Pemetrexed: Drug information

For additional information see "Pemetrexed: Patient drug information"

For abbreviations, symbols, and age group definitions show table

Brand Names: US

Alimta;
Axtle;
Pemfexy;
Pemrydi RTU

Brand Names: Canada

Alimta;
TARO-PEMEtrexed

Pharmacologic Category

Antineoplastic Agent, Antimetabolite;
Antineoplastic Agent, Antimetabolite (Antifolate)

Dosing: Adult

Dosage guidance:

Safety: Start vitamin supplements 1 week before initial pemetrexed dose: Folic acid 400 to 1,000 mcg orally once daily (begin 7 days prior to treatment initiation; continue daily during treatment and for 21 days after last pemetrexed dose) and vitamin B₁₂ 1,000 mcg IM 7 days prior to treatment initiation and then every 3 cycles. Subsequent vitamin B₁₂ doses may be administered on the same day as pemetrexed treatments. In patients without preexisting anemia, some data suggest that pemetrexed and cyanocobalamin may be started simultaneously to avoid delaying pemetrexed initiation (Ref). Administer dexamethasone 4 mg orally twice daily for 3 days, beginning the day before treatment to minimize cutaneous reactions. New treatment cycles should not begin unless ANC ≥1,500/mm³, platelets ≥100,000/mm³, CrCl ≥45 mL/minute, and recovery of nonhematologic toxicity to ≤ grade 2.

Clinical considerations: Refer to the protocol or institutional guidance for additional details of off-label dosing.

Bladder cancer, metastatic, relapsed

Bladder cancer, metastatic, relapsed (off-label use): IV: 500 mg/m² on day 1 of each 21-day cycle until disease progression or unacceptable toxicity (Ref).

Cervical cancer, recurrent or persistent

Cervical cancer, recurrent or persistent (off-label use): IV: 500 mg/m² on day 1 of each 21-day cycle until disease progression or unacceptable toxicity occurs (Ref) or 900 mg/m² on day 1 of each 21-day cycle (Ref).

Mesothelioma, pleural

Mesothelioma, pleural: Note: American Society of Clinical Oncology guidelines for pleural mesothelioma recommend a duration of 4 to 6 cycles for pemetrexed-based chemotherapy; for patients with stable or responding disease, a break from chemotherapy is recommended at that point (Ref).

IV: 500 mg/m² on day 1 of a 21-day treatment cycle (in combination with cisplatin); continue until disease progression or unacceptable toxicity (Ref).

Off-label dosing/combinations: IV:

Single-agent therapy: IV: 500 mg/m² on day 1 of a 21-day treatment cycle (as a single agent); continue until disease progression or unacceptable toxicity (Ref).

In combination with carboplatin: IV: 500 mg/m² on day 1 of a 21-day treatment cycle (in combination with carboplatin); the median number of cycles administered was 6 (Ref) or 500 mg/m² on day 1 of a 21-day treatment cycle (in combination with carboplatin); continue until disease progression, unacceptable toxicity, or for a maximum of 9 cycles (Ref).

In combination with cisplatin and bevacizumab: IV: 500 mg/m² on day 1 of a 21-day treatment cycle (in combination with cisplatin and bevacizumab) for up to 6 cycles, followed by bevacizumab (as a single agent) maintenance therapy until disease progression or unacceptable toxicity (Ref).

In combination with pembrolizumab and a platinum: IV: 500 mg/m² on day 1 of a 21-day treatment cycle (in combination with pembrolizumab and either cisplatin or carboplatin) for up to 6 cycles; continue pembrolizumab (as a single agent) until disease progression, unacceptable toxicity, or (in patients without disease progression) for up to 24 months (Ref).

Non–small cell lung cancer, nonsquamous

Non–small cell lung cancer, nonsquamous:

Neoadjuvant/adjuvant regimens for resectable non–small cell lung cancer (NSCLC) (off-label dosing ):

In combination with nivolumab and a platinum: IV: 500 mg/m² once every 3 weeks (in combination with nivolumab and cisplatin) for up to 3 cycles. Patients underwent surgery within 6 weeks of completion of neoadjuvant therapy and then adjuvant therapy of 500 mg/m² once every 3 weeks (in combination with cisplatin ± radiation therapy) for up to 4 cycles (Ref) or 500 mg/m² on day 1 every 3 weeks (in combination with nivolumab and either carboplatin or cisplatin; neoadjuvant therapy) until disease progression, unacceptable toxicity, or for 4 cycles (whichever comes first), followed by surgery, and then nivolumab (as a single agent) for up to 1 year or until disease progression or unacceptable toxicity (Ref).

In combination with pembrolizumab and cisplatin: IV: 500 mg/m² once every 3 weeks (in combination with pembrolizumab and cisplatin) for 4 cycles. Patients underwent definitive surgery within 20 weeks after the first cycle of the neoadjuvant phase and then adjuvant therapy with up to 39 weeks of single-agent pembrolizumab was administered beginning no sooner than 4 weeks and no later than 12 weeks following definitive surgery (Ref).

In combination with durvalumab and either cisplatin or carboplatin: IV: 500 mg/m² once every 3 weeks (in combination with durvalumab and either cisplatin or carboplatin) for 4 cycles, followed by surgery (within 40 days of completion of neoadjuvant therapy), followed by adjuvant durvalumab (as a single agent) every 4 weeks for a maximum of 12 cycles after surgery, unless disease progression that precludes definitive surgery, recurrence, or unacceptable toxicity occurs at any point during the treatment course (Ref).

Initial treatment of locally advanced or metastatic NSCLC:

In combination with cisplatin: IV: 500 mg/m² on day 1 of each 21-day cycle (in combination with cisplatin) for up to 6 cycles or until disease progression or unacceptable toxicity (Ref).

In combination with pembrolizumab and a platinum: IV: 500 mg/m² on day 1 of each 21-day cycle (in combination with pembrolizumab and either carboplatin or cisplatin) for 4 cycles; following platinum-based therapy, may continue pemetrexed (500 mg/m² on day 1 of a 21-day cycle), alone or with pembrolizumab, as maintenance therapy until disease progression or unacceptable toxicity (Ref).

In combination with cemiplimab and a platinum (off-label combination): IV: 500 mg/m² on day 1 of each 21-day cycle (in combination with cemiplimab and either carboplatin or cisplatin) for 4 cycles, followed by pemetrexed maintenance therapy (500 mg/m² on day 1 of a 21-day cycle) and cemiplimab until disease progression or unacceptable toxicity, or for up to 108 weeks (Ref).

In combination with durvalumab, tremelimumab, and a platinum (off-label combination): IV: 500 mg/m² on day 1 of each 21-day cycle (in combination with either carboplatin or cisplatin, durvalumab, and tremelimumab) for 4 cycles, followed by optional pemetrexed maintenance therapy (500 mg/m² on day 1 of a 28-day cycle), in combination with durvalumab, if eligible; continue until disease progression or unacceptable toxicity (Ref).

