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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

As well as its needed effects, pemetrexed may cause unwanted side effects that 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

Minor Side Effects

Some pemetrexed side effects may not need any medical attention. As your body gets used to the medicine these side effects may disappear. Your health care professional may be able to help you prevent or reduce these side effects, but do check with them if any of the following side effects continue, or if you are concerned 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

Cardiovascular

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]

Dermatologic

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]

Gastrointestinal

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]

Hematologic

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]

Hypersensitivity

Uncommon (0.1% to 1%): Allergic reaction/hypersensitivity
Rare (0.01% to 0.1%): Anaphylactic shock[Ref]

Hepatic

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

Immunologic

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

Metabolic

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]

Other

Very common (10% or more): Fatigue (up to 48%), pain
Common (1% to 10%): Fever, chest pain[Ref]

Psychiatric

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

Ocular

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

Renal

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]

Respiratory

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

References

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

2. Pharmaceutical Society of Australia "APPGuide online. Australian prescription products guide online. Available from: URL: http://www.appco.com.au/appguide/default.asp." ([2006]):

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

It is possible that some side effects of pemetrexed may not have been reported. These can be reported to the FDA here. Always consult a healthcare professional for medical advice.

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. Drugs.com 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.

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