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Alimta Side Effects

Generic name: pemetrexed

Medically reviewed by Last updated on Feb 2, 2023.

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


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

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

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:

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
  • sore throat
  • sudden onset of slurred speech
  • sudden vision changes
  • swollen glands
  • trouble breathing
  • ulcers, sores, or white spots in the mouth
  • unusual bleeding or bruising
  • unusual tiredness or weakness

Less common

  • Bloody urine or bloody stools
  • chest tightness
  • decreased frequency or amount of urine
  • fainting or loss of consciousness
  • fast or irregular breathing
  • increased blood pressure
  • increased thirst
  • itching, skin rash
  • loss of appetite
  • nausea
  • swelling of the eyes, eyelids, face, fingers, or lower legs
  • 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

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:

More common

  • Burning, tingling, numbness, or pain in the hands, arms, feet, or legs
  • confusion
  • cough
  • diarrhea
  • difficulty having a bowel movement
  • difficulty with moving
  • difficulty with swallowing
  • discouragement
  • dizziness
  • dry mouth
  • feeling sad or empty
  • hair loss
  • headache
  • heartburn
  • hoarseness
  • increase in heart rate
  • irritability
  • lightheadedness
  • loss of interest or pleasure
  • mood changes
  • muscle ache, cramp, or 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 or inflammation of the mouth
  • swollen joints
  • thinning of the hair
  • thirst
  • tiredness
  • trouble concentrating
  • trouble sleeping
  • weight loss
  • wrinkled skin

For Healthcare Professionals

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


Uncommon (0.1% to 1%): Myocardial infarction, angina pectoris, cerebrovascular accident, transient ischemic attack, peripheral ischemia (sometimes leading to extremity necrosis), supraventricular arrhythmia, ventricular tachycardia, syncope, arrhythmia[Ref]


Very common (10% or more): Rash/desquamation (up to 16%), alopecia (up to 11%)

Common (1% to 10%): Pruritus, urticaria

Rare (less than 0.1%): Radiation recall, bullous conditions (including Stevens-Johnson syndrome and toxic epidermal necrolysis) which in some cases were fatal[Ref]


Very common (10% or more): Nausea (up to 82%), vomiting (up to 57%), stomatitis/pharyngitis (up to 23%), anorexia (up to 20%), diarrhea (up to 17%), constipation (up to 12%)

Common (1% to 10%): Dyspepsia/heartburn

Uncommon (0.1% to 1%): Colitis (including intestinal and rectal bleeding, sometimes fatal, intestinal perforation, intestinal necrosis, neutropenic enterocolitis), esophagitis/radiation esophagitis, GI obstruction[Ref]


Very common (10% or more): Neutropenia (up to 56%), granulocytopenia (up to 56%), leukopenia (up to 53%), hemoglobinemia (up to 26%), platelets decreased (up to 23%), thrombocytopenia (up to 10%)

Common (1% to 10%):

Uncommon (0.1% to 1%): Pancytopenia

Rare (0.01% to 0.1%): Immune mediated hemolytic anemia[Ref]


Uncommon (0.1% to 1%): Allergic reaction/hypersensitivity

Rare (0.01% to 0.1%): Anaphylactic shock[Ref]


Common (1% to 10%): SGPT (ALT) elevation, SGOT (AST) elevation[Ref]


Common (1% to 10%): Sepsis (sometimes fatal), infection[Ref]


Common (1% to 10%): Dehydration

Uncommon (0.1% to 1%): Edema, increased gamma-glutamyl transpeptidase (GGT)[Ref]

Nervous system

Very common (10% or more): Sensory neuropathy (up to 10%)

Common (1% to 10%): Taste disturbance

Uncommon (0.1% to 1%): Motor neuropathy[Ref]


Very common (10% or more): Fatigue (up to 48%), pain

Common (1% to 10%): Fever, chest pain[Ref]


Uncommon (0.1% to 1%): Depression[Ref]


Common (1% to 10%): Conjunctivitis[Ref]


Common (1% to 10%): Renal disorders (including increased serum/blood creatinine, decreased glomerular filtration rate, renal failure, renal/genitourinary- other)

Uncommon (0.1% to 1%): Acute renal failure[Ref]


Uncommon (0.1% to 1%): Interstitial pneumonitis with respiratory insufficiency (sometimes fatal), radiation pneumonitis, pulmonary embolism[Ref]

Frequently asked questions


1. "Product Information. Alimta (pemetrexed)." Lilly, Eli and Company (2004):

2. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0

3. Pharmaceutical Society of Australia "APPGuide online. Australian prescription products guide online." (2006):

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Some side effects may not be reported. You may report them to the FDA.