Distrupts folate-dependent metabolic processes essential for cell replication.

500 mg/m² IV infusion over 10 minutes every 21 days with cisplatin (75 mg/m² over two hours) to follow 30 minutes later.

Given in combination with cisplatin for the treatment of malignant pleural mesothelioma for non-surgical candidates.

Given as a single agent for patients with locally advanced or metastatic nonsmall cell lung cancer who have received one prior chemotherapy treatment.

Side effects with pemetrexed plus cisplatin regimen included myelosuppression, fatigue, nausea, vomiting, and dyspnea. Side effects were reduced with vitamin supplementation.

To decrease side effects, administer folic acid, 350–1000 mcg daily, starting 1-3 weeks prior to the first cycle and daily for 1-3 weeks after final cycle (Should take at least five doses in the week prior to first treatment). Vitamin B12 injection 1000mcg IM was given 1-3 weeks before first cycle and repeated every 9 weeks until treatment completed.

Administering dexamethasone 4 mg bid for three days starting the day before treatment decreases the incidence of skin rash.

Monitor complete blood count on 8 and 15. Hold treatment if ANC <1500, platelet count <100,000, or creatinine clearance <45 mL/min. Monitor renal and hepatic function.

The concurrent use of ibuprofen may increase risk of renal damage.