Alimta Side Effects

Generic name: pemetrexed

Medically reviewed by Drugs.com. Last updated on Mar 7, 2025.

Note: This document provides detailed information about Alimta.

Applies to pemetrexed: intravenous powder for solution, intravenous solution Side Effects associated with pemetrexed. Some dosage forms listed on this page may not apply specifically to the brand name Alimta.

Applies to pemetrexed: intravenous powder for solution, intravenous solution.

Precautions

It is very important that your doctor check your progress at regular visits to make sure that this medicine is working properly. Blood and urine tests may be needed to check for unwanted effects.

Receiving this medicine while you are pregnant can harm your unborn baby. If you are a woman who can get pregnant, your doctor will do tests to make sure you are not pregnant before receiving this medicine. It may also cause birth defects if the father is using it when his sexual partner becomes pregnant. Female patients should use effective birth control during treatment with this medicine and for at least 6 months after the last dose. Male patients who have female partners should use effective birth control during treatment with this medicine and for at least 3 months after the last dose. If you think you have become pregnant while receiving this medicine, tell your doctor right away.

Pemetrexed and cisplatin can sometimes cause nausea and vomiting. However, it is very important that you continue to receive the medicine, even if you begin to feel ill. You can get medicines to help control the nausea and vomiting. Talk with your doctor if you get any of these symptoms.

Pemetrexed can temporarily lower the number of white blood cells in your blood, increasing the chance of getting an infection. It can also lower the number of platelets, which are necessary for proper blood clotting. If this occurs, there are certain precautions you can take, especially when your blood count is low, to reduce the risk of infection or bleeding:

• If you can, avoid people with infections. Check with your doctor immediately if you think you are getting an infection or if you get a fever or chills, cough or hoarseness, diarrhea, lower back or side pain, mouth sores, or painful or difficult urination.
• Check with your doctor immediately if you notice any unusual bleeding or bruising, black, tarry stools, blood in the urine or stools, or pinpoint red spots on your skin.
• Be careful when using a regular toothbrush, dental floss, or toothpick. Your medical doctor, dentist, or nurse may recommend other ways to clean your teeth and gums. Check with your medical doctor before having any dental work done.
• Do not touch your eyes or the inside of your nose unless you have just washed your hands and have not touched anything else in the meantime.
• Be careful not to cut yourself when you are using sharp objects such as a safety razor or fingernail or toenail cutters.
• Avoid contact sports or other situations where bruising or injury could occur.

Check with your doctor right away if you have bloody urine, a decrease in frequency or amount of urine, an increase in blood pressure, increased thirst, loss of appetite, lower back or side pain, nausea, swelling of the face, fingers, or lower legs, trouble breathing, unusual tiredness or weakness, vomiting, or weight gain. These could be symptoms of a serious kidney problem.

Serious skin reactions can occur with this medicine. Check with your doctor right away if you have blistering, peeling, or loosening of the skin, red skin lesions, severe acne or a skin rash, sores or ulcers on the skin, or fever or chills with this medicine.

Serious lung or breathing problems (eg, interstitial pneumonitis) may occur after you receive this medicine. Call your doctor right away if have any changes in your breathing after you receive this medicine.

Tell your doctor if you have received radiation treatment in the past. You may be more sensitive to the effects of this medicine (eg, pain and redness of the skin at the place of earlier radiation treatment).

If you have kidney problems, make sure your doctor knows if you are using an NSAID or pain or arthritis medicine, especially ibuprofen. Do not take ibuprofen at least 2 days before or 2 days after receiving this medicine. Taking ibuprofen during treatment with this medicine may increase your risks for bone marrow, kidney, and stomach or bowel problems.

If you plan to have children, talk with your doctor before using this medicine. Some men receiving this medicine have become infertile (unable to have children).

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Serious side effects of Alimta

Along with its needed effects, pemetrexed (the active ingredient contained in Alimta) may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur while taking pemetrexed:

Other side effects of Alimta

Some side effects of pemetrexed may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.

Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

For healthcare professionals

Applies to pemetrexed: intravenous powder for injection, intravenous solution.

General adverse events

The most common adverse reactions reported with this drug were: fatigue, nausea, and anorexia (when administered as a single agent); vomiting, neutropenia, anemia, stomatitis/pharyngitis, thrombocytopenia, and constipation (when administered with cisplatin); and fatigue/asthenia, nausea, constipation, diarrhea, decreased appetite, rash, vomiting, cough, dyspnea, and pyrexia (when administered with pembrolizumab and platinum chemotherapy).^[Ref]

Cardiovascular

• Very common (10% or more): Hypertension (up to 11%)
• Common (1% to 10%): Thrombosis/embolism, cardiac failure, arrhythmia
• Uncommon (0.1% to 1%): Serious cardiovascular events (including myocardial infarction, angina pectoris), angina, myocardial infarction, coronary artery disease, supraventricular arrhythmia
• Frequency not reported: Ventricular tachycardia
• Postmarketing reports: Peripheral ischemia (sometime leading to extremity necrosis)

Serious cardiovascular and cerebrovascular events (including myocardial infarction, angina pectoris, cerebrovascular accident, transient ischemic attack) have been uncommonly reported during clinical studies with this drug, usually when given in combination with another cytotoxic agent. Most of the patients experiencing such events had preexisting cardiovascular risk factors.

