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Pemetrexed Side Effects

In Summary

Commonly reported side effects of pemetrexed 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. See below for a comprehensive list of adverse effects.

For the Consumer

Applies to pemetrexed: intravenous powder for solution

Along with its needed effects, pemetrexed 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
  • 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

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 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


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]


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

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

3. Pharmaceutical Society of Australia "APPGuide online. Australian prescription products guide online. Available from: URL:" ([2006]):

Some side effects of pemetrexed may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.

Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. This information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill , knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate safety, effectiveness, or appropriateness for any given patient. does not assume any responsibility for any aspect of healthcare administered with the aid of materials provided. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the substances you are taking, check with your doctor, nurse, or pharmacist.