Anthropometric Measurements as Predictors of Low Birth Weight Among Tanzanian Neonates: A Hospital-Based Study
November 7, 2025
Free CME credits
Both our subscription plans include Free CME/CPD AMA PRA Category 1 credits.
Brand Name :
Alimta
(United States) [Available] ,Pemrydi RTU
(United States) [Available] ,Axtle
(United States) [Available] ,Pemfexy
(United States) [Available]Synonyms :
Pemetrexed (Rx)
Class :
Anticancer & antimetabolites 
Brand Name :
Alimta
(United States) [Available] ,Pemrydi RTU
(United States) [Available] ,Axtle
(United States) [Available] ,Pemfexy
(United States) [Available]Synonyms :
Pemetrexed (Rx)
Class :
Anticancer & antimetabolites 
ADULT DOSINGÂ Â
Dosage Forms & StrengthsÂ
Dosage forms & Strengths Â
Lyophilized powder for injection Â
100 mg/vial Â
500 mg/vial Â
Injectable solution Â
500 mg/vial Â
21-day cycle for metastatic bladder & cervical cancer:
500
mg
Intravenous (IV)
on the first day of the cycle, repeat the cycle until disease progression
Malignant Pleural Mesothelioma
21-day cycle (in combination with cisplatin):
500
mg/m^2
pemetrexed with cisplatin IV on the first day of the cycle, repeat the cycle until disease progression
Combination therapy
:
500
mg/m^2
Intravenous (IV)
pemetrexed on day 1 of a 21-day cycle in combination with pembrolizumab and platinum therapy for 4 cycles
500 mg/m2 IV pemetrexed on day 1 of a 21-day cycle in combination with cisplatin for up to 6 cycles
Single-agent therapy:
500 mg/m2 pemetrexed IV on day 1 of 21-day cycle continue until disease progression or unacceptable toxicity
Safety and efficacy not establishedÂ
Refer adult dosing
may have an increased neutropenic effect when combined with deferiprone
may have an increased myelosuppressive effect when combined with ropeginterferon alfa-2b
may enhance the serum concentration when combined with pemetrexed
may increase the Myelosuppressive effect of each other when combined
It may increase pemetrexed toxicities by increasing the serum concentration. Avoid aspirin from the 2 days before, through the treatment, and after 2 days.
avoid the combination as it may increase nephrotoxicity
increases toxicities such as myelosuppression, renal toxicity, and GI toxicity
may enhance myelosuppressive toxicity of pemetrexed
high-risk for serious infections due to increasing immunosuppression
may increase toxic adverse effects of pemetrexed
increases serum concentration and toxic effect on GI, avoid the combination
increases serum concentration and toxic effect on GI, avoid the combinationÂ
increases serum concentration and toxic effect on GI, avoid the combination
interaction with NSAIDs may lead to increased toxicity such as myelosuppression, renal toxicity, and GI toxicity
interaction with NSAIDs may lead to increased toxicity such as myelosuppression, renal toxicity, and GI toxicity
interaction with NSAIDs may lead to increased toxicity such as myelosuppression, renal toxicity, and GI toxicity
increases the serum level of pemetrexed
interaction with NSAIDs may lead to increased toxicity such as myelosuppression, renal toxicity, and GI toxicity
interaction with NSAIDs may lead to increased toxicity such as myelosuppression, renal toxicity, and GI toxicity
interaction with NSAIDs may lead to increased toxicity such as myelosuppression, renal toxicity, and GI toxicity
interaction with NSAIDs may lead to increased toxicity such as myelosuppression, renal toxicity, and GI toxicity
interaction with NSAIDs may lead to increased toxicity such as myelosuppression, renal toxicity, and GI toxicity
interaction with NSAIDs may lead to increased toxicity such as myelosuppression, renal toxicity, and GI toxicity
interaction with NSAIDs may lead to increased toxicity such as myelosuppression, renal toxicity, and GI toxicity
avoid palifermin during pemetrexed therapy and before and after 24 hours of treatment
interaction with NSAIDs may lead to increased toxicity such as myelosuppression, renal toxicity, and GI toxicity
interaction with NSAIDs may lead to increased toxicity such as myelosuppression, renal toxicity, and GI toxicity
interaction with NSAIDs may lead to increased toxicity such as myelosuppression, renal toxicity, and GI toxicity
increase toxic adverse effects and immunosuppression
interaction with NSAIDs may lead to increased toxicity such as myelosuppression, renal toxicity, and GI toxicity
myelosuppressive agents may diminish the therapeutic effect of BCG
may increase the level of each other by an unknown mechanism