Dermatologic

• Very common (10% or more): Rash (includes genital rash, rash, generalized rash, macular rash, maculopapular rash, papular rash, pruritic rash, pustular rash; up to 25%), rash/desquamation (up to 14%), alopecia (up to 12%), skin exfoliation
• Common (1% to 10%): Pruritus/itching, erythema multiforme, urticaria, hyperpigmentation
• Rare (0.01% to 0.1%): Erythema, recall phenomenon
• Very rare (less than 0.01%): Dermo-hypodermitis, pemphigoid, bullous dermatitis, acquired epidermolysis bullosa, erythematous edema (mainly of the lower limbs), pseudocellulitis, dermatitis, eczema, prurigo
• Postmarketing reports: Serious and fatal bullous skin conditions, Stevens-Johnson syndrome (in some cases fatal), toxic epidermal necrolysis (in some cases fatal), radiation recall, hyperpigmentation, infectious/noninfectious disorders of the dermis/hypodermis/subcutaneous tissue (e.g., acute bacterial dermo-hypodermitis, pseudocellulitis, dermatitis)

Gastrointestinal

• Very common (10% or more): Nausea (up to 82.1%), vomiting (up to 57%), constipation (up to 35%), diarrhea (up to 31%), stomatitis/pharyngitis (up to 23.2%), diarrhea (without colostomy; up to 12.4%), pharyngitis, stomatitis
• Common (1% to 10%): Dyspepsia/heartburn, mucositis/stomatitis, abdominal pain
• Uncommon (0.1% to 1%): Esophagitis, radiation esophagitis, colitis (including intestinal/rectal bleeding [sometimes fatal], intestinal perforation, intestinal necrosis, typhlitis), rectal hemorrhage, gastrointestinal hemorrhage, intestinal perforation
• Frequency not reported: Gastrointestinal obstruction, severe esophagitis (resulting in hospitalization)
• Postmarketing reports: Colitis, pancreatitis

Hematologic

• Very common (10% or more): Anemia (up to 85%), lymphopenia (up to 64%), neutropenia (up to 56%), decreased neutrophils/granulocytes (up to 56%), decreased leukocytes (up to 53%), decreased hemoglobin (up to 33%), thrombocytopenia (up to 30%), decreased platelets (up to 23.2%), RBC transfusions required (up to 13%), erythropoiesis stimulating agents required (up to 12%), leukopenia
• Common (1% to 10%): Febrile neutropenia, neutropenic infection, transfusions required (primarily RBC transfusions), platelet transfusions required, granulocyte colony stimulating factors required
• Uncommon (0.1% to 1%): Pancytopenia
• Rare (0.01% to 0.1%): Autoimmune hemolytic anemia
• Postmarketing reports: Immune-mediated hemolytic anemia

Hepatic

• Very common (10% or more): Increased ALT (up to 47%), increased AST (up to 47%)
• Common (1% to 10%): Increased GGT
• Rare (0.01% to 0.1%): Hepatitis

Hypersensitivity

• Common (1% to 10%): Allergic reaction/hypersensitivity
• Postmarketing reports: Anaphylactic shock

Metabolic

• Very common (10% or more): Hyperglycemia (up to 63%), hypoalbuminemia (up to 39%), hyponatremia (up to 32%), hypophosphatemia (up to 30%), decreased appetite (up to 30%), anorexia (up to 27%), hypocalcemia (up to 24%), hyperkalemia (up to 24%), hypokalemia (up to 21%)
• Common (1% to 10%): Dehydration

Nervous system

• Very common (10% or more): Peripheral sensory neuropathy (up to 10.1%)
• Common (1% to 10%): Taste disturbance/disorder, peripheral motor neuropathy, dizziness
• Uncommon (0.1% to 1%): Serious cerebrovascular events (including cerebrovascular accident, transient ischemic attack), cerebrovascular accident, ischemic stroke, intracranial hemorrhage
• Frequency not reported: Syncope

Ocular

• Common (1% to 10%): Conjunctivitis, ocular surface disease, increased lacrimation, dry eye, keratoconjunctivitis sicca, eyelid edema

Other

• Very common (10% or more): Fatigue (includes asthenia, fatigue; up to 58%), increased alkaline phosphatase (up to 29%), pyrexia (up to 20%), infection (with and without neutropenia)
• Common (1% to 10%): Asthenia, pain, edema, chest pain, infection (with Grade 3 to 4 neutropenia), sepsis (with or without neutropenia [including fatal cases]), infection (without neutropenia), fever (without neutropenia), mucosal inflammation
• Postmarketing reports: Edema

Psychiatric

• Frequency not reported: Depression

Renal

• Very common (10% or more): Increased blood creatinine (up to 37%), decreased CrCl (up to 16%)
• Common (1% to 10%): Renal failure, acute kidney injury, renal disorders (includes increased serum/blood creatinine, decreased GFR, renal failure, renal/genitourinary - other), decreased GFR
• Uncommon (0.1% to 1%): Acute renal failure
• Postmarketing reports: Nephrogenic diabetes insipidus, renal tubular necrosis

Respiratory

• Very common (10% or more): Cough (up to 28%), dyspnea (up to 26%)
• Common (1% to 10%): Pneumonitis, pneumonia
• Uncommon (0.1% to 1%): Interstitial pneumonitis (with respiratory insufficiency [sometimes fatal]), pulmonary embolism, radiation pneumonitis
• Postmarketing reports: Interstitial pneumonitis, radiation pneumonitis

See also:

Frequently asked questions

• How does pemetrexed work?

Further information

Alimta side effects can vary depending on the individual. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Note: Medication side effects may be underreported. If you are experiencing side effects that are not listed, submit a report to the FDA by following this guide.

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