Pemetrexed
Pronunciation: (peh-MEH-treh-xed).
- Generic name
- pemetrexed
- Brand names
- Pemgem, Pemnat, Pemetrexed Sandoz, Pemetrexed Accord, Pemetero, Pemetrexed Hospira
- Drug class
- Antineoplastic (Antifolate Chemotherapy Agent)
Availability and supply rules vary by country
Trade names by country: United States · Canada
Australia: · Full directory
What pemetrexed is and how it works
Uses, formulations, monitoring, and supply rules can differ by patient, product, and country. Follow the exact local product information and professional advice.
Mechanism of action: how pemetrexed works
Pemetrexed is a multi-targeted antifolate antineoplastic agent. It inhibits several key enzymes involved in folate-dependent metabolic processes essential for cell replication, including thymidylate synthase (TS), dihydrofolate reductase (DHFR), and glycinamide ribonucleotide formyltransferase (GARFT). By blocking these enzymes, pemetrexed disrupts DNA and RNA synthesis, leading to cell cycle arrest and apoptosis in rapidly dividing tumor cells. (1)
What pemetrexed is used for
Non-small cell lung cancer (NSCLC)
Non-small cell lung cancer (NSCLC) (1)
Malignant pleural mesothelioma
Malignant pleural mesothelioma (1)
Metastatic colorectal cancer (off-label)
Metastatic colorectal cancer (off-label) (1)
Pancreatic cancer (off-label)
Pancreatic cancer (off-label) (1)
Before taking pemetrexed
Do not take / not appropriate for
- Contraindicated in patients with hypersensitivity to pemetrexed or its excipients, and in pregnancy or breastfeeding. (Contraindication) (1)
- Pre-treatment with folic acid and vitamin B12 is mandatory to reduce toxicity. (Contraindication) (1)
Tell your clinician about
(1)How to take pemetrexed
- General Instructions: Pemetrexed is given as an intravenous infusion, usually every 21 days. It must be administered by a healthcare professional in a clinical setting.. Adult Dosing: Typical dose is 500 mg/m² IV over 10 minutes on Day 1 of each 21-day cycle, often combined with other chemotherapy agents. Dose may be adjusted based on blood counts and kidney function.. Pediatric Dosing: Safety and efficacy in children have not been established. Use in pediatric patients is not routinely recommended.. Administration: Administered as an IV infusion. Patients should receive folic acid and vitamin B12 supplementation before and during treatment to reduce toxicity.. When To Stop: Treatment may be stopped if there is disease progression, unacceptable toxicity, or at the direction of your oncologist.. Storage: Store unopened vials at room temperature (below 25°C/77°F), protected from light. Prepared solutions should be used promptly or stored as directed by the healthcare facility.
- This page does not provide a dose calculator. Dosing must follow the prescriber, pharmacist, or product label.
Procedures and treatment changes
Tell the treating team before surgery, procedures, or any medicine change. Do not alter treatment without the responsible clinician. (1)
Missed dose
If you miss an appointment for your pemetrexed infusion, contact your healthcare provider immediately to reschedule. Do not attempt to self-administer or double up doses.
Overdose
In case of suspected overdose, seek emergency medical attention. Symptoms may include severe bone marrow suppression, infection, or organ toxicity. Supportive care and monitoring are essential. (1)
Side effects
Side effects and their urgency vary; report severe, persistent, or concerning symptoms to a healthcare professional.
Myelosuppression
Incidence: Reported in the clinician-authored database; frequency not established
Nausea
Incidence: Reported in the clinician-authored database; frequency not established
Vomiting
Incidence: Reported in the clinician-authored database; frequency not established
Diarrhea
Incidence: Reported in the clinician-authored database; frequency not established
Fatigue
Incidence: Reported in the clinician-authored database; frequency not established
Rash
Incidence: Reported in the clinician-authored database; frequency not established
Mucositis
Incidence: Reported in the clinician-authored database; frequency not established
Serious warnings
May cause severe bone marrow suppression — serious
Symptoms: May cause severe bone marrow suppression. Risk of serious infections. Potential for kidney and liver toxicity. Can cause severe skin reactions. Not recommended during pregnancy or breastfeeding.