In combination with nivolumab, ipilimumab, and a platinum (off-label combination): IV: 500 mg/m² on day 1 every 3 weeks (in combination with ipilimumab, nivolumab, and either carboplatin or cisplatin) for 2 cycles, followed by ipilimumab and nivolumab maintenance therapy until disease progression or unacceptable toxicity for a maximum of 2 years (Ref).

In combination with osimertinib and a platinum (off-label combination): IV: 500 mg/m² on day 1 every 3 weeks (in combination with osimertinib and either carboplatin or cisplatin) for 4 cycles, followed by osimertinib and pemetrexed (500 mg/m² every 3 weeks) until disease progression or unacceptable toxicity (Ref).

In combination with carboplatin (off-label combination): IV: 500 mg/m² on day 1 of each 21-day cycle (in combination with carboplatin) for up to 4 cycles (Ref).

In combination with amivantamab and carboplatin (off-label combination): IV: 500 mg/m² on day 1 every 3 weeks (in combination with amivantamab and carboplatin) for 4 cycles, followed by amivantamab and pemetrexed (500 mg/m² every 3 weeks) until disease progression or unacceptable toxicity (Ref).

In combination with bevacizumab and a platinum (off-label combinations): Note: The combination of pemetrexed plus bevacizumab maintenance therapy has no survival advantage and has significantly increased toxicity compared to either pemetrexed or bevacizumab alone (Ref).

IV: 500 mg/m² on day 1 of each 21-day cycle (in combination with bevacizumab and carboplatin) for up to 4 cycles, followed by pemetrexed (500 mg/m² on day 1 of a 21-day cycle) and bevacizumab maintenance therapy until disease progression or unacceptable toxicity (Ref) or 500 mg/m² on day 1 of each 21-day cycle (in combination with bevacizumab and cisplatin) for 4 cycles, followed (if achieved a response or stable disease) by pemetrexed (500 mg/m² on day 1 of a 21-day cycle) and bevacizumab maintenance therapy until disease progression or unacceptable toxicity (Ref).

Maintenance treatment of locally advanced or metastatic NSCLC (after 4 cycles of initial platinum-based therapy): IV: 500 mg/m² on day 1 of each 21-day cycle (as a single-agent); continue until disease progression or unacceptable toxicity (Ref).

Second-line treatment of recurrent/metastatic disease:

After prior chemotherapy (as a single agent): IV: 500 mg/m² on day 1 of a 21-day treatment cycle (as a single agent); continue until disease progression or unacceptable toxicity (Ref).

After progression on osimertinib (in combination with amivantamab and carboplatin ; off-label combination): IV: 500 mg/m² on day 1 of a 21-day treatment cycle (in combination with amivantamab and carboplatin) for 4 cycles, followed by amivantamab and pemetrexed (500 mg/m² on day 1 of a 21-day treatment cycle) until disease progression or unacceptable toxicity (Ref).

Ovarian cancer, platinum resistant

Ovarian cancer, platinum resistant (off-label use): IV: 500 mg/m² on day 1 of each 21-day cycle (Ref).

Primary CNS lymphoma, relapsed or refractory

Primary CNS lymphoma, relapsed or refractory (off-label use): IV: 900 mg/m² on day 1 every 21 days until disease progression or unacceptable toxicity (Ref).

Thymoma or thymic carcinoma, advanced or metastatic, relapsed or refractory

Thymoma or thymic carcinoma, advanced or metastatic, relapsed or refractory (later-line therapy) (off-label use): IV: 500 mg/m² on day 1 every 3 weeks; continue until disease progression, unacceptable toxicity, or a maximum of 6 cycles (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Kenar D. Jhaveri, MD; Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.

Kidney impairment prior to treatment initiation:

Altered kidney function: IV:

Note: Kidney function may be estimated using the Cockcroft-Gault formula. Measures to mitigate nephrotoxicity (eg, avoiding dehydration, nonsteroidal anti-inflammatory drugs, other potentially nephrotoxic agents during pemetrexed maintenance therapy) should be considered. Ibuprofen administration decreases pemetrexed elimination, specifically in CrCl <80 mL/minute; consult drug interactions database for more information.

CrCl ≥45 mL/minute: IV: No dosage adjustment necessary (Ref). Note: Patients with CrCl 45 to 60 mL/minute may be at increased risk of hematological, GI, and kidney-related toxicities; use with caution (Ref).

CrCl <45 mL/minute: IV: Use not recommended (Ref). Pharmacokinetic modeling suggests substantially lower doses would be necessary to avoid severe neutropenia (Ref). Additionally, an increased risk of hematologic toxicity in patients with CrCl <45 mL/minute has been reported (Ref).

Augmented renal clearance (measured urinary CrCl ≥130 mL/minute/1.73 m²):

Note: Augmented renal clearance (ARC) is a condition that occurs in certain critically ill patients without organ dysfunction and with normal serum creatinine concentrations. Young patients (<55 years of age) admitted post trauma or major surgery are at highest risk for ARC, as well as those with sepsis, burns, or hematologic malignancies. An 8- to 24-hour measured urinary CrCl is necessary to identify these patients (Ref).

IV: Although the correlation of renal function with AUC suggests an increased dose of pemetrexed may be needed in patients with documented ARC, there are no clinical data to support the efficacy or safety of this approach (Ref).

Hemodialysis, intermittent (thrice weekly): IV: Somewhat dialyzable (Ref): Avoid use (Ref).

Peritoneal dialysis: IV: Dialyzability unknown: Avoid use (Ref).

CRRT: IV: Avoid use (Ref). In a single case report, a patient receiving pemetrexed (in combination with cisplatin) had persistent pemetrexed concentrations in ascites and plasma despite receiving continuous veno-venous hemodialysis (Ref).

PIRRT (eg, sustained, low-efficiency diafiltration): IV: Avoid use (Ref).

Nephrotoxicity during therapy: Acute kidney injury attributed to single-agent pemetrexed or pemetrexed in combination with other chemotherapy agents has been reported. Causality of acute kidney injury with pemetrexed reported in retrospective analysis and case reports is often confounded by concurrent or recent cisplatin or carboplatin administration (Ref). Consider interrupting pemetrexed therapy if acutely deteriorating kidney function attributable to pemetrexed is suspected (Ref). Additionally, withhold pemetrexed if CrCl falls below 45 mL/minute and do not reinitiate until CrCl is ≥45 mL/minute (Ref).

Dosing: Liver Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling; however, elevated AST, AST, or total bilirubin do not appear to affect pemetrexed pharmacokinetics.

Dosing: Obesity: Adult

American Society of Clinical Oncology guidelines for appropriate systemic therapy dosing in adults with cancer with a BMI ≥30 kg/m²: Utilize patient's actual body weight for calculation of BSA- or weight-based dosing; manage regimen-related toxicities in the same manner as for patients with a BMI <30 kg/m²; if a dose reduction is utilized due to toxicity, may consider resumption of full, weight-based dosing (or previously tolerated dose level) with subsequent cycles only if dose escalations are allowed in the prescribing information, if contributing underlying factors (eg, hepatic or kidney impairment) are sufficiently resolved, AND if performance status has markedly improved or is considered adequate (Ref).

