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At a glance

Pemetrexed is a folate analog metabolic inhibitor used for the treatment of non-squamous non-small cell lung cancer (NSCLC) and malignant pleural mesothelioma.

Indications
  • Non-squamous Non-Small Cell Lung Cancer (NSCLC)
  • Malignant Pleural Mesothelioma
Pharmacology

Pemetrexed is a folate analog that inhibits thymidylate synthase (TS), dihydrofolate reductase (DHFR), and glycinamide ribonucleotide formyltransferase (GARFT). After entry into cells, it is converted to polyglutamate forms that are retained in cells and act as inhibitors of TS and GARFT.

Dosage

Adult Dose (Intravenous):

  • NSCLC (with Pembrolizumab and platinum): 500 mg/m² on Day 1 every 21 days for 4 cycles
  • NSCLC (with Cisplatin): 500 mg/m² on Day 1 every 21 days for up to 6 cycles
  • NSCLC (maintenance): 500 mg/m² on Day 1 every 21 days
  • Mesothelioma (with Cisplatin): 500 mg/m² on Day 1 every 21 days
  • Requires creatinine clearance ≥45 mL/min
Side effects

Side Effects:

  • Myelosuppression (neutropenia, thrombocytopenia, anemia)
  • Renal failure
  • Bullous and exfoliative skin toxicity (SJS/TEN)
  • Interstitial pneumonitis
  • Radiation recall
Use in pregnancy

Use in Pregnancy: Can cause fetal harm when administered to a pregnant woman; advise women of potential risk to the fetus.

Pregnancy Category: D — always consult a doctor before taking during pregnancy.

Precautions & warnings
  • Vitamin supplementation (folic acid and vitamin B12) must be initiated before first dose and continued for 21 days after last dose; increased myelosuppression risk without supplementation
  • Withhold if creatinine clearance <45 mL/min
  • Permanently discontinue for severe bullous/exfoliative skin toxicity
  • Permanently discontinue if pneumonitis is confirmed
  • Permanently discontinue for radiation recall
Overdose effects

No drugs approved for overdose treatment; in animal studies, leucovorin may mitigate toxicities; not known if dialyzable.

Storage conditions

Store below 30°C in a cool and dry place, away from sunlight; keep out of reach of children.

Pemetrexed — see the full informationPharmacology, precautions, pregnancy, overdose and the rest on the generic page
⚠️ This information is for educational purposes only — not a substitute for medical advice. Consult a registered physician before taking any medicine.