pemetrexed disodium hemipentahydrate at a glance
Medicine class
Multitargeted antifolate chemotherapy
Licensed uses
Selected adult cases of malignant pleural mesothelioma and non-squamous non-small-cell lung cancer
Administration
Diluted and given into a vein by a specialist cancer team
Supportive treatment
Folic acid, vitamin B12 and corticosteroid premedication are required to reduce toxicity and skin reactions
Routine checks
Blood counts and kidney and liver function are assessed during treatment
What is pemetrexed disodium hemipentahydrate used for?
The selected product is licensed for adults in the following settings:
With cisplatin for previously untreated, unresectable malignant pleural mesothelioma.
With cisplatin as first-line treatment for locally advanced or metastatic non-small-cell lung cancer that is not predominantly squamous.
Alone as maintenance treatment for locally advanced or metastatic non-squamous non-small-cell lung cancer that has not progressed immediately after platinum-based chemotherapy.
Alone as second-line treatment for locally advanced or metastatic non-squamous non-small-cell lung cancer.
How does pemetrexed disodium hemipentahydrate work?
Pemetrexed enters cells and is converted into forms that remain active inside them. It blocks several folate-dependent enzymes, reducing the building blocks needed to make DNA and RNA. This particularly disrupts rapidly dividing cancer cells.
pemetrexed disodium hemipentahydrate preparations and strengths
Solution for infusion
Route: Intravenous
Strengths: 25 mg/mL
How to take pemetrexed disodium hemipentahydrate
Pemetrexed is not taken by mouth. A trained cancer team dilutes the concentrate and administers it into a vein under specialist supervision.
Take folic acid and attend for vitamin B12 injections exactly as directed; these reduce treatment-related toxicity.
Take prescribed corticosteroid premedication exactly as directed to reduce skin reactions.
Tell the team before treatment if supportive medicines were missed, you feel unwell, or you have started any new prescription, non-prescription or herbal product.
Attend scheduled blood tests and report infusion-site pain, redness or swelling promptly.
pemetrexed disodium hemipentahydrate side effects
Common or expected effects
- Low white cells, red cells or platelets
- Infections
- Tiredness
- Reduced appetite
- Nausea or vomiting
- Sore mouth or throat
- Diarrhoea or constipation
- Rash or hair loss
- Changes in kidney or liver blood tests
Get urgent medical advice
- Fever, chills or other infection symptoms, which may indicate neutropenic infection or sepsis
- Unexpected bruising, bleeding or profound weakness from bone-marrow suppression
- Sudden breathlessness, chest pain, coughing blood or limb swelling, which may indicate a clot or serious lung problem
- Facial or throat swelling, wheezing, collapse or a rapidly spreading rash suggesting a severe allergic reaction
- Blistering, peeling or painful widespread skin lesions
- Markedly reduced urine, severe thirst, confusion or worsening dehydration suggesting kidney injury
pemetrexed disodium hemipentahydrate in pregnancy
Pemetrexed is suspected to cause serious fetal harm and should only be used during pregnancy when a specialist judges it clearly necessary after weighing maternal need against fetal risk. Effective contraception is required during treatment and afterwards for the product-specified period. Fertility preservation should be discussed before treatment where relevant.
pemetrexed disodium hemipentahydrate while breastfeeding
Breastfeeding is contraindicated during pemetrexed treatment because transfer into human milk is unknown and serious effects in the infant cannot be excluded. Ask the oncology and infant-feeding teams before expressing milk for later use or restarting breastfeeding after treatment.
pemetrexed disodium hemipentahydrate interactions
The oncology team should review all medicines, vaccines and supplements before treatment.
NSAIDs and high-dose aspirin
These may reduce renal elimination of pemetrexed and increase bone-marrow and gastrointestinal toxicity, particularly when kidney function is impaired.
Nephrotoxic medicines
Aminoglycosides, loop diuretics, platinum compounds and ciclosporin may delay pemetrexed clearance, so kidney function may require closer monitoring.
OAT3 inhibitors
Probenecid, penicillins and proton-pump inhibitors may delay pemetrexed clearance; assess the combination and monitor for toxicity.
Common questions about pemetrexed disodium hemipentahydrate
Answers are fully visible for fast scanning and source review.
What type of chemotherapy is pemetrexed?
Pemetrexed is a cytotoxic, multitargeted antifolate that blocks several enzymes needed for DNA and RNA production.
Why are folic acid and vitamin B12 needed with pemetrexed?
They reduce serious blood, infection and other treatment-related toxicities without preventing pemetrexed's intended action.
How is pemetrexed given?
It is diluted and administered into a vein by a specialist cancer team; it is not an oral treatment.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.