pemetrexed disodium hydrate at a glance
Medicine class
Cytotoxic antimetabolite; multi-targeted antifolate.
Main uses
Malignant pleural mesothelioma and locally advanced or metastatic non-small-cell lung cancer other than predominantly squamous disease.
How it is given
A healthcare professional dilutes the concentrate and gives it by intravenous infusion under specialist cancer supervision.
Supportive treatment
Prescribed folic acid, vitamin B12 and a corticosteroid help reduce important treatment toxicities.
What is pemetrexed disodium hydrate used for?
The selected UK product is licensed for:
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 other than predominantly squamous histology.
Alone as maintenance treatment for locally advanced or metastatic non-small-cell lung cancer other than predominantly squamous histology when disease has not progressed after platinum-based chemotherapy.
Alone as second-line treatment for locally advanced or metastatic non-small-cell lung cancer other than predominantly squamous histology.
How does pemetrexed disodium hydrate work?
Pemetrexed blocks several folate-dependent enzymes, including thymidylate synthase, dihydrofolate reductase and GARFT. This reduces production of DNA building blocks and limits cell replication. Intracellular conversion to polyglutamate forms helps retain and strengthen its activity within cells.
pemetrexed disodium hydrate preparations and strengths
Solution for infusion
Route: Intravenous
Strengths: 25 mg/mL
How to take pemetrexed disodium hydrate
Pemetrexed is prepared and diluted by trained staff, then infused into a vein in a hospital or specialist clinic. Take prescribed folic acid and corticosteroid exactly as directed and attend for vitamin B12 injections; these measures reduce blood, gastrointestinal and skin toxicity. Tell the team if supportive medicines were missed or vomited, and report new medicines, vaccines or radiotherapy before treatment.
Do not attempt to prepare or administer the concentrate yourself.
Tell staff about side effects before each treatment visit.
Avoid driving or operating machinery if treatment makes you tired or dizzy.
pemetrexed disodium hydrate side effects
Common or expected effects
- Low white cells, red cells or platelets, increasing the risk of infection, tiredness, breathlessness, bruising or bleeding
- Nausea, vomiting, reduced appetite, diarrhoea or constipation
- Sore mouth or throat
- Fatigue
- Rash, skin peeling or itching
- Changes in kidney or liver blood tests
- Hair loss
- Numbness or tingling
Get urgent medical advice
- Sepsis or infection associated with low white-cell counts
- Severe allergic reaction or anaphylaxis
- Severe blistering or peeling skin reactions
- Kidney failure or marked reduction in kidney function
- Pulmonary embolism, interstitial pneumonitis or respiratory failure
- Serious bleeding or profound bone-marrow suppression
- Heart attack, stroke, heart failure or significant rhythm disturbance
- Severe gastrointestinal inflammation, bleeding or perforation
pemetrexed disodium hydrate in pregnancy
Pemetrexed may seriously harm an unborn baby and should be used during pregnancy only when a specialist judges it clearly necessary after considering maternal need and fetal risk. Effective contraception is required during treatment and for 6 months afterwards for people who could become pregnant; men are advised not to father a child during treatment and for 3 months afterwards. Discuss pregnancy, contraception and fertility preservation with the cancer team before treatment.
pemetrexed disodium hydrate while breastfeeding
Breastfeeding is contraindicated during pemetrexed treatment because transfer into milk is unknown and harm to the infant cannot be excluded. Ask the oncology and infant-feeding teams before considering restarting breastfeeding.
pemetrexed disodium hydrate interactions
The oncology team should review prescribed, over-the-counter and complementary products before treatment.
NSAIDs, including ibuprofen and high-dose aspirin
They may reduce renal elimination of pemetrexed and increase blood, gastrointestinal or other toxicity, particularly when kidney function is impaired.
Nephrotoxic medicines, including aminoglycosides, loop diuretics and ciclosporin
Combined use may delay pemetrexed clearance, so caution and closer renal monitoring may be needed.
Medicines cleared by renal tubular secretion, including probenecid and penicillins
Competition for renal secretion may delay pemetrexed clearance and increase toxicity.
Common questions about pemetrexed disodium hydrate
Answers are fully visible for fast scanning and source review.
Why are folic acid and vitamin B12 given with pemetrexed?
They reduce important pemetrexed toxicities, particularly severe effects on blood cells and the gastrointestinal system. They are protective supportive treatment rather than treatment for vitamin deficiency.
Why is a steroid prescribed with pemetrexed?
A corticosteroid such as dexamethasone reduces the frequency and severity of pemetrexed-associated skin reactions.
Can I take ibuprofen while receiving pemetrexed?
Check with the oncology team before taking ibuprofen or another NSAID. These medicines can delay pemetrexed clearance and increase toxicity, especially when kidney function is reduced.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.