Dosing: Adjustment for Toxicity: Adult

Note: Dosage modification of other concomitant anticancer agents may also be recommended.

**Recommend** **ed Pemetrexed Dosage Modifications for Adverse Reactions**
Adverse reaction	Pemetrexed dosage modification for next cycle
^aIf ANC <500/mm³ or platelets <50,000/mm³ in previous cycles, permanently reduce pemetrexed dose.
Hematologic toxicity
ANC <500/mm³ and platelets ≥50,000/mm³	Delay the next cycle until ANC ≥1,500/mm³ and platelets ≥100,000/mm³; upon recovery, reduce pemetrexed dose to 75% of previous dose^a.
Platelets <50,000/mm³ without bleeding	Delay the next cycle until platelets ≥100,000/mm³; upon recovery, reduce pemetrexed dose to 75% of previous dose^a.
Platelets <50,000/mm³ with bleeding	Delay the next cycle until platelets ≥100,000/mm³; upon recovery, reduce pemetrexed dose to 50% of previous dose^a.
Recurrent grade 3 or 4 myelosuppression after 2 dose reductions	Discontinue pemetrexed.
Nonhematologic toxicity
Dermatologic toxicity: Severe or life-threatening bullous, blistering, or exfoliating skin toxicity	Permanently discontinue pemetrexed.
GI toxicity: Diarrhea, grade 3 or 4 or any diarrhea requiring hospitalization	Delay the next cycle until recovery to ≤ grade 2; upon recovery, reduce pemetrexed dose to 75% of previous dose.
GI toxicity: Mucositis, grade 3 or 4	Delay the next cycle until recovery to ≤ grade 2; upon recovery, reduce pemetrexed dose to 50% of previous dose.
Neurotoxicity, grade 3 or 4	Permanently discontinue pemetrexed.
Pulmonary toxicity: Interstitial pneumonitis	Withhold pemetrexed for acute onset of new or progressive unexplained pulmonary symptoms (eg, dyspnea, cough, fever) and evaluate; if interstitial pneumonitis is confirmed, permanently discontinue pemetrexed.
Radiation recall (signs/symptoms)	Permanently discontinue pemetrexed.
Other toxicity, grade 3 or 4 toxicity	Delay the next cycle until recovery to ≤ grade 2; upon recovery, reduce pemetrexed dose to 75% of previous dose.
Recurrent grade 3 or 4 nonhematologic toxicity after 2 dose reductions	Permanently discontinue pemetrexed.

Dosing: Older Adult

Refer to adult dosing.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Reported adverse reactions are for monotherapy in adults.

>10%:

Dermatologic: Desquamation (≤14%), skin rash (≤14%)

Gastrointestinal: Anorexia (19% to 22%), diarrhea (5% to 13%; grades 3/4: 1%), nausea (12% to 31%; grades 3/4: ≤3%), stomatitis (≤15%; grades 3/4: ≤1%), vomiting (6% to 16%; grades 3/4: 2%)

Hematologic & oncologic: Anemia (15% to 19%; grades 3/4: 3% to 5%), neutropenia (6% to 11%; grades 3/4: 3% to 5%)

Nervous system: Fatigue (18% to 34%)

Respiratory: Pharyngitis (≤15%)

1% to 10%:

Cardiovascular: Edema (5%)

Dermatologic: Alopecia (6%), erythema multiforme (<5%), pruritus (7%)

Gastrointestinal: Abdominal pain (1% to 5%), constipation (6%)

Hematologic & oncologic: Febrile neutropenia (<5%), thrombocytopenia (8%; grades 3/4: 2%)

Hepatic: Increased serum alanine aminotransferase (8% to 10%), increased serum aspartate aminotransferase (7% to 8%)

Hypersensitivity: Hypersensitivity reaction (<5%)

Infection: Infection ( 5%)

Nervous system: Neuropathy (sensory: 9%; motor: <5%)

Ophthalmic: Conjunctivitis (≤5%), increased lacrimation (1% to <5%)

Miscellaneous: Fever (8%)

<1%:

Cardiovascular: Pulmonary embolism (grades 3/4), supraventricular cardiac arrhythmia, syncope (grades 3/4), ventricular tachycardia (grades 3/4)

Gastrointestinal: Gastrointestinal obstruction (grades 3/4)

Nervous system: Depression (grades 3/4), pain (grades 3/4)

Renal: Renal failure syndrome

Postmarketing (may be reported as part of combination chemotherapy regimen):

Dermatologic: Bullous rash, Stevens-Johnson syndrome, toxic epidermal necrolysis

Gastrointestinal: Colitis, pancreatitis

Hematologic & oncologic: Hemolytic anemia

Respiratory: Interstitial pneumonitis

Miscellaneous: Radiation recall phenomenon

Contraindications

Severe hypersensitivity to pemetrexed or any component of the formulation.

Canadian labeling: Additional contraindications (not in the US labeling): Concomitant yellow fever vaccine.

Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Warnings/Precautions

Concerns related to adverse effects:

• Bone marrow suppression: Pemetrexed may cause severe myelosuppression, including anemia, neutropenia, thrombocytopenia, and/or pancytopenia; myelosuppression is often dose-limiting. Severe myelosuppression may require blood transfusion or may lead to neutropenic infection. Prophylactic folic acid and vitamin B₁₂ supplements are necessary to reduce hematologic toxicity, febrile neutropenia, and infection; the risk for myelosuppression is higher in patients who did not receive vitamin supplementation.

• Cutaneous reactions: Serious and occasionally fatal, bullous, blistering, and exfoliative dermatologic toxicity may occur; pretreatment with dexamethasone is necessary to reduce the incidence and severity of cutaneous reactions. Rarely, Stevens-Johnson syndrome and toxic epidermal necrolysis have been reported.

• GI toxicity: GI toxicity may occur; prophylactic folic acid and vitamin B₁₂ supplements are necessary to reduce GI toxicity.

• Hypersensitivity: Hypersensitivity (including allergic reaction) has been reported with pemetrexed.

• Nephrotoxicity: Pemetrexed may cause severe (and potentially fatal) kidney toxicity (kidney toxicity may occur with single-agent pemetrexed or when used in combination with other chemotherapy agents).

• Pulmonary toxicity: Interstitial pneumonitis has been observed; may be serious and/or fatal. Signs/symptoms indicative of interstitial pneumonitis may include acute onset new or progressive pulmonary symptoms such as dyspnea, cough, or fever.

• Radiation recall: Radiation recall may occur in patients administered pemetrexed who received radiation previously (weeks to years).

Disease-related concerns:

• Renal impairment: Pemetrexed is primarily cleared by the kidneys; decreased renal function results in increased toxicity. Concurrent nephrotoxic medications may result in delayed pemetrexed clearance.

• Third space fluid: Although the effect of third space fluid on pemetrexed pharmacokinetics has not been fully defined, studies have determined pemetrexed concentrations in patients with mild to moderate ascites/pleural effusions were similar to concentrations in trials of patients without third space fluid accumulation.

