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Pemetrexed and carboplatin

This page tells you about the chemotherapy drug combination pemetrexed and carboplatin (PemCarbo) and its possible side effects. There is information about


What pemetrexed and carboplatin is

Pemetrexed and carboplatin is a combination of chemotherapy drugs used to treat non small cell lung cancer

  • Carboplatin is also known by its brand name Paraplatin.
  • Pemetrexed is also called Alimta

How you have pemetrexed and carboplatin

Pemetrexed and carboplatin drugs are liquids. You have them into your bloodstream (intravenously). You can have them through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have them through a central line, a portacath or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. You have the tube put in just before your course of treatment starts and it stays in place as long as you need it.

You have both drugs by drip over 1 to 2 hours every 3 weeks. You may need to go to your clinic 2 weeks after you have each treatment for a check up. Depending on your needs, you may have 4 to 6 treatments, taking 3 to 6 months in total.

Pemetrexed is a type of drug known as an anti folate. It blocks the action of folic acid in the body. To help reduce the side effects this causes, you need to

  • Take folic acid tablets – starting 5 days before you begin treatment, and continuing throughout treatment and for 3 weeks afterwards
  • Have vitamin B12 injections – 1 injection in the week before you start treatment and then 1 before every third treatment cycle

You will also take a steroid tablet to help reduce the side effects of the treatment. You start this the day before you have your chemotherapy. You take the tablets twice a day for 3 days – with breakfast and with lunch.

The side effects of a combination of drugs are usually a mixture of those of each drug. The combination may increase or decrease your chance of getting each side effect or it may change the severity.

The side effects associated with pemetrexed and carboplatin are listed below. You can use the underlined links to find out more about each one. Where there is no link, see our side effects of cancer drugs section or use the search box at the top of the page.


Common side effects

More than 10 in every 100 people have one or more of these effects.

  • An increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, a sore throat, pain passing urine, or you may feel cold and shivery. If you have a severe infection this can be life threatening. Contact your treatment centre straight away if you have any of these effects or if your temperature goes above 38°C
  • Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
  • Bruising more easily due to a drop in platelets – you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia
  • Tiredness and weakness (fatigue) during and after treatment – most people find their energy levels are back to normal within 6 months to a year  
  • Feeling or being sick – this is usually well controlled with anti sickness medicines
  • Diarrhoea – drink plenty of fluids and tell your doctor or nurse if diarrhoea becomes severe, or continues for more than 3 days
  • A sore mouth
  • A skin rash – you may have some itching and your skin may become sore
  • Loss of appetite
  • Kidney damage – you will have blood tests before your treatment to make sure your kidneys are able to cope
  • Women may stop having periods (amenorrhoea) but this may be temporary
  • Loss of fertility – you may not be able to become pregnant or father a child after treatment with this drug. Talk to your doctor before starting treatment if you think you may want to have a baby in the future. Men may be able to store sperm before starting treatment

Occasional side effects

Between 1 and 10 in every 100 people have one or more of these effects.

  • Numbness or tingling in fingers and toes affects about 1 out of every 10 people (10%) and can cause difficulty with fiddly things such as doing up buttons – this starts within a few days or weeks and usually goes within a few months of finishing treatment  
  • Some people have an allergic reaction while having this treatment, usually at the first or second treatment – let your treatment team know immediately if you feel hot or have any skin rashes, itching, dizziness, headaches, shivering, breathlessness, anxiety, flushing of the face, or a sudden need to pass urine
  • Hair thinning
  • Loss of taste or a metallic taste
  • A high temperature (fever) – taking paracetamol every 6 to 8 hours can help until your temperature goes down
  • Constipation – drink plenty of fluids and tell your doctor or nurse if it continues for more than 3 days
  • Liver changes that are very mild and unlikely to cause symptoms – these will almost certainly go back to normal when treatment ends, but you will have regular blood tests to check how well your liver is working
  • Loss of ability to hear some high pitched sounds, which usually gets better on its own
  • About 1 in 100 people (1%) have ringing in their ears (tinnitus)

Rare side effects

Fewer than 1 in 100 people have some damage to heart muscle. This is usually temporary but for a small number of people may be permanent. Your doctor will check your heart before and after your treatment.


Important points to remember

You may have a few of the side effects mentioned above. A side effect may get worse through your course of treatment. Or you may have more side effects as the course goes on. This depends on

  • How many times you've had a drug before
  • Your general health
  • How much of the drug you have (the dose)
  • Other drugs you are having

Coping with side effects

Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.

Other medicines 

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies. Some drugs can react together.

Pregnancy and contraception

These drugs may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having this treatment and for a few months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.


Do not breastfeed during this treatment because the drug may come through in the breast milk.


Immunisations and chemotherapy

You should not have immunisations with live vaccines while you are having treatment or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG, yellow fever and Zostavax (shingles vaccine).

You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your treatment. It is safe to have the flu vaccine.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines) but not many people in the UK have these now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.


Related information

On this website you can read about 

Non small cell lung cancer




More information about PemCarbo drugs

This page does not list all the very rare side effects of these drugs that are very unlikely to affect you. For further information look at the Electronic Medicines Compendium website at

If you have a side effect not mentioned here that you think may be due to this treatment you can report it to the Medicines Health and Regulatory Authority (MHRA) at

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Updated: 24 February 2014