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Alimta Side Effects

Generic Name: pemetrexed

Note: This page contains information about the side effects of pemetrexed. Some of the dosage forms included on this document may not apply to the brand name Alimta.

In Summary

Common side effects of Alimta include: neutropenia, leukopenia, thrombocytopenia, anemia, nausea, vomiting, fever, pharyngitis, chest pain, increased serum creatinine, depression, fatigue, desquamation, diarrhea, stomatitis, neuropathy, constipation, dyspnea, infection without neutropenia, skin rash, anorexia, and mood changes. Other side effects include: thrombosis, embolism, dysphagia, dehydration, esophagitis, and odynophagia. See below for a comprehensive list of adverse effects.

For the Consumer

Applies to pemetrexed: intravenous powder for solution

In addition to its needed effects, some unwanted effects may be caused by pemetrexed (the active ingredient contained in Alimta). In the event that any of these side effects do occur, they may require medical attention.

If any of the following side effects occur while taking pemetrexed, check with your doctor or nurse immediately:

More common:
  • Black, tarry stools
  • bleeding gums
  • chest pain
  • chills
  • cough
  • fever
  • loss of coordination
  • lower back or side pain
  • painful or difficult urination
  • pains in the chest, groin, or legs, especially calves of the legs
  • pale skin
  • pinpoint red spots on the skin
  • severe headaches of sudden onset
  • shortness of breath
  • sore throat
  • sudden onset of slurred speech
  • sudden vision changes
  • swollen glands
  • troubled breathing
  • ulcers, sores, or white spots in the mouth
  • unusual bleeding or bruising
  • unusual tiredness or weakness
Less common:
  • Bloody urine or bloody stools
  • decreased frequency or amount of urine
  • fainting or loss of consciousness
  • fast or irregular breathing
  • increased blood pressure
  • increased thirst
  • itching
  • loss of appetite
  • nausea
  • skin rash
  • swelling of the eyes or eyelids
  • swelling of the face, fingers, or lower legs
  • tightness in the chest or wheezing
  • vomiting
  • weight gain
Incidence not known:
  • Blistering, peeling, or loosening of the skin
  • joint or muscle pain
  • pain and redness of the skin in the area of earlier radiation treatment
  • red skin lesions, often with a purple center
  • red, irritated eyes
  • stomach cramps, tenderness, or pain
  • watery diarrhea

Severity: Minor

Some of the side effects that can occur with pemetrexed may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:

More common:
  • Burning, tingling, numbness, or pain in the hands, arms, feet, or legs
  • confusion
  • cough or hoarseness
  • decreased urination
  • diarrhea
  • difficulty having a bowel movement (stool)
  • difficulty with moving
  • difficulty with swallowing
  • discouragement
  • dizziness
  • dry mouth
  • feeling sad or empty
  • hair loss
  • headache
  • heartburn
  • increase in heart rate
  • irritability
  • lightheadedness
  • loss of interest or pleasure
  • mood changes
  • muscle aches or cramping
  • muscle stiffness
  • pain or burning in the throat
  • pain produced by swallowing
  • rapid breathing
  • sensation of pins and needles
  • stabbing pain
  • stuffy or runny nose
  • sunken eyes
  • swelling
  • swelling or inflammation of the mouth
  • swollen joints
  • thinning of the hair
  • thirst
  • tiredness
  • trouble concentrating
  • trouble sleeping
  • weight loss
  • wheezing
  • wrinkled skin

For Healthcare Professionals

Applies to pemetrexed: intravenous powder for injection


Side effects below show the incidence of CTC grade 3/4 toxicities in patients who received both pemetrexed (the active ingredient contained in Alimta) and cisplatin along with vitamin supplementation including daily folic acid and vitamin B12.[Ref]


Gastrointestinal side effects including nausea (84%), vomiting (58%), constipation (44%), anorexia (35%), stomatitis/pharyngitis (28%), diarrhea without colostomy (26%), dehydration (7%), and dysphagia/esophagitis/odynophagia (6%) have been reported. Postmarketing side effects have included colitis and pancreatitis.[Ref]


General side effects including fatigue (80%), chest pain (40%), fever (17%), other constitutional symptoms (11%), and edema have been reported.[Ref]


Respiratory side effects including dyspnea (66%) and interstitial pneumonitis have been reported.[Ref]


Hematologic side effects including neutropenia (58%), leukopenia (55%), anemia (33%), and thrombocytopenia (27%) have been reported. Postmarketing side effects have included immune-mediated hemolytic anemia.[Ref]


Dermatologic side effects including rash/desquamation (22%) and asteatotic eczema have been reported. Postmarketing side effects have included Stevens-Johnson syndrome and toxic epidermal necrolysis.[Ref]

Nervous system

Nervous system side effects including neuropathy/sensory effects (17%) have been reported.[Ref]


Renal side effects including creatinine elevation (16%), and renal failure (2%) have been reported.[Ref]


Psychiatric side effects including mood alterations/depression (14%) have been reported.[Ref]


Cardiovascular side effects including thrombosis/embolism (7%) have been reported.[Ref]


Immunologic side effects including infection without neutropenia (1%), infection with grade 3 or grade 4 neutropenia (6%), infection/febrile neutropenia-other (3%), and febrile neutropenia (1%) have been reported.[Ref]


Hypersensitivity side effects including allergic reactions (2%) have been reported.[Ref]


Other side effects including radiation recall have been reported in patients who have previously received radiotherapy.


1. "Product Information. Alimta (pemetrexed)." Lilly, Eli and Company, Indianapolis, IN.

2. Frouin E, Sebille G, Freudenberger S, et al. "Asteatotic eczema ("eczema craquele") with histopathological interface dermatitis: a new cutaneous reaction following pemetrexed." Br J Dermatol 166 (2011): 1359-60

Not all side effects for Alimta may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.

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