Action: Follow the urgency stated and seek prompt or emergency care when indicated. (1)
Contraindications recorded in the clinician database — serious
Symptoms: Contraindications recorded in the clinician database: Contraindicated in patients with hypersensitivity to pemetrexed or its excipients, and in pregnancy or breastfeeding. Use with caution in patients with renal impairment (creatinine clearance <45 mL/min), hepatic dysfunction, or bone marrow suppression. Pre-treatment with folic acid and vitamin B12 is mandatory to reduce toxicity. Monitor for signs of infection, bleeding, and organ dysfunction.
Action: Follow the urgency stated and seek prompt or emergency care when indicated. (1)
Interactions
| Medicine or test | Effect | Action |
|---|---|---|
| Recorded interactions | Pemetrexed can interact with NSAIDs, increasing the risk of kidney toxicity, especially in patients with impaired renal function. It may also interact with other chemotherapy agents and vaccines. Always inform your healthcare provider about all medications and supplements you are taking. | (1) |
Pregnancy, breastfeeding, kidney/liver function, age
Pregnancy
The FDA label states pemetrexed was embryotoxic, fetotoxic, and teratogenic in animal studies at doses far below the human dose, and can cause fetal harm. Anyone of reproductive potential is advised to use effective contraception during treatment and for 6 months after the last dose, and to tell their prescriber about a known or suspected pregnancy right away. (1)
Breastfeeding
The FDA label advises against breastfeeding during pemetrexed treatment and for 1 week after the last dose, because of the potential for serious adverse effects on a nursing infant. (1)
Children
Frequency: Not applicable.. Weight Based: Not recommended for pediatric use.. Max Daily Dose: Not applicable.. Max Single Dose: Not applicable.. Age Restrictions: Safety not established in children. (1)
Renal_impairment
Renal: the FDA label states pemetrexed should NOT be given when creatinine clearance is below 45 mL/min, because clearance decreases and drug exposure rises substantially as kidney function falls (for example, roughly 65% higher exposure at a creatinine clearance of 45 mL/min compared with normal function). Hepatic: pemetrexed has not been formally studied in patients with hepatic impairment, though clinical studies did not find that elevated liver enzymes or bilirubin affected its pharmacokinetics — the oncology team will individualize monitoring for significant liver disease. (1)
Hepatic_impairment
Renal: the FDA label states pemetrexed should NOT be given when creatinine clearance is below 45 mL/min, because clearance decreases and drug exposure rises substantially as kidney function falls (for example, roughly 65% higher exposure at a creatinine clearance of 45 mL/min compared with normal function). Hepatic: pemetrexed has not been formally studied in patients with hepatic impairment, though clinical studies did not find that elevated liver enzymes or bilirubin affected its pharmacokinetics — the oncology team will individualize monitoring for significant liver disease. (1)
Monitoring
(1)Storage
This is a healthcare-professional-administered infusion; storage and preparation are handled by the treating facility. Once diluted/reconstituted, the FDA label specifies the solution should be refrigerated at 2°C-8°C (36°F-46°F) and used within 24 hours of reconstitution, then discarded.
Professional information
Clinician-facing context only. This section does not replace current product labeling.
General
Indication: Non-small cell lung cancer (NSCLC)
Dose summary: The recommended dose of pemetrexed for the treatment of non-small cell lung cancer and malignant pleural mesothelioma is 500 mg/m² administered as an intravenous infusion over 10 minutes.
Renal context: Pemetrexed must NOT be administered when creatinine clearance is below 45 mL/min, per the FDA label — clearance of the drug falls and systemic exposure (AUC) rises substantially as renal function declines (approximately 65%, 54%, and 13% higher exposure at creatinine clearances of 45, 50, and 80 mL/min respectively, compared with 100 mL/min). Additionally, in patients with a creatinine clearance between 45 and 79 mL/min, ibuprofen should be avoided for 2 days before, the day of, and 2 days after pemetrexed administration, since it further increases pemetrexed exposure in this group. (1)
Hepatic guidance
Pemetrexed has not been formally studied in patients with hepatic impairment. In clinical studies, elevated AST, ALT, or total bilirubin were not observed to affect pemetrexed's pharmacokinetics, but the oncology team should still individualize monitoring for patients with significant liver disease given the absence of dedicated hepatic-impairment studies.
