Pemetrexed (Alimta ®)
Pemetrexed is a chemotherapy drug used to treat non-small cell lung cancer and pleural mesothelioma (a type of cancer that affects the lining of the lung). Pemetrexed may be given along with other chemotherapy drugs.
This information should ideally be read with our general information about chemotherapy and your type of cancer.
Before you have pemetrexed
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You'll be given folic acid and vitamin B12 to take before your treatment with pemetrexed begins, and throughout your chemotherapy. It's very important to take these as they reduce the side effects of pemetrexed without reducing its effectiveness.
You can take folic acid as a tablet. You usually take it five days before the first treatment, and then every day until three weeks after treatment with pemetrexed is complete.
While you're having pemetrexed, it‘s best to 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 consult your pharmacist before taking these.
Vitamin B12 is injected into a muscle one week before the first treatment with pemetrexed and again with every third treatment (roughly 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 alright 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 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 (cannula) that the nurse puts into a vein in your arm or hand
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 over about 10 minutes. They usually run the drip through a pump, which gives you the treatment over a set time.
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.
But this will depend 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.
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.
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 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 contact 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 white blood cells are still low, your doctor may delay your treatment for a short time.
Bruising and bleeding
Premetexed 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.
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. 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.
Less common side effects of pemetrexed
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Your eyes may become sore and inflamed (conjunctivitis). Your doctor can prescribe eye drops if you need them.
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.
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 take some regular gentle exercise.
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 can affect your fertility (being able to get pregnant or father a child). If you are worried about this, you can talk to your doctor 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 a few 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 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 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 section has been compiled using a number of reliable sources, including:
electronic Medicines Compendium (eMC). medicines.org.uk (accessed September 2013).
British National Formulary. 65th edition. 2013. British Medical Association and Royal Pharmaceutical Society of Great Britain.
Micromedex® 2.0, 2013, Truven Health Analytics Inc. Available at: micromedexsolutions.com (accessed September 2013).
With thanks to: Rena Chauhan, Senior Cancer Services Pharmacist, Nottingham University Hospitals NHS Trust who reviewed this edition.
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