Concurrent drug therapy issues:

• Ibuprofen: Ibuprofen may reduce the clearance of pemetrexed. In patients with CrCl 45 to 79 mL/minute, interrupt ibuprofen therapy 2 days prior to, during, and 2 days after pemetrexed therapy. If concomitant use cannot be avoided, monitor for myelosuppression, renal, and gastrointestinal toxicity.

Dosage form specific issues:

• Propylene glycol: Some dosage forms may contain propylene glycol; large amounts are potentially toxic and have been associated with hyperosmolality, lactic acidosis, seizures, and respiratory depression; use caution (AAP 1997; Zar 2007).

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Solution, Intravenous:

Pemfexy: 500 mg/20 mL (20 mL) [contains propylene glycol]

Solution, Intravenous [preservative free]:

Generic: 100 mg/4 mL (4 mL); 500 mg/20 mL (20 mL); 1 g/40 mL (40 mL)

Solution, Intravenous, as disodium:

Generic: 100 mg/4 mL (4 mL); 500 mg/20 mL (20 mL)

Solution, Intravenous, as disodium [preservative free]:

Pemrydi RTU: 100 mg/10 mL (10 mL); 500 mg/50 mL (50 mL)

Generic: 100 mg/4 mL (4 mL); 500 mg/20 mL (20 mL); 850 mg/34 mL (34 mL [DSC]); 1 g/40 mL (40 mL)

Solution Reconstituted, Intravenous:

Alimta: 500 mg (1 ea)

Generic: 100 mg (1 ea); 500 mg (1 ea [DSC]); 1000 mg (1 ea)

Solution Reconstituted, Intravenous [preservative free]:

Alimta: 100 mg (1 ea)

Generic: 100 mg (1 ea); 500 mg (1 ea); 750 mg (1 ea); 1000 mg (1 ea)

Solution Reconstituted, Intravenous, as dipotassium [strength expressed as base]:

Axtle: 100 mg (1 ea); 500 mg (1 ea)

Generic: 100 mg (1 ea); 500 mg (1 ea)

Generic Equivalent Available: US

Yes

Pricing: US

Solution (PEMEtrexed Disodium Intravenous)

1 g/40mL (per mL): $27.00

100 mg/4 mL (per mL): $33.00 - $210.58

500 mg/20 mL (per mL): $29.87 - $210.57

Solution (PEMEtrexed Intravenous)

1 g/40mL (per mL): $56.48

100 mg/4 mL (per mL): $59.46

500 mg/20 mL (per mL): $59.46

Solution (Pemfexy Intravenous)

500 mg/20 mL (per mL): $267.15

Solution (Pemrydi RTU Intravenous)

100 mg/10 mL (per mL): $95.88

500 mg/50 mL (per mL): $95.88

Solution (reconstituted) (Alimta Intravenous)

100 mg (per each): $970.32

500 mg (per each): $4,851.60

Solution (reconstituted) (Axtle Intravenous)

100 mg (per each): $948.00

500 mg (per each): $4,740.00

Solution (reconstituted) (PEMEtrexed Dipotassium Intravenous)

100 mg (per each): $948.00

500 mg (per each): $4,740.00

Solution (reconstituted) (PEMEtrexed Disodium Intravenous)

100 mg (per each): $13.96 - $856.16

500 mg (per each): $60.18 - $1,189.12

750 mg (per each): $866.26 - $6,421.18

1000 mg (per each): $222.84 - $8,561.57

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Solution Reconstituted, Intravenous:

Alimta: 100 mg (1 ea); 500 mg ([DSC])

Generic: 100 mg (1 ea); 500 mg (1 ea); 1000 mg (1 ea)

Administration: Adult

IV: Infuse over 10 minutes.

Administration sequence (for combination therapy):

In combination with platinum-based therapy (cisplatin or carboplatin): Administer pemetrexed first, followed by the platinum on the day of dosing (Ref).

In combination with cemiplimab and a platinum (cisplatin or carboplatin): Administer pemetrexed first, followed by the platinum, followed by cemiplimab on the day of dosing (Ref).

In combination with pembrolizumab and a platinum (cisplatin or carboplatin): Administer pembrolizumab first, followed by pemetrexed, followed by the platinum on the day of dosing (Ref).

In combination with durvalumab and a platinum (cisplatin or carboplatin): Administer durvalumab first, followed by pemetrexed/platinum chemotherapy (Ref).

In combination with durvalumab, tremelimumab, and a platinum (cisplatin or carboplatin): Administer tremelimumab first, followed by durvalumab, followed by pemetrexed, followed by the platinum on the day of dosing (Ref).

In combination with nivolumab, ipilimumab, and a platinum (cisplatin or carboplatin): Administer nivolumab first, followed by ipilimumab, followed by the platinum-based doublet chemotherapy on the day of dosing (Ref).

In combination with amivantamab and carboplatin: Administer pemetrexed first, followed by carboplatin, followed by amivantamab on the day of dosing (Ref).

In combination with nivolumab and cisplatin: Administer nivolumab first, followed by platinum-based doublet chemotherapy on the day of dosing (Ref).

Hazardous Drugs Handling Considerations

Hazardous agent (NIOSH 2024 [table 1]).

Use appropriate precautions for receiving, handling, storage, preparation, dispensing, transporting, administration, and disposal. Follow NIOSH and USP 800 recommendations and institution-specific policies/procedures for appropriate containment strategy (NIOSH 2023; NIOSH 2024; USP-NF 2020).

Use: Labeled Indications

Mesothelioma, pleural: Initial treatment of malignant pleural mesothelioma (in combination with cisplatin) that is unresectable or in patients who are not otherwise candidates for curative surgery.

Non-small cell lung cancer, nonsquamous:

Initial treatment of locally advanced or metastatic nonsquamous non-small cell lung cancer (NSCLC) (in combination with cisplatin).

Initial treatment of metastatic, nonsquamous NSCLC (in combination with platinum chemotherapy and pembrolizumab) in patients with no epidermal growth factor receptor (EGFR) or anaplastic lymphoma kinase (ALK) genomic tumor aberrations.

Maintenance treatment (single-agent) of locally advanced or metastatic nonsquamous NSCLC if no progression after 4 cycles of platinum-based first-line therapy.

Single-agent treatment (after prior chemotherapy) of recurrent/metastatic nonsquamous NSCLC.

Limitation of use: Pemetrexed is not indicated for the treatment of squamous cell NSCLC.

Use: Off-Label: Adult

Bladder cancer, metastatic, relapsed; Cervical cancer, persistent or recurrent; Ovarian cancer, platinum-resistant; Primary CNS lymphoma, relapsed or refractory; Thymoma or thymic carcinoma, advanced or metastatic, relapsed or refractory

Medication Safety Issues

Sound-alike/look-alike issues:

PEMEtrexed may be confused with methotrexate, pembrolizumab, pemigatinib, PRALAtrexate

High alert medication:

The Institute for Safe Medication Practices (ISMP) includes this medication among its list of drug classes (chemotherapeutic agent, parenteral and oral) which have a heightened risk of causing significant patient harm when used in error (High-Alert Medications in Acute Care, Community/Ambulatory Care, and Long-Term Care Settings).