may have an increased myelosuppressive effect when combined with fexinidazole
abiraterone acetate and niraparibÂ
may increase the neutropenic effect of myelosuppressive agents
dipyridamole: it may decrease the therapeutic effect of myelosuppressive agents
olopatadine: it may decrease the therapeutic effect of myelosuppressive agents
paraldehyde: it may decrease the therapeutic effect of myelosuppressive agents
interaction may raise the risk of serious infections due to immunosuppressive effects
may diminish the therapeutic effect of brincidofovir
may diminish the therapeutic effect of the covid-19 vaccine
pemetrexed may enhance the immunosuppressive effect of inebilizumab
pemetrexed may decrease the therapeutic effects of lenograstim, avoid within 24 hours of administration of antineoplastic agents
may increase the serum concentration of oat1/3 substrates
may enhance the immunosuppressive effects of ocrelizumab
may enhance the immunosuppressive effects of pemetrexed
myelosuppressive agents may enhance adverse myelosuppressive effects of olaparib
pemetrexed may diminish the therapeutic effects of pidotimod
may enhance adverse myelosuppressive effects
may enhance the adverse toxic effects of pemetrexed
myelosuppressive Agents may enhance the adverse/toxic effect of clozapine
myelosuppressive Agents may enhance the myelosuppressive effect of Olaparib
myelosuppressive Agents may enhance the neutropenic effect of deferiprone
may enhance the effect of myelosuppressive agents
may enhance the effect of myelosuppressive agents
may have an increased myelosuppressive effect when combined with myelosuppressive agents
may have an increased myelosuppressive effect when combined with olaparib
may have an increased adverse effect when combined with clozapine
may have an increased adverse effect when comb
may decrease the therapeutic effect when combined with BCG vaccine
may have an increased myelosuppressive effect when combined with myelosuppressive agents
may increase the toxic effect of myelosuppressive agents
It may enhance the risk of adverse effects when combined with Hormone Antagonists
ozanimod: it may decrease the therapeutic effect of myelosuppressive agents
tofacitinib: it may decrease the therapeutic effect of myelosuppressive agents
decreases renal elimination of either entecavir or the coadministered drug
The immunosuppressive effect of immunosuppressants (cytotoxic chemotherapy) may be increased by denosumab
Pemetrexed (ALIMTA) is a folate analog that disrupts key folate-dependent metabolic processes necessary for cell replication. It inhibits several enzymes involved in the synthesis of DNA building blocks, including thymidylate synthase (TS), dihydrofolate reductase (DHFR), and glycinamide ribonucleotide formyltransferase (GARFT). The drug enters cells via folate transporters and is then converted into polyglutamate forms by folylpolyglutamate synthetase. These polyglutamated forms remain inside cells longer and more effectively inhibit TS and GARFT, leading to prolonged anti-cancer activity, especially in tumor cells.
Frequency defined:Â Â
Frequency defined:Â Â
>10%:Â Â Â
Nausea (30%)Â Â
Vomiting (30%)Â Â
Weight loss Â
Increased liver enzymes (14%)Â Â
Mucositis Â
Myelosuppression (11%)Â Â
Fatigue (30%)Â Â
Anemia (19%)Â Â
decreased CrCl (16%)Â Â
1% to 10%Â Â
Alopecia (10%)Â Â
Dermatitis (3%)Â Â
Burning sensation of the skin Â
Skin photosensitivity Â
Gastrointestinal ulcer (10%)Â Â
Pruritis Â
Leukopenia Â
Pancytopenia Â
Thrombocytopenia Â
Dizziness Â
Frequency not defined:Â Â
Cerebral thrombosis Â
Arterial thrombosis Â
Hypotension Â
Decreased libido Â
Menstrual diseases Â
Pancreatitis Â
Hepatic failure Â
Nonimmune anaphylaxis Â
Haematuria Â
Infertility Â
Vaginal discharge Â
Bone fracture Â
Kidney toxicity is associated with pemetrexed, causing conditions like acute tubular necrosis (ATN), interstitial edema, distal renal tubular acidosis (RTA), and nephrogenic diabetes insipidus. Pemetrexed, either alone or with other cytotoxic agents, poses nephrotoxic risks, especially with factors like dehydration, hypertension, baseline kidney disease, and preexisting diabetes. The risk of pemetrexed-associated acute kidney injury (AKI) is generally low (1%–5%) but can be higher in certain cases, particularly with combination chemotherapy. Pemetrexed-induced AKI may not always be reversible. Combining pemetrexed with cisplatin appears to be less nephrotoxic than cisplatin alone.
