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Pemfexy Side Effects

Generic name: pemetrexed

Medically reviewed by Last updated on Jan 9, 2024.

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

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

Serious side effects of Pemfexy

Along with its needed effects, pemetrexed (the active ingredient contained in Pemfexy) 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

Less common

Incidence not known

Other side effects of Pemfexy

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

For Healthcare Professionals

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


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]


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.


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)


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


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


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


Common (1% to 10%): Allergic reaction/hypersensitivity

Postmarketing reports: Anaphylactic shock


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


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


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


Frequency not reported: Depression


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


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

Frequently asked questions


1. (2022) "Product Information. Alimta (PEMEtrexed)." Lilly, Eli and Company, SUPPL-55

2. (2019) "Product Information. Alimta (pemetrexed)." Eli Lilly Australia Pty Ltd, vA15_Nov2019

3. (2022) "Product Information. Alimta (pemetrexed)." Eli Lilly and Company Ltd

4. (2021) "Product Information. Pemetrexed (pemetrexed)." Genus Pharmaceuticals Ltd

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.