Metabolism/Transport Effects

Substrate of OAT1/3;

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.

5-Aminosalicylic Acid Derivatives: May increase myelosuppressive effects of Myelosuppressive Agents. Risk C: Monitor

Abrocitinib: May increase immunosuppressive effects of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid

Antithymocyte Globulin (Equine): Immunosuppressants (Cytotoxic Chemotherapy) may increase adverse/toxic effects of Antithymocyte Globulin (Equine). Specifically, these effects may be unmasked if the dose of cytotoxic chemotherapy is reduced. Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Antithymocyte Globulin (Equine). Specifically, infections may occur with greater severity and/or atypical presentations. Risk C: Monitor

Antithyroid Agents: Myelosuppressive Agents may increase neutropenic effects of Antithyroid Agents. Risk C: Monitor

Baricitinib: Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Baricitinib. Risk X: Avoid

BCG Products: Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of BCG Products. Immunosuppressants (Cytotoxic Chemotherapy) may increase adverse/toxic effects of BCG Products. Specifically, the risk of vaccine-associated infection may be increased. Risk X: Avoid

Brincidofovir: Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Brincidofovir. Risk C: Monitor

Brivudine: May increase adverse/toxic effects of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid

Chikungunya Vaccine (Live): Immunosuppressants (Cytotoxic Chemotherapy) may increase adverse/toxic effects of Chikungunya Vaccine (Live). Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Chikungunya Vaccine (Live). Risk X: Avoid

Chloramphenicol (Ophthalmic): May increase adverse/toxic effects of Myelosuppressive Agents. Risk C: Monitor

Chloramphenicol (Systemic): Myelosuppressive Agents may increase myelosuppressive effects of Chloramphenicol (Systemic). Risk X: Avoid

Cladribine: Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Cladribine. Risk X: Avoid

CloZAPine: Myelosuppressive Agents may increase adverse/toxic effects of CloZAPine. Specifically, the risk for neutropenia may be increased. Risk C: Monitor

Coccidioides immitis Skin Test: Coadministration of Immunosuppressants (Cytotoxic Chemotherapy) and Coccidioides immitis Skin Test may alter diagnostic results. Management: Consider discontinuing cytotoxic chemotherapy several weeks prior to coccidioides immitis skin antigen testing to increase the likelihood of accurate diagnostic results. Risk D: Consider Therapy Modification

COVID-19 Vaccine (Inactivated Virus): Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of COVID-19 Vaccine (Inactivated Virus). Risk C: Monitor

COVID-19 Vaccine (mRNA): Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of COVID-19 Vaccine (mRNA). Management: Give a 3-dose primary series for all patients aged 6 months and older taking immunosuppressive medications or therapies. Booster doses are recommended for certain age groups. See CDC guidance for details. Risk D: Consider Therapy Modification

COVID-19 Vaccine (Subunit): Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of COVID-19 Vaccine (Subunit). Risk C: Monitor

Deferiprone: Myelosuppressive Agents may increase neutropenic effects of Deferiprone. Management: Avoid the concomitant use of deferiprone and myelosuppressive agents whenever possible. If this combination cannot be avoided, monitor the absolute neutrophil count more closely. Risk D: Consider Therapy Modification

Dengue Tetravalent Vaccine (Live): Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Dengue Tetravalent Vaccine (Live). Immunosuppressants (Cytotoxic Chemotherapy) may increase adverse/toxic effects of Dengue Tetravalent Vaccine (Live). Specifically, the risk of vaccine-associated infection may be increased. Risk X: Avoid

Denosumab: May increase immunosuppressive effects of Immunosuppressants (Cytotoxic Chemotherapy). Management: Consider the risk of serious infections versus the potential benefits of coadministration of denosumab and cytotoxic chemotherapy. If combined, monitor patients for signs/symptoms of serious infections. Risk D: Consider Therapy Modification

Deucravacitinib: May increase immunosuppressive effects of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid

Etrasimod: May increase immunosuppressive effects of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid

Fexinidazole: Myelosuppressive Agents may increase myelosuppressive effects of Fexinidazole. Risk X: Avoid

Filgotinib: May increase immunosuppressive effects of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid

Ibuprofen: May increase serum concentration of PEMEtrexed. Management: In patients with an estimated creatinine clearance of 45 to 79 mL/min, avoid ibuprofen for 2 days before, the day of, and 2 days following the administration of pemetrexed. Monitor for increased pemetrexed toxicities if combined. Risk D: Consider Therapy Modification

Inebilizumab: Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Inebilizumab. Risk C: Monitor

Influenza Virus Vaccines: Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Influenza Virus Vaccines. Management: Administer influenza vaccines at least 2 weeks prior to initiating chemotherapy if possible. If vaccination occurs less than 2 weeks prior to or during chemotherapy, revaccinate at least 3 months after therapy discontinued if immune competence restored. Risk D: Consider Therapy Modification

Inhibitors of the Proton Pump (PPIs and PCABs): May increase adverse/toxic effects of PEMEtrexed. Specifically, the risk of hematological toxicities may be increased. Risk C: Monitor

Leflunomide: Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Leflunomide. Management: Increase the frequency of chronic monitoring of platelet, white blood cell count, and hemoglobin or hematocrit to monthly, instead of every 6 to 8 weeks, if leflunomide is coadministered with immunosuppressive agents, such as cytotoxic chemotherapy. Risk D: Consider Therapy Modification

Lenograstim: Antineoplastic Agents may decrease therapeutic effects of Lenograstim. Management: Avoid the use of lenograstim 24 hours before until 24 hours after the completion of myelosuppressive cytotoxic chemotherapy. Risk D: Consider Therapy Modification

Linezolid: May increase myelosuppressive effects of Myelosuppressive Agents. Risk C: Monitor

Lipegfilgrastim: Antineoplastic Agents may decrease therapeutic effects of Lipegfilgrastim. Management: Avoid concomitant use of lipegfilgrastim and myelosuppressive cytotoxic chemotherapy. Lipegfilgrastim should be administered at least 24 hours after the completion of myelosuppressive cytotoxic chemotherapy. Risk D: Consider Therapy Modification

Methotrexate: PEMEtrexed may increase serum concentration of Methotrexate. Management: Avoid coadministration of pemetrexed and methotrexate if possible. If coadministration is required, monitor closely for methotrexate toxicities (eg, hematological, gastrointestinal, nephrotoxicity toxicities). Risk D: Consider Therapy Modification

Mumps- Rubella- or Varicella-Containing Live Vaccines: Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Mumps- Rubella- or Varicella-Containing Live Vaccines. Immunosuppressants (Cytotoxic Chemotherapy) may increase adverse/toxic effects of Mumps- Rubella- or Varicella-Containing Live Vaccines. Specifically, the risk of vaccine-associated infection may be increased. Risk X: Avoid

Nadofaragene Firadenovec: Immunosuppressants (Cytotoxic Chemotherapy) may increase adverse/toxic effects of Nadofaragene Firadenovec. Specifically, the risk of disseminated adenovirus infection may be increased. Risk X: Avoid