Contraindications Â
Hypersensitivity Â
Concomitant yellow fever vaccineÂ
Cautions Â
Renal impairment Â
Hepatic impairment Â
Drug interactions Â
Pregnancy  Â
Breastfeeding Â
Skin toxicity (SJS etc.,) Â
Interstitial pneumotitis Â
Pregnancy consideration: Pemetrexed is assigned under pregnancy category D. Avoid during pregnancy. Â
Lactation: No sufficient data is available that shows whether pemetrexed and its metabolites are excreted in breast milk. Because of the potential risks, it is advised to avoid the treatment for breastfeeding women.Â
Pregnancy category:Â
Pemetrexed is an antifolate antineoplastic agent that disrupts essential folate-dependent metabolic processes required for cell replication. By inhibiting these folate-mediated pathways, pemetrexed impairs DNA and RNA synthesis, thereby blocking cellular replication and proliferation. This disruption of critical cellular functions underlies its anti-cancer activity.Â
PharmacokineticsÂ
Absorption: Pemetrexed is administered intravenously and exhibits dose-proportional increases in systemic exposure (AUC) and peak plasma concentration (Cmax) across doses ranging from 0.2 to 838 mg/m². Its pharmacokinetics remain consistent over multiple treatment cycles.Â
Distribution: The drug has a steady-state volume of distribution of approximately 16.1 liters and is about 81% bound to plasma proteins. Protein binding is not affected by renal impairment.Â
Metabolism: Pemetrexed undergoes minimal metabolism.Â
Elimination/Excretion: It is primarily eliminated unchanged via the kidneys, with 70% to 90% of the administered dose recovered in the urine within 24 hours. Clearance decreases and systemic exposure increases as renal function declines. The total systemic clearance is around 91.8 mL/min, and the elimination half-life is approximately 3.5 hours in patients with normal kidney function.Â
PharmacodynamicsÂ
After a single dose of pemetrexed (ALIMTA), the severity of neutropenia (measured by the lowest absolute neutrophil count, ANC nadir) is linked to the drug’s systemic exposure (AUC). Patients with high baseline levels of cystathionine or homocysteine tend to experience lower ANC nadirs, but these levels can be reduced with folic acid and vitamin B12 supplementation. The ANC nadir typically occurs 8 to 9.6 days after treatment, with recovery to baseline occurring within 4.2 to 7.5 days. Importantly, repeated dosing does not lead to a cumulative decrease in ANC nadir over multiple cycles.Â
Infuse intravenously over 10 minutes, administering after pembrolizumab and before platinum agents in combination therapy. Premedicate with oral folic acid, intramuscular vitamin B12, and oral dexamethasone. Store unopened vials at 20–25°C; reconstituted and diluted solutions require refrigeration and use within 24–48 hours, while Pemfexy multidose vials can be refrigerated up to 28 days after opening. Pemetrexed is cytotoxic and must be handled with proper safety precautions.Â
Patient information leafletÂ
Generic Name: pemetrexedÂ
Pronounced: peh-meh-TREKS-edÂ
Why do we use pemetrexed?Â
Pemetrexed is used for the treatment of locally advanced or metastatic nonsquamous non-small cell lung cancer (NSCLC). It is employed as an initial therapy in combination with cisplatin, as maintenance treatment for patients whose disease has not progressed after four cycles of platinum-based chemotherapy, and as a single agent after prior chemotherapy. Additionally, pemetrexed is used in combination with cisplatin for the treatment of mesothelioma.Â
Both our subscription plans include Free CME/CPD AMA PRA Category 1 credits.
On course completion, you will receive a full-sized presentation quality digital certificate.
A dynamic medical simulation platform designed to train healthcare professionals and students to effectively run code situations through an immersive hands-on experience in a live, interactive 3D environment.
When you have your licenses, certificates and CMEs in one place, it's easier to track your career growth. You can easily share these with hospitals as well, using your medtigo app.