Frequently asked questions
What types of cancer does pemetrexed treat?
Pemetrexed is primarily used to treat malignant pleural mesothelioma and non-small cell lung cancer (NSCLC), often in combination with other chemotherapy drugs.
How is pemetrexed administered?
It is given as an intravenous (IV) infusion by a healthcare professional, usually every 21 days.
What should I do if I develop a fever during treatment?
Contact your healthcare provider immediately, as fever may indicate a serious infection due to low white blood cell counts.
Why do I need to take folic acid and vitamin B12 with pemetrexed?
Supplementation with folic acid and vitamin B12 helps reduce the risk of severe side effects, such as bone marrow suppression and mouth sores.
Can I take over-the-counter pain relievers with pemetrexed?
Some pain relievers, especially NSAIDs, can increase the risk of kidney problems with pemetrexed. Always consult your doctor before taking any new medications.
Is pemetrexed safe during pregnancy or breastfeeding?
No, pemetrexed can harm an unborn baby and is not recommended during pregnancy or breastfeeding.
What monitoring is required during pemetrexed treatment?
Regular blood tests to monitor blood cell counts, kidney and liver function, and assessment for side effects are essential during treatment.
What happens if I take too much Pemetrexed?
Taking too much Pemetrexed can lead to severe and life-threatening side effects, including profound myelosuppression, mucositis, and gastrointestinal toxicity. Symptoms may include extreme fatigue, fever, bleeding, or severe mouth sores. If an overdose is suspected, it is crucial to seek immediate emergency medical attention. Prompt intervention is vital for managing potential complications.
Can I drink alcohol while taking Pemetrexed?
It is generally recommended to avoid or significantly limit alcohol consumption while undergoing treatment with Pemetrexed. Alcohol can exacerbate common side effects of chemotherapy, such as nausea, vomiting, and liver toxicity. Furthermore, alcohol may interact with other medications you are taking or impair your body's ability to recover from treatment. Always consult your healthcare provider for personalized advice.
Is Pemetrexed safe during pregnancy?
Pemetrexed is categorized as a drug with potential risks during pregnancy. It can cause fetal harm and is generally contraindicated for use in pregnant women. Women of childbearing potential should use effective contraception during treatment and for a period afterward. It is imperative to discuss your pregnancy status or plans with your healthcare provider before starting or continuing Pemetrexed treatment.
What is the mechanism of action of pemetrexed?
Pemetrexed is a multi-targeted antifolate antineoplastic agent. It inhibits several key enzymes involved in folate-dependent metabolic processes essential for cell replication, including thymidylate synthase (TS), dihydrofolate reductase (DHFR), and glycinamide ribonucleotide formyltransferase (GARFT). By blocking these enzymes, pemetrexed disrupts DNA and RNA synthesis, leading to cell cycle arrest and apoptosis in rapidly dividing tumor cells. (1)
What is the generic name of Pemetrexed?
The generic name is pemetrexed. It is sold under brand names including Pemgem, Pemnat, Pemetrexed Sandoz, Pemetrexed Accord, Pemetero, Pemetrexed Hospira.
What class of drug is pemetrexed?
Pemetrexed is classed as: Antineoplastic (Antifolate Chemotherapy Agent).
References
- Not providedNot provided in research notes · Not provided · accessed 2026-08-07 · source 1
- PEMFEXY (PEMETREXED) INJECTION [ACACIA PHARMA, LTD.] — US prescribing information (DailyMed SPL)U.S. National Library of Medicine (DailyMed) · US · accessed 2026-08-14 · source 2
- PEMRYDI RTU — FDA approval record (Drugs@FDA NDA215179)U.S. Food and Drug Administration · US · accessed 2026-08-14 · source 3
- pemetrexed — RxNorm normalized drug concept (RXCUI 2590669)U.S. National Library of Medicine (RxNorm) · US · accessed 2026-08-14 · source 4
Brand names by country
Single-ingredient pemetrexed names are shown separately by country. Product availability, strengths, and supply rules can change; combination products are not included here.
Priority countries
United States
- Pemfexy25 mg/mL · acacia pharma, ltd.
- AXTLE500 mg/20mL, 100 mg/4mL · avyxa pharma, llc
Canada
- ALIMTA