Natalizumab: Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Natalizumab. Risk X: Avoid

Nitisinone: May increase serum concentration of OAT1/3 Substrates (Clinically Relevant). Risk C: Monitor

Ocrelizumab: Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Ocrelizumab. Risk C: Monitor

Ofatumumab: Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Ofatumumab. Risk C: Monitor

Olaparib: Myelosuppressive Agents may increase myelosuppressive effects of Olaparib. Risk C: Monitor

Palifermin: May increase adverse/toxic effects of Antineoplastic Agents. Specifically, the duration and severity of oral mucositis may be increased. Management: Do not administer palifermin within 24 hours before, during infusion of, or within 24 hours after administration of myelotoxic chemotherapy. Risk D: Consider Therapy Modification

Pidotimod: Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Pidotimod. Risk C: Monitor

Pimecrolimus: May increase immunosuppressive effects of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid

Piperacillin: May increase hypokalemic effects of Antineoplastic Agents. Risk C: Monitor

Pneumococcal Vaccines: Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Pneumococcal Vaccines. Risk C: Monitor

Poliovirus Vaccine (Live/Trivalent/Oral): Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Poliovirus Vaccine (Live/Trivalent/Oral). Immunosuppressants (Cytotoxic Chemotherapy) may increase adverse/toxic effects of Poliovirus Vaccine (Live/Trivalent/Oral). Specifically, the risk of vaccine-associated infection may be increased. Risk X: Avoid

Polymethylmethacrylate: Immunosuppressants (Cytotoxic Chemotherapy) may increase hypersensitivity effects of Polymethylmethacrylate. Management: Use caution when considering use of bovine collagen-containing implants such as the polymethylmethacrylate-based Bellafill brand implant in patients who are receiving immunosuppressants. Consider use of additional skin tests prior to administration. Risk D: Consider Therapy Modification

Pretomanid: May increase serum concentration of OAT1/3 Substrates (Clinically Relevant). Risk C: Monitor

Promazine: May increase myelosuppressive effects of Myelosuppressive Agents. Risk C: Monitor

Pyrimethamine: May increase adverse/toxic effects of PEMEtrexed. Risk C: Monitor

Rabies Vaccine: Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Rabies Vaccine. Management: Complete rabies vaccination at least 2 weeks before initiation of immunosuppressant therapy if possible. If combined, check for rabies antibody titers, and if vaccination is for post exposure prophylaxis, administer a 5th dose of the vaccine. Risk D: Consider Therapy Modification

Ritlecitinib: Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Ritlecitinib. Risk X: Avoid

Ropeginterferon Alfa-2b: Myelosuppressive Agents may increase myelosuppressive effects of Ropeginterferon Alfa-2b. Management: Avoid coadministration of ropeginterferon alfa-2b and other myelosuppressive agents. If this combination cannot be avoided, monitor patients for excessive myelosuppressive effects. Risk D: Consider Therapy Modification

Ruxolitinib (Topical): Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Ruxolitinib (Topical). Risk X: Avoid

Sipuleucel-T: Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Sipuleucel-T. Management: Consider reducing the dose or discontinuing the use of immunosuppressants, such as cytotoxic chemotherapy, prior to initiating sipuleucel-T therapy. Risk D: Consider Therapy Modification

Sphingosine 1-Phosphate (S1P) Receptor Modulators: May increase immunosuppressive effects of Immunosuppressants (Cytotoxic Chemotherapy). Risk C: Monitor

Tacrolimus (Topical): Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Tacrolimus (Topical). Risk X: Avoid

Talimogene Laherparepvec: Immunosuppressants (Cytotoxic Chemotherapy) may increase adverse/toxic effects of Talimogene Laherparepvec. Specifically, the risk of infection from the live, attenuated herpes simplex virus contained in talimogene laherparepvec may be increased. Risk X: Avoid

Taurursodiol: May increase serum concentration of OAT1/3 Substrates (Clinically Relevant). Risk X: Avoid

Teriflunomide: May increase serum concentration of OAT1/3 Substrates (Clinically Relevant). Risk C: Monitor

Tertomotide: Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Tertomotide. Risk X: Avoid

Tofacitinib: Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Tofacitinib. Risk X: Avoid

Typhoid Vaccine: Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Typhoid Vaccine. Immunosuppressants (Cytotoxic Chemotherapy) may increase adverse/toxic effects of Typhoid Vaccine. Specifically, the risk of vaccine-associated infection may be increased. Risk X: Avoid

Ublituximab: Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Ublituximab. Risk C: Monitor

Upadacitinib: Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Upadacitinib. Risk X: Avoid

Vaborbactam: May increase serum concentration of OAT1/3 Substrates (Clinically Relevant). Risk C: Monitor

Vaccines (Live): Immunosuppressants (Cytotoxic Chemotherapy) may increase adverse/toxic effects of Vaccines (Live). Specifically, the risk of vaccine-associated infection may be increased. Vaccines (Live) may decrease therapeutic effects of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid

Vaccines (Non-Live/Inactivated/Non-Replicating): Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Vaccines (Non-Live/Inactivated/Non-Replicating). Management: Give non-live/inactivated/non-replicating vaccines at least 2 weeks prior to starting chemotherapy when possible. Patients vaccinated less than 14 days before or during chemotherapy should be revaccinated at least 3 months after therapy is complete. Risk D: Consider Therapy Modification

Vadadustat: May increase serum concentration of OAT1/3 Substrates (Clinically Relevant). Risk C: Monitor

Yellow Fever Vaccine: Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Yellow Fever Vaccine. Immunosuppressants (Cytotoxic Chemotherapy) may increase adverse/toxic effects of Yellow Fever Vaccine. Specifically, the risk of vaccine-associated infection may be increased. Risk X: Avoid

Zoster Vaccine (Live/Attenuated): Immunosuppressants (Cytotoxic Chemotherapy) may increase adverse/toxic effects of Zoster Vaccine (Live/Attenuated). Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Zoster Vaccine (Live/Attenuated). Risk X: Avoid

Reproductive Considerations

Verify pregnancy status prior to treatment initiation in patients who could become pregnant. Patients who could become pregnant should use effective contraception during treatment and for at least 6 months after the last pemetrexed dose. Patients with partners who could become pregnant should use effective contraception during treatment and for 3 months after the last pemetrexed dose. Pemetrexed may impair fertility in males.

Pregnancy Considerations

Based on findings in animal reproduction studies and on the mechanism of action, in utero exposure to pemetrexed may cause fetal harm.

Breastfeeding Considerations

It is not known if pemetrexed is present in breast milk.

Due to the potential for serious adverse reactions in the breastfed infant, breastfeeding is not recommended during treatment and for 1 week after the last pemetrexed dose.

