Pemetrexed
Trade Name:
Alimta
Type of Drug:
Pemetrexed is a multi-targeted antifolate that disrupts the DNA synthesis of tumor cells.   It is FDA approved to treat Mesothelioma and Non-Small Cell Lung Cancer.
How Drug Works:
Pemetrexed inhibits enzymes within a tumor cell that are necessary for cell growth.  Enzymes such as dihydrofolate reductase, thymidylate synthetase, and glycinamide ribonucleotide formyltransferase, which are involved in purine and pyrimidine synthesis. This stops the growth of the cancer cell
How Drug Is Given:
Pemetrexed is given by an injection into the vein over 10 minutes and repeated every three weeks.  The dose depends upon your size.  You must receive adequate hydration and be premedicated with corticosteroids and vitamin supplementation with each treatment.  The vitamin supplementation consists of a Vitamin B-12 IM injection one week before the first treatment, and then every third cycle.  It may be given on the same day as pemetrexed.  Folic Acid (dose ranging from 350-1000mcg) should be taken daily.  It can be taken as part of a multivitamin.  The corticosteroid is used to help prevent some of the side effects of pemetrexed.
Read the following information. If you do not understand it or if any of it causes you special concern, check with your doctor.

Before taking this drug, tell your doctor:

  • If you are trying to become pregnant, are pregnant, or breastfeeding. This drug may cause birth defects if either the male or female is taking it at the time of conception or during pregnancy. Men and women who are taking this drug need to use some kind of birth control. However, do not use oral contraceptives (“the pill”) without checking with your doctor.

  • If you think you may want to have children in the future. Many chemotherapy drugs can cause sterility.

  • If you are taking any medications that may harm your kidneys, such as certain antibiotics. • If you are taking any other prescription or over-the-counter drugs, including vitamins and herbals.

Talk to your doctor before getting flu shots or other vaccines while you are receiving this medicine. Vaccines may not work as well, or they could make you ill while you are using this medicine.

Should I avoid any other medicines, foods, alcohol, and/or activities?
Your prescription and nonprescription medicines may interact with other drugs, causing harm. Certain foods or alcohol can also interact with drug products. Never begin taking a new medicine—prescription or nonprescription—without asking your doctor or nurse if it will interact with alcohol, food, or other medicines. Some drug products can cause drowsiness and affect activities such as driving.
Precautions:
Make sure your doctor knows if you are breast-feeding, or if you have kidney disease or liver disease. Tell your doctor if you have pleural effusion (fluid around your lungs) or ascites (fluid in your abdomen).
Pemetrexed can lower the numbers of certain types of blood cells, making you more prone to infections.  Take extra precautions, wash hands more often, and try to avoid people who are sick.  Be careful brushing and flossing your teeth, and clipping your finger and toenails.
Allergic reactions such as fever and chills may occur but they are not common. Other reactions include itching, hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest pain, unusual bleeding or weakness.  Call your doctor immediately if you experience any of these effects.
Some less serious side effects may also occur, such as loss of appetite, and mild sore throat. 
Tell all the doctors, dentists, and pharmacists you visit that you are taking this drug.
  • Most of the following side effects probably will not occur.
  • Your doctor or nurse will want to discuss specific care instructions with you.
  • They can help you understand these side effects and help you deal with them.
Side Effects:
More Common Side Effects
  • Chest Pain
  • Dyspnea
  • Itching
  • Hives
  • Nausea
  • Vomiting
  • Constipation
  • Neutropenia
  • Anemia
Less Common Side Effects
  • Edema
  • Fever
  • Rash
  • Mild nephrotoxicity (reversible)
  • Joint Pain
  • Thrombocytopenia
Rare Side Effects
  • Thromboembolism
  • Renal failure
Side Effects / Symptoms of the Drug

Call your doctor or nurse right away if you develop a severe rash, fever of 100.5°F or greater, and/or symptoms of infection such as cough with sputum or burning when urinating.
Other side effects not listed above can also occur in some patients. Tell your doctor or nurse if you develop any problems.
FDA Approval: This drug is approved for cancer treatment.