Pemetrexed (Alimta ®)
It’s best to read this information with our general information about chemotherapy and the type of cancer you have.
Before you have pemetrexed
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You'll be given folic acid and vitamin B12 before you start treatment with pemetrexed. You’ll continue taking these during your chemotherapy. They help reduce the side effects of pemetrexed, so it's important to take them.
You take folic acid as a tablet. You usually start taking it five days before your first treatment. Then you’ll take it every day until three weeks after your treatment with pemetrexed finishes.
While you're having pemetrexed, you should not take any folic acid supplements other than those prescribed by your cancer specialist. Some multivitamins or food supplements contain folic acid, so you should talk to your pharmacist before taking these.
You will have an injection of vitamin B12 into a muscle a week before your first treatment with pemetrexed. You will have another injection before every third treatment (about every nine weeks).
You will take steroid tablets for three days, starting the day before you have pemetrexed. These help prevent a skin reaction.
Always take your tablets exactly as explained to you by the nurse or pharmacist.
How pemetrexed is given
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You usually have pemetrexed in the chemotherapy day unit. A chemotherapy nurse will give it to you.
During treatment, you usually see a cancer doctor, a chemotherapy nurse or a specialist nurse. This is who we mean when we mention doctor or nurse in this information.
Before or on the day of treatment, a nurse or person trained to take blood (phlebotomist) will take a blood sample from you. This is to check that it is okay for you to have chemotherapy.
You will also see a doctor or nurse before you have chemotherapy. They will ask you about how you have been. If your blood results are all right on the day of your treatment, the pharmacist will prepare your chemotherapy. Your nurse will tell you when your treatment is likely to be ready.
Your nurse gives you anti-sickness (anti-emetic) drugs as an injection into a vein. They give you the drugs and chemotherapy through one of the following (depending if you have a line in or not):
a short thin tube that the nurse puts into a vein in your arm or hand (cannula)
a fine tube that goes under the skin of your chest and into a vein close by (central line)
a fine tube that is put into a vein in your arm and goes up into a vein in your chest (PICC line).
Your nurse gives you pemetrexed as a drip (infusion) into your cannula or line. They usually run the drip through a pump, which gives you the treatment over a set time (about 10 minutes).
When the chemotherapy is being given
Some people might have side effects while they are having chemotherapy.
Pemetrexed may cause an allergic reaction while it’s being given. Your nurse will check you for this. If you have a reaction, they will treat it quickly.
Signs of a reaction can include:
feeling itchy, flushed or short of breath
swelling of your face or lips
having pain in your tummy, back or chest
Tell your nurse straight away if you have any of these symptoms. They may give you drugs to help reduce the risk of a reaction.
Your course of chemotherapy
You have chemotherapy as a course of several sessions (or cycles) of treatment over a few months. Each cycle of pemetrexed usually takes 21 days (three weeks).
At the end of the 21 days, you start your second cycle of pemetrexed. This is the same as the first cycle.
You may have pemetrexed on its own or with other chemotherapy drugs. This depends on the type of cancer you have. Your doctor or nurse will tell you more about this and the number of cycles you are likely to have.
Before you go home, the nurse or pharmacist will give you anti-sickness drugs to take. Take all your tablets exactly as explained.
Possible side effects of pemetrexed
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We explain the most common side effects of pemetrexed here. But we don’t include all the rare ones that are unlikely to affect you. You may get some of the side effects we mention, but you are very unlikely to get all of them.
If you are having other chemotherapy drugs as well, you may have some side effects that we don’t list here. Always tell your doctor or nurse about the side effects you have.
Your doctor can prescribe drugs to help control some side effects. It is very important to take them exactly as your nurse or pharmacist has explained. This means they will be more likely to work better for you. Your nurse will give you advice about managing your side effects. After your treatment is over, the side effects will start to improve.
Serious and life-threatening side effects
Sometimes cancer drugs can result in very serious side effects, which rarely may be life-threatening. Your cancer doctor and nurse can explain the risk of these side effects to you.
Contact the hospital
Your nurse will give you telephone numbers for the hospital. You can call them if you feel unwell or need advice any time of day or night. Save these numbers in your phone or keep them somewhere safe.
More information about this drug
We’re not able to list every side effect for this treatment here, particularly the rarer ones. For more detailed information you can visit the electronic Medicines Compendium (eMC).
Common side effects of pemetrexed
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Risk of infection
Pemetrexed can reduce the number of white blood cells in your blood. This will make you more likely to get an infection. When the number of white blood cells is low, it’s called neutropenia.
Your white blood cells start to reduce seven days after treatment and are usually at their lowest 10–14 days after.
Contact the hospital straight away on the number you’ve been given if:
your temperature goes over 37.5°C (99.5°F) or over 38°C (100.4°F), depending on the advice given by your chemotherapy team
you suddenly feel unwell, even with a normal temperature
you have symptoms of an infection – this can include feeling shaky, a sore throat, a cough or needing to pass urine often.
The number of white blood cells usually increases steadily and returns to normal before your next chemotherapy. You will have a blood test before having more chemotherapy. If your number of white blood cells is still low, your doctor may delay your treatment for a short time.
Bruising and bleeding
Pemetrexed can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. Tell your doctor if you have any bruising or bleeding you can’t explain. This includes nosebleeds, bleeding gums, blood spots or rashes on the skin. Some people may need a drip to give them extra platelets.
Anaemia (low number of red blood cells)
Pemetrexed can reduce the number of red blood cells in your blood. These cells carry oxygen around the body. If the number of red blood cells is low, you may be tired and breathless. Tell your doctor or nurse if you feel like this. If you are very anaemic, you may need a drip to give you extra red blood cells (blood transfusion).
