reactions - Serious

  • Severe myelosuppression leading to infections or bleeding (Serious (rare))
  • Renal toxicity (Serious (rare))
  • Pulmonary toxicity (pneumonitis, fibrosis) (Serious (rare))
  • Hepatotoxicity (Serious (rare))

Drug-Drug Interactions

  • Other myelosuppressive agents, nephrotoxic drugs, hepatotoxic drugs

Drug-Food Interactions

  • Folate supplements (should be managed carefully to balance efficacy and toxicity)

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor complete blood counts, renal and hepatic function, respiratory status, and oral mucosa.

Diagnoses:

  • Risk for infection
  • Impaired oral mucous membrane
  • Risk for bleeding

Implementation: Administer folic acid and vitamin B12 as prescribed. Ensure adequate hydration. Educate patient on mucositis and management.

Evaluation: Monitor for hematologic toxicity, mucositis, renal and hepatic adverse effects, and overall response.

Patient/Family Teaching

  • Report fever, sore throat, mouth sores, or unusual bleeding.
  • Maintain good oral hygiene.
  • Follow dosing schedule and attend all monitoring appointments.
  • Use effective contraception during treatment and for some time after.

Special Considerations

Black Box Warnings:

  • Severe myelosuppression, mucositis, and renal toxicity.

Genetic Factors: N/A

Lab Test Interference: Potential interference with folate and vitamin B12 levels; interpret labs accordingly.

Overdose Management

Signs/Symptoms: Severe myelosuppression, mucositis, renal failure.

Treatment: Supportive care including blood product transfusions, growth factors, hydration, and symptomatic management. Hemodialysis may be considered in cases of toxicity.

Storage and Handling

Storage: Store at controlled room temperature, 20°C to 25°C (68°F to 77°F). Keep in original container.

Stability: Stable under recommended storage conditions until expiration date.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.