Monitoring Parameters

CBC with differential and platelets (at the beginning of each cycle, and on days 8 and 15 of each cycle if clinically indicated); kidney function tests (serum creatinine, creatinine clearance, BUN; prior to each cycle and as needed) total bilirubin, ALT, AST (periodic). Verify pregnancy status prior to treatment initiation (in patients who could become pregnant). Monitor for signs/symptoms of mucositis and diarrhea, pulmonary toxicity, dermatologic toxicity, and radiation recall (monitor for inflammation or blistering in areas of prior radiation treatment).

The American Society of Clinical Oncology hepatitis B screening and management provisional clinical opinion (ASCO [Hwang 2020]) recommends hepatitis B virus (HBV) screening with hepatitis B surface antigen, hepatitis B core antibody, total Ig or IgG, and antibody to hepatitis B surface antigen prior to beginning (or at the beginning of) systemic anticancer therapy; do not delay treatment for screening/results. Detection of chronic or past HBV infection requires a risk assessment to determine antiviral prophylaxis requirements, monitoring, and follow-up.

Mechanism of Action

Pemetrexed is an antifolate; it disrupts folate-dependent metabolic processes essential for cell replication. Pemetrexed inhibits thymidylate synthase (TS), dihydrofolate reductase (DHFR), glycinamide ribonucleotide formyltransferase (GARFT), and aminoimidazole carboxamide ribonucleotide formyltransferase (AICARFT), the enzymes involved in folate metabolism and DNA synthesis, resulting in inhibition of purine and thymidine nucleotide and protein synthesis.

Pharmacokinetics (Adult Data Unless Noted)

Distribution: V_dss: 16.1 L

Protein binding: 81%

Metabolism: Minimal

Half-life elimination: Normal renal function: 3.5 hours

Excretion: Urine (70% to 90% as unchanged drug)

Pharmacokinetics: Additional Considerations (Adult Data Unless Noted)

Altered kidney function: Pemetrexed clearance decreases and AUC increases as renal function decreases; in patients with CrCl of 45, 50, and 80 mL/minute, AUC was increased 65%, 54%, and 13%, respectively, compared with patients with CrCl of 100 mL/minute.

Brand Names: International

International Brand Names by Country

For country code abbreviations (show table)

