Alimta™ Injection (Pemetrexed)
Compared with: Blackmores Conceive Well Gold 28 Tablets + 28 Capsules
Alimta™ Injection (Pemetrexed) is an antifolate chemotherapy agent indicated for first‑line and maintenance treatment of advanced non‑small cell lung cancer (NSCLC) and unresectable malignant pleural mesothelioma. Administered intravenously with vitamin supplementation, Alimta disrupts folate‑dependent metabolic processes essential for cell replication, improving progression‑free survival when used alone or in combination regimens.
Pemetrexed Disodium – available as 100 mg and 500 mg lyophilized powder for reconstitution.

Other Popular and Common Names
Pemetrexed

Alimta™ via Eli Lilly

Antifolate Antineoplastic Agent

PEM (abbreviation in oncology protocols)
Pemetrexed inhibits multiple folate‑dependent enzymes—thymidylate synthase, dihydrofolate reductase, and glycinamide ribonucleotide formyltransferase—thereby blocking thymidine and purine synthesis. This multi‑targeted antifolate activity disrupts DNA and RNA synthesis, inducing apoptosis in rapidly dividing tumor cells.

Unresectable Malignant Pleural Mesothelioma: As monotherapy after platinum‑based chemotherapy.

Non‑Small Cell Lung Cancer (NSCLC):

First‑line, nonsquamous NSCLC in combination with cisplatin.

Maintenance therapy for patients with stable disease after platinum‑based induction.
Indication Dose Schedule Supplementation
Mesothelioma (Monotherapy) 500 mg/m² IV infusion over 10 minutes Every 21 days Folic acid 400 µg – 1 mg daily; B₁₂ 1 mg IM every 9 weeks; dexamethasone premedication
NSCLC (Combination with Cisplatin) 500 mg/m² IV infusion over 10 minutes Day 1 of 21‑day cycle Same vitamin regimen; dexamethasone days –1 to +1

Hydration: Ensure adequate hydration and diuresis with sodium bicarbonate to reduce renal toxicity.

Pre‑Medications: Dexamethasone 4 mg orally twice daily the day before, day of, and day after each dose to mitigate skin rash.

Prescribing Information
Formulation: Lyophilized powder in single‑use vials

Strengths: 100 mg/vial, 500 mg/vial, reconstituted and diluted for IV infusion

Route: Intravenous infusion

Legal Status: Prescription Only (Oncology)
Pregnancy: Category D – Embryo‑fetal toxicity; use effective contraception during and six months post‑therapy.

Breastfeeding: Contraindicated; discontinue breastfeeding.

Hematologic: Monitor CBC with differential and platelet count prior to each cycle.

Renal Function: Adjust dose or withhold if creatinine clearance <45 mL/min.

Hepatic Impairment: Use with caution; monitor liver enzymes.
Common (≥20 %):

Neutropenia, anemia, thrombocytopenia

Fatigue, nausea, vomiting

Mucositis, diarrhea

Rash

Elevated liver enzymes

Serious:

Sepsis with neutropenia

Severe cutaneous reactions (SJS/TEN)

Interstitial pneumonitis

Renal failure

Thromboembolic events
Bone Marrow Suppression: Delay dosing until recovery of ANC ≥1.5 × 10⁹/L and platelets ≥100 × 10⁹/L.

Pulmonary Toxicity: Discontinue on severe dyspnea, unresolving cough, or radiographic infiltrates.

Dermatologic: Treat rash with topical emollients; withhold for grade ≥3.

Electrolyte Monitoring: Ensure folate, B₁₂, and magnesium are within normal limits.

Drug Classification
Therapeutic Class: Antineoplastic, Chemotherapy Agent

Pharmacologic Class: Multitargeted Antifolate

Legal Category: Prescription Oncology Medicine
NSAIDs: Avoid in patients with creatinine clearance 45–79 mL/min; may impair renal excretion of pemetrexed.

Live Vaccines: Contraindicated during and six months post‑treatment due to immunosuppression.

Vitamin Supplementation: Mandatory folic acid and B₁₂ to reduce hematologic and gastrointestinal toxicity.

Cisplatin: Standard partner in NSCLC regimens; requires rigorous hydration protocols
Vogelzang et al., JCO 2003: Demonstrated improved survival in mesothelioma with pemetrexed plus cisplatin versus cisplatin alone.

JMDB Trial, Lancet 2008: Showed non‑inferior efficacy of pemetrexed‑cisplatin versus gemcitabine‑cisplatin in nonsquamous NSCLC with a favorable toxicity profile.

Comparison with Blackmores Conceive Well Gold
Alimta™ Injection is a high‑potency anticancer therapy requiring specialist administration, while Blackmores Conceive Well Gold is a nutritional supplement supporting preconception health. Both may be part of comprehensive care for women at different stages: Alimta™ during cancer treatment with fertility preservation considerations, and Conceive Well Gold for reproductive planning once cancer therapy is complete.

FAQs – Alimta™ Injection (Pemetrexed)
Q1. How is Alimta administered?
A: Intravenously over 10 minutes every 21 days with vitamin supplementation and dexamethasone premedication.

Q2. Why are folic acid and B₁₂ required?
A: To mitigate severe hematologic, gastrointestinal, and dermatologic toxicities by supporting normal cell folate metabolism.

Q3. What monitoring is needed?
A: CBC, renal and liver function tests before each cycle; clinical assessment for pulmonary or cutaneous toxicity.
Q4. Can patients receive live vaccines?
A: No; immunosuppression from pemetrexed contraindicates live or live‑attenuated vaccines.
Q5. Is hydration necessary?
A: Yes; adequate hydration and, if indicated, sodium bicarbonate reduce renal toxicity from pemetrexed.
Q6. How long does therapy continue?
A: Until disease progression, unacceptable toxicity, or patient decision. Maintenance pemetrexed may follow induction in NSCLC.
Q7. Can Alimta be used in renal impairment?
A: Dose adjustments or avoidance recommended if creatinine clearance is <45 mL/min; contraindicated below 15 mL/min.
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