Pemetrexed (Alimta)

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General information

Class/mechanism: Folate analog, antimetabolite. Pemetrexed inhibits the activity of several folate-dependent enzymes involved in the synthesis of thymidine and purine nucleotides, such as thymidylate synthase (TS), dihydrofolate reductase (DHFR), and glycinamide ribonucleotide formyltransferase (GARFT).[1][2]
Route: IV
Extravasation: neutral

Supportive care examples:[1]

  • Patients should take daily folic acid (example dose: 1mg PO daily) while on therapy and at least 5 doses in the 7 days before starting Pemetrexed (Alimta) therapy.
  • Vitamin B12 1000mcg should be given during the week before the first dose of Pemetrexed (Alimta) and then every 3 cycles thereafter.
  • Dexamethasone 4mg PO BID the day before, the day of, and day after Pemetrexed (Alimta) helps to reduce the incidence and severity of cutaneous reactions.

For conciseness and simplicity, currently will focus on treatment regimens and not list information such as: renal/hepatic dose adjustments, metabolism (including CYP450), excretion, monitoring parameters (although this will be considered for checklists), or manufacturer. Instead, for the most current information, please refer to your preferred pharmacopeias such as Micromedex, Lexicomp, UpToDate (courtesy of Lexicomp), or the prescribing information.[1]

Diseases for which it is used

Patient drug information

History of changes in FDA indication

  • 2/4/2004: Initial FDA approval: "in combination with cisplatin is indicated for the treatment of patients with malignant pleural mesothelioma whose disease is either unresectable or who are otherwise not candidates for curative surgery."
  • 8/19/2004: New indication: "as a single-agent is indicated for the treatment of patients with locally advanced or metastatic non-small cell lung cancer after prior chemotherapy."
  • 9/26/2008: Indications revised:
  1. Nonsquamous Non-Small Cell Lung Cancer: "initial treatment in combination with cisplatin."
  2. Nonsquamous Non-Small Cell Lung Cancer "as a single-agent after prior chemotherapy."
  3. Mesothelioma: "in combination with cisplatin"
  • 7/2/2009: Additional indication for Nonsquamous Non-Small Cell Lung Cancer: "Maintenance treatment of patients whose disease has not progressed after four cycles of platinum-based first-line chemotherapy."
  • 7/2/2009: Limitation: "not indicated for the treatment of patients with squamous cell non-small cell lung cancer."

Also known as

  • Brand names: Alimta, Antifol, Kabipem, Pemetero, Pemetra, Pemetrex, Pemex, Pemgem, Pemibenz, Pemnat, Pexotra


  1. 1.0 1.1 1.2 1.3 Pemetrexed (Alimta) package insert
  2. Pemetrexed (Alimta) package insert (locally hosted backup)
  3. Pemetrexed (Alimta) patient drug information (Chemocare)
  4. Pemetrexed (Alimta) patient drug information (UpToDate)