(AE) United Arab Emirates: Pemetrexed spc;
(AR) Argentina: Alimta | Alltrexed | Ekel | Enzastar | Holista | Lidoras | Martxel | Paxequime | Pemetrexed glenmark | Pemetrexed gp pharm | Pemetrexed ima | Pemetrexed varifarma | Peymetrel | Praxed | Sukuba | Tepenac | Trexam | Venusted | Xulia;
(AT) Austria: Alimta | Armisarte | Pemegerolan | Pemetrexed accord | Pemetrexed ever pharma | Pemetrexed fresenius kabi | Pemetrexed krka | Pemetrexed sandoz | Pemetrexed stada | Pemetrexed zentiva;
(AU) Australia: Alimta | Dbl pemetrexed | Pemetrexed accord | Pemetrexed aft | Pemetrexed apotex | Pemetrexed juno | Pemetrexed myx | Pemetrexed sandoz | Pemetrexed sun | Reladdin | Tevatrexed;
(BD) Bangladesh: Alimta;
(BE) Belgium: Alimta | Armisarte | Pemetrexed accord | Pemetrexed eg | Pemetrexed ever pharma | Pemetrexed Fresenius Kabi | Pemetrexed fresenius kabi | Pemetrexed hospira | Pemetrexed krka | Pemetrexed mylan | Pemetrexed sandoz;
(BG) Bulgaria: Alimta | Armisarte | Pemetrexed alvogen | Pemetrexed heaton | Pemetrexed sandoz;
(BR) Brazil: Alimta | Atred | Eroxym | Mesotem | Pemeglenn | Pemetrexede | Pemetrexede dissodico | Pemetrexede dissodico heptaidratado | Pemtryx | Plexeden | Sukhi;
(CH) Switzerland: Alimta | Amtiris | Pemetrexed accord | Pemetrexed mylan | Pemetrexed pfizer | Pemetrexed sandoz | Pemetrexed Spirig HC | Pemetrexed Teva | Pemetrexed zentiva;
(CL) Chile: Alimta | Pemetrexed | Pemtero | Trexam;
(CN) China: Alimta | Ao tian cheng | Jie bai li | Pu lai le | Sai zhen | Yi luo ze;
(CO) Colombia: Alimta | Cacitab | Enzastar | Genetrexed | Lekarna | Martxel | Nextrexed | Paxib | Pemeker | Pemeta | Pemetrexed | Pemetrexed kemex | Pemetrexseven | Pemgem | Pemintas | Pexed | Pexitaz | Pleurex | Prelonex | Prelun | Revotrain | Sumitrexed | Taxitan | Tremzated | Venprex;
(CR) Costa Rica: Pemetrexed;
(CZ) Czech Republic: Alimta | Armisarte | Pemetrexed accord | Pemetrexed ever pharma | Pemetrexed fresenius kabi | Pemetrexed glenmark | Pemetrexed heaton | Pemetrexed krka | Pemetrexed sandoz | Pemetrexed Teva | Pemetrexed zentiva | Trixid;
(DE) Germany: Albotiva | Alimta | Pemetrexed accord | Pemetrexed beta | Pemetrexed ever pharma | Pemetrexed fresenius kabi | Pemetrexed Fresenius Kabi | Pemetrexed hexal | Pemetrexed hospira | Pemetrexed medac | Pemetrexed mylan | Pemetrexed neocorp | Pemetrexed ribosepharm | Pemetrexed seacross | Pemetrexed stada | Pemetrexed sun | Pemetrexed tad | Pemetrexed zentiva;
(DO) Dominican Republic: Alimta;
(EC) Ecuador: Alimta | Enzastar | Pemetrexed | Pemetrexed kemex | Pemtexa | Pexitaz | Sukuba | Trexam | Venusted;
(EE) Estonia: Alimta | Pemetrexed accord | Pemetrexed alvogen | Pemetrexed medac | Pemetrexed sandoz;
(EG) Egypt: Alimta;
(ES) Spain: Alimta | Armisarte | Mintayax | Pemetrexed accord | Pemetrexed Aurovit | Pemetrexed ebewe | Pemetrexed ever pharma | Pemetrexed Fresenius Kabi | Pemetrexed glenmar | Pemetrexed hospira | Pemetrexed mylan | Pemetrexed sala | Pemetrexed Stadage | Pemetrexed sun | Pemetrexed tillomed | Pemetrexed zentiva;
(ET) Ethiopia: Pemetrexed | Pemxcel;
(FI) Finland: Alimta | Pemetrexed accord | Pemetrexed ever pharma | Pemetrexed Fresenius Kabi | Pemetrexed hexal | Pemetrexed medac | Pemetrexed zentiva;
(FR) France: Alimta | Armisarte | Pemetrexed | Pemetrexed accord | Pemetrexed ever pharma | Pemetrexed Fresenius Kabi | Pemetrexed mylan | Pemetrexed zentiva;
(GB) United Kingdom: Alimta | Pemetrexed | Pemetrexed hospira | Pemetrexed sandoz | Pemetrexed seacross | Pemetrexed sun;
(GR) Greece: Alimta | Pemetrexed/vocate;
(HK) Hong Kong: Accord pemetrexed | Alimta | Dbl pemetrexed | Pemenon;
(HR) Croatia: Alimta;
(HU) Hungary: Alimta | Armisarte | Pemetrexed accord | Pemetrexed pharmaswiss | Pemetrexed sandoz | Pemetrexed stada | Pemetrexed Teva | Trixid;
(ID) Indonesia: Alimta | Fontrexed | Kabipem | Pemtero | Primexa;
(IE) Ireland: Armisarte | Pemetrexed | Pemetrexed krka | Pemetrexed mylan;
(IL) Israel: Alimta;
(IN) India: Adpem | Antifol | Kabipem | Pamifect | Pemanat | Pemecad | Pemeplast | Pemetero | Pemex | Pemexar | Pemgem | Pemmet | Pemotide | Pemxcel | Pexetrust | Pexitaz | Pleumet | Prexx | Relitrexed | Strimta | Symyx | Temeran | Zupemed;
(IT) Italy: Alimta | Armisarte | Pemetrexed accord | Pemetrexed eg | Pemetrexed ever pharma | Pemetrexed Fresenius Kabi | Pemetrexed hospira | Pemetrexed mylan | Pemetrexed reddy | Pemetrexed sandoz | Pemetrexed sun;
(JO) Jordan: Alimta | Pemitra | Trixem;
(JP) Japan: Alimta | Pemetrexed | Pemetrexed towa;
(KE) Kenya: Alimta;
(KR) Korea, Republic of: Alexia | Algik | Alimta | Alimxed | Mainta | Pelimta | Pemebit | Pemecin | Pemecine | Pemed | Pemed s | Pemirex | Pemta | Pemxed | Pfizer pemetrexed;
(KW) Kuwait: Alimta;
(LB) Lebanon: Alimta | Pleutrex;
(LT) Lithuania: Alimta | Pemetrexed accord | Pemetrexed alvogen | Pemetrexed ebewe | Pemetrexed fresenius kabi | Pemetrexed medac | Pemetrexed mylan | Pemetrexed zentiva;
(LV) Latvia: Alimta | Pemetrexed accord | Pemetrexed alvogen | Pemetrexed fresenius kabi | Pemetrexed zentiva;
(MA) Morocco: Alimta | Pemetrexed zenith;
(MX) Mexico: Alimta | Asocapul | Bemetad | Empet | Itara | Martxel | Pemetrexed | Pexitaz | Tec pred | Tremzated | Trexedical | Virplazit | Zulamed;
(MY) Malaysia: Accord pemetrexed | Ontrex | Pemenon | Podoxred;
(NL) Netherlands: Alimta | Armisarte | Pemetrexed | Pemetrexed accord | Pemetrexed b medical | Pemetrexed cf | Pemetrexed ever pharma | Pemetrexed fresenius kabi | Pemetrexed krka | Pemetrexed mylan | Pemetrexed sandoz | Pemetrexed zentiva;
(NO) Norway: Alimta | Pemetrexed | Pemetrexed accord | Pemetrexed Fresenius Kabi | Pemetrexed fresenius kabi | Pemetrexed medac | Pemetrexed sandoz;
(NZ) New Zealand: Alimta | Dbl pemetrexed | Pemetrexed | Pemetrexed juno;
(PE) Peru: Alimta | Enzastar | Metanex | Pemeker | Pemetrexed | Trexocord;
(PH) Philippines: Alimta | Pemirex | Pexate;
(PK) Pakistan: Algik | Alimta | Maclimta | Pemetrexed sandoz | Proxed;
(PL) Poland: Alimta | Pemetreksed sun | Pemetrexed accord | Pemetrexed alvogen | Pemetrexed Fresenius Kabi | Pemetrexed glenmark | Pemetrexed sandoz;
(PR) Puerto Rico: Alimta | Pemetrexed | Pemrydi rtu;
(PT) Portugal: Alimta | Pemetrexed sandoz | Pemetrexed stada | Pemetrexedo accord | Pemetrexedo ebewe | Pemetrexedo ever pharma | Pemetrexedo fresenius kabi | Pemetrexedo mylan | Pemetrexedo Refta;
(PY) Paraguay: Alimta | Enzastar | Holista | Lekarna | Lidoras | Mytrex | Pemeker | Pemetrexed bauel top | Pemetrexed imedic | Pemetrexed intas | Pemetrexed kemex | Pemetrexed medicine | Pemetrexed prosalud | Pemetrexed sandoz | Pemetrexed varifarma | Venusted;
(QA) Qatar: Alimta;
(RO) Romania: Alimta | Armisarte | Pemetrexed accord | Pemetrexed dr reddys | Pemetrexed stada | Pemetrexed sun | Pemetrexed zentiva;
(RU) Russian Federation: Alimta | Folitrex | Ispolat | Pemelan | Pemetrexed | Pemetrexed canon | Pemetrexed deco | Pemetrexed J | Pemetrexed kelun kazpharm | Pemetrexed nativ | Pemetrexed rus | Pemetrexed TL | Pemjem | Verotrexed;
(SA) Saudi Arabia: Alix | Almetra | Pemetrexed spc | Pemitra;
(SE) Sweden: Alimta | Armisarte | Pemetrexed | Pemetrexed accord | Pemetrexed ever pharma | Pemetrexed fresenius kabi | Pemetrexed hexal | Pemetrexed hospira | Pemetrexed mylan | Pemetrexed reig jofre | Pemetrexed stada | Pemetrexed zentiva;
(SG) Singapore: Alimta;
(SI) Slovenia: Pemetreksed accord | Pemetreksed krka | Pemetrexed ever pharma;
(SK) Slovakia: Alimta | Pemetrexed accord | Pemetrexed ever pharma | Pemetrexed fresenius kabi | Pemetrexed generics | Pemetrexed glenmark | Pemetrexed pharmevid | Pemetrexed sandoz | Pemetrexed stada | Pemetrexed Teva | Trixid;
(TH) Thailand: Alimta | Emetex | Pemetrex venus;
(TN) Tunisia: Alimta | Cytolim | Pemetrexed neapolis | Trexam;
(TR) Turkey: Alimta | Pemetu | Pemtrex | Prexet | Relitrexed;
(TW) Taiwan: Alimta | Apeta | Pemeda | Pemetrexed | Pemgem | Pexeda;
(UA) Ukraine: Alimta | Pemetrexed mb | Pemetro;
(UY) Uruguay: Alimta | Pemetrexed;
(VE) Venezuela, Bolivarian Republic of: Pemetrexed;
(VN) Viet Nam: Pemehope;
(ZA) South Africa: Aliloma | Alimta | Pemetrexed accord | Pemetrexed fresenius kabi | Pemject | PEMTORI IV | Terexta

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Pemetrexed injection 100 mg/4 mL, 500 mg/20 mL, and 1,000 mg/40 mL [prescribing information]. Parsippany, NJ: Teva Pharmaceuticals; June 2022.
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Refer to manufacturer's labeling.
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Pemetrexed: Drug information