Pemetrexed
Pemetrexed is a folate analog antimetabolite chemotherapy medication used to treat certain cancers, including malignant pleural mesothelioma and non-small cell lung cancer. It works by inhibiting multiple folate-dependent enzymes essential for DNA synthesis and cell division, ultimately preventing cancer cells from multiplying. This medication is typically administered intravenously under the supervision of an oncologist.
Antimetabolite chemotherapy drug that inhibits folate metabolism to stop cancer cell growth in mesothelioma and lung cancer patients.
Key facts at a glance
- ATC
- L01BA04
- RxNorm
- 68446
- Generic
- Pemetrexed
- Class
- atc-l01
- Brands
- Pemfexy, Pemrydi Rtu, Axtle, Alimta
- Availability
- rx
- Lactation
- unknown
- Routes
- —
- Forms
- injection, solution
- Regions
- US, EU, CN, JP
- Monitoring
- —
This page is for informational purposes only.
Do not use this information to diagnose yourself or to replace a physician's advice. Always consult a qualified healthcare provider before starting, stopping, or changing any medication. If you believe you are experiencing a medical emergency, call your local emergency number immediately.
Dosage and administration
- Usual dose
- 500mg/m²
- Maximum
- consult physician
- Frequency
- every 21 days (every 3 weeks)
- Instructions
- Follow physician instructions
- Duration limits
- as prescribed
- Monitoring
- standard
- Usual dose
- safety and efficacy not established
- Maximum
- consult physician
- Frequency
- not applicable
- Instructions
- Follow physician instructions
- Duration limits
- as prescribed
- Monitoring
- standard
- Usual dose
- 500mg/m²
- Maximum
- consult physician
- Frequency
- every 21 days (every 3 weeks)
- Instructions
- Follow physician instructions
- Duration limits
- as prescribed
- Monitoring
- standard
Overdose information
Special Populations
9 groupspregnancy
first trimesteravoid use
pemetrexed is contraindicated during pregnancy due to potential harm to the fetus
regular fetal monitoring and ultrasound assessments
Use of this medication in this population requires careful consideration of risks and benefits.
pregnancy
second third trimesteravoid use
continue avoidance throughout pregnancy
regular fetal monitoring
Use of this medication in this population requires careful consideration of risks and benefits.
lactation
n adiscontinue breastfeeding
do not breastfeed during treatment and for at least 1 week after last dose
n/a
Use of this medication in this population requires careful consideration of risks and benefits.
geriatric
n ano specific dose adjustment required
use standard dosing but monitor renal function closely as elderly may have reduced renal function
monitor renal function and for adverse reactions
Use with caution and monitor for adverse effects.
pediatric_age
children adolescentsnot recommended
not approved for use in pediatric patients - safety and efficacy not established
n/a
Use of this medication in this population requires careful consideration of risks and benefits.
renal_impairment
mild moderatedose reduction required based on creatinine clearance
for CrCl 45-79 mL/min: reduce dose to 75% of standard; for CrCl 80+ mL/min: no reduction needed
monitor renal function prior to each cycle
Use with caution and monitor for adverse effects.
renal_impairment
severeuse not recommended
avoid use in patients with CrCl less than 45 mL/min due to increased toxicity risk
close monitoring if used
Use of this medication in this population requires careful consideration of risks and benefits.
hepatic_impairment
mild moderateno dose adjustment required
no adjustment needed for mild to moderate hepatic impairment
monitor liver function tests
hepatic_impairment
severeuse with caution
limited data in severe hepatic impairment - use only if benefits outweigh risks
frequent monitoring of liver function
Use with caution and monitor for adverse effects.
Statistics and clinical data
FDA approval year
Initial FDA approval for pemetrexed
Drug class
ATC code L01BA04
Primary indications
Approved therapeutic indications
Mechanism of action
Primary pharmacodynamic mechanism
Pemetrexed is indicated for the treatment of malignant pleural mesothelioma (in combination with cisplatin) and for the treatment of non-small cell lung cancer (as a single agent or in combination with other therapies).
As a folate analog metabolic inhibitor, pemetrexed disrupts folate-dependent metabolic processes essential for cell replication. It inhibits key enzymes including thymidylate synthase (TS), dihydrofolate reductase, and glycinamide ribonucleotide formyltransferase, which are necessary for DNA and RNA synthesis in rapidly dividing cells.
Patients must receive folic acid and vitamin B12 supplementation before and during treatment to reduce side effects. Regular blood monitoring is required due to risk of bone marrow suppression. Contraindicated in pregnancy; use effective contraception during treatment. Administered as intravenous infusion by healthcare professionals experienced in chemotherapy.
Contraindications
Conditions and patient states where this medication should be avoided or used with caution.
Do not use (1)
Known allergy to this medication or its components
Use caution (1)
Consult healthcare provider for benefits vs risks assessment
Official drug label
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This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment.
This content is for general informational and educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of a qualified healthcare provider with any questions you have about a medical condition, and never disregard professional medical advice or delay seeking it because of something you read here.
If you think you may have a medical emergency, call your local emergency number or go to the nearest emergency department immediately.
Medically reviewed by WellAlly Editorial Team Last reviewed July 26, 2026. · Read our editorial policy