This may happen in the first few days after chemotherapy. Your doctor will prescribe anti-sickness (anti-emetic) drugs to help prevent or control sickness. Take the drugs exactly as your nurse or pharmacist explains to you. It’s easier to prevent sickness than to treat it after it has started.
If you still feel sick or are vomiting, contact the hospital as soon as possible. They can give you advice and change the anti-sickness drug to one that works better for you.
Some anti-sickness drugs can make you constipated. Tell your doctor or nurse if this is a problem.
Loss of appetite
You may lose your appetite during your treatment. Try to eat small meals regularly. Don’t worry if you don’t eat much for a day or two.
If your appetite doesn’t improve after a few days, let your nurse or dietitian know. They can give you advice on getting more calories and protein in your diet. They may give you food supplements or meal replacement drinks to try. Your doctor can prescribe some of these and you can buy them from chemists.
Your mouth may become sore and you may get ulcers. This can make you more likely to get an infection in your mouth. Gently clean your teeth and/or dentures morning and night and after meals. Use a soft-bristled or children’s toothbrush. Your nurse might ask you to rinse your mouth regularly or use mouthwashes. It’s important to follow any advice you are given and to drink plenty of fluids.
Tell your nurse or doctor if you have any problems with your mouth. They can prescribe medicines to prevent or treat mouth infections and reduce any soreness.
Your doctor can prescribe drugs to control diarrhoea. Let them know if it is severe or if it doesn’t get better. Make sure you drink at least two litres (three and a half pints) of fluids every day if you have diarrhoea.
Pemetrexed may make you constipated. Drinking at least two litres of fluids (three and a half pints) every day will help. Try to eat more foods that contain fibre, such as fruit, vegetables and wholemeal bread, and do some regular, gentle exercise.
Feeling very tired is a common side effect. It’s often worse towards the end of treatment and for some weeks after it’s over. Try to pace yourself and get as much rest as you need. It helps to balance this with some gentle exercise, such as short walks. If you feel sleepy, don’t drive or operate machinery.
Chemotherapy may affect your skin. Your doctor or nurse can tell you what to expect.
If your skin feels dry, try using an unperfumed moisturising cream every day. If you’ve had radiotherapy recently or in the past, the area that was treated may become red or sore. Pemetrexed can cause a rash, which may be itchy.
Always tell your doctor or nurse about any skin changes. They can give you advice and may prescribe creams or medicines to help. Any changes to your skin are usually temporary and improve when treatment finishes.
Numb or tingling hands or feet
These symptoms are caused by the effect of pemetrexed on the nerves. It’s called peripheral neuropathy. You may also find it hard to fasten buttons or do other fiddly tasks.
Always tell your doctor if you have these symptoms. They may be able to control them by lowering the dose of the drug.
The symptoms usually improve slowly after treatment finishes, but in some people they may never go away. Talk to your doctor if you are worried about this.
Your hair may thin, but you’re unlikely to lose all the hair from your head. This usually starts after your first or second cycle of chemotherapy. It is almost always temporary and your hair will grow back after chemotherapy ends. Your nurse can give you advice about coping with hair loss.
Less common side effects of pemetrexed
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Changes to your heartbeat
Pemetrexed may cause changes to your heartbeat. This doesn’t usually cause serious problems and goes back to normal after treatment finishes. Let your doctor know if you notice your heartbeat is irregular or fast. If you get pain in your chest or feel dizzy, go to your doctor straight away.
Effects on the lungs
Pemetrexed can sometimes cause changes to the lungs. Always tell your doctor if you develop wheezing, a cough, a fever or feel breathless. You should also let them know if any existing breathing problems get worse. They can arrange for you to have tests to check your lungs.
Your eyes may become sore and inflamed (conjunctivitis). Tell your doctor if this happens. They can prescribe eye drops to help.
Changes in the way the kidneys and liver work
Pemetrexed can affect how your kidneys and liver work. This is usually mild and goes back to normal after treatment. You will have blood tests before chemotherapy to check how well your kidneys and liver are working.
It is important to tell your doctor or nurse straight away if you feel ill or have severe side effects. This includes any we don’t mention here.
Other information about pemetrexed
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Blood clot risk
Cancer increases the chances of a blood clot (thrombosis) and chemotherapy can add to this.
A clot can cause symptoms such as pain, redness and swelling in a leg, breathlessness and chest pain. Contact your doctor straight away if you have any of these symptoms.
A blood clot is serious, but your doctor can treat it with drugs that thin the blood. Your doctor or nurse can give you more information.
Some medicines can interact with chemotherapy or be harmful when you are having chemotherapy. This includes medicines you can buy in a shop or chemist. Pemetrexed may interact with non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and aspirin. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.
Pemetrexed may affect your fertility (being able to get pregnant or father a child). If you are worried about this, you can talk to your doctor or nurse before treatment starts.
Your doctor will advise you not to become pregnant or father a child during treatment. This is because the drugs may harm a developing baby. It’s important to use contraception during and for six months after chemotherapy. You can talk to your doctor or nurse about this.
If you have sex within the first couple of days of having chemotherapy, you need to use a condom. This is to protect your partner in case there is any chemotherapy in your semen or vaginal fluid.
Women are advised not to breastfeed during treatment and for a few months after. This is in case there is chemotherapy in their breast milk.
Medical and dental treatment
If you need to go into hospital for any reason other than cancer, always tell the doctors and nurses that you are having chemotherapy. Give them the contact details for your cancer doctor.
Talk to your cancer doctor or nurse if you think you need dental treatment. Always tell your dentist you are having chemotherapy.
This page has been compiled using information from a number of reliable sources, including the electronic Medicines Compendium (eMC; medicines.org.uk). If you’d like further information on the sources we use, please feel free to contact us.
This information was reviewed by a medical professional.
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