Pemetrexed and carboplatin

Pemetrexed and carboplatin is the name of a chemotherapy combination that includes:

  • pemetrexed (also known as Alimta)
  • carboplatin

It is a treatment for:

  • non small cell lung cancer (NSCLC)
  • mesothelioma that started in the layers of tissue that cover the lung (pleural mesothelioma)

How pemetrexed and carboplatin works

These chemotherapy drugs destroy quickly dividing cells, such as cancer cells.

How you have pemetrexed and carboplatin

Pemetrexed and carboplatin drugs are liquids. You have them as a drip into your bloodstream (intravenously). 

Into your bloodstream

You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

  • central line
  • PICC line
  • portacath

If you don't have a central line

You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm. You have a new cannula each time you have treatment.

When you have pemetrexed and carboplatin

You usually have pemetrexed and carboplatin as cycles of treatment. Each cycle of treatment lasts 21 days (3 weeks).

Depending on your cancer, you may have between 4 and 6 cycles of treatment, taking about 4 months in total.

You have each treatment cycle in the following way:

Day 1
  • You have pemetrexed as a drip into your bloodstream over 10 minutes.
  • You have carboplatin as a drip into your bloodstream over 30 to 60 minutes.
Day 2 to 21
  • You have no treatment.

You then start a new cycle of treatment.

To help reduce the side effects of this treatment, you have:

  • folic acid tablets – starting 1 to 3 weeks before treatment and for 3 weeks afterwards
  • vitamin B12 injections – starting 1 to 3 weeks before treatment and then once, every 9 weeks (with every third cycle)

You may also have a steroid tablet to help with the side effects, starting on the day before your chemotherapy. You take the tablets twice a day, for up to 3 days (with breakfast and lunch).


You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Side effects

How often and how severe the side effects are can vary from person to person. They also depend on what other treatments you're having. 

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

  • you have severe side effects 
  • your side effects aren’t getting any better
  • your side effects are getting worse

Early treatment can help manage side effects better. 

Contact your advice line immediately if you have signs of infection, including a temperature above 37.5C or below 36C.

We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects. But you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Increased risk of infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, try eating small meals and snacks, drinking plenty of water, and relaxation techniques can all help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.

Bruising, bleeding gums or nose bleeds

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae).

Breathlessness and looking pale

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.


Tiredness and weakness (fatigue) can happen during and after treatment. Doing gentle exercises each day can keep your energy up. Don't push yourself, rest when you start to feel tired and ask others for help.

Sore mouth and throat

It may be painful to swallow drinks or food. Painkillers and mouth washes can help to reduce the soreness and keep your mouth healthy. 

Loss of appetite and weight loss

You might not feel like eating and may lose weight. Eating several small meals and snacks throughout the day can be easier to manage. You can talk to a dietitian if you are concerned about your appetite or weight loss. 

Diarrhoea or constipation

Tell your healthcare team if you have diarrhoea or constipation. They can give you medicine to help. 

Skin rash

A rash can also be itchy. Tell your doctor or nurse if you have a skin rash. They can prescribe medicine to stop the itching and soothe your skin.

Hair thinning and hair loss

Your hair may thin but you’re unlikely to lose all your hair. This usually starts after your first or second cycle of treatment. It is almost always temporary and your hair will grow back when you finish your treatment.

Kidney changes

You might have some changes in the way your kidneys work. You have regular blood tests to check how well they are working.

Changes in the levels of substances in your body

Your blood contains different minerals, salts, proteins and enzymes. This treatment can change the levels of calcium, magnesium, sodium and potassium in your blood. It can also change enzymes levels which can affect your bones and liver.

You have regular blood tests to check for any changes.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:

  • an allergic reaction may happen during the infusion, causing a skin rash, itching, swelling of the lips, face or throat, breathing difficulties, fever and chills
  • liver changes that are usually mild – you have regular blood tests to check this
  • a high temperature (fever)
  • muscle weakness
  • taste changes
  • indigestion or heartburn
  • tummy (abdominal) pain
  • numbness or tingling in hands, feet, arms and legs(peripheral neurophathy)
  • hearing changes such as ringing in your ears
  • burning and pricking sensation
  • decreased tendon reflex
  • eye problems – temporary changes to your vision, rarely loss of vision or sore, red and watery eyes (conjunctivitis)
  • problems with your heart not pumping properly – you have regular tests to check this
  • lung changes such as shortness of breath if you are having or had radiotherapy to the lungs (radiation pneumonitis) or tightness of the chest and wheezing
  • pain in your bones, muscles and joints
  • lack of fluid in the body (dehydration)

Rare side effects

These side effects happen in fewer than 1 in 100 people (fewer than 1%). You might have one or more of them. They include:

  • a build up of fluid (swelling) in your arms, hands, ankles, legs, face and other parts of the body
  • blood clots that are life threatening; signs are pain, swelling and redness where the clot is. Feeling breathless can be a sign of a blood clot on the lung. Contact your advice line or doctor straight away if you have any of these symptoms
  • a skin rash over areas of previous radiotherapy
  • weight gain
  • inflammation of the bowel and food pipe
  • a severe skin reaction that may start as tender red patches which leads to peeling or blistering of the skin. You might also feel feverish and your eyes may be more sensitive to light. This is serious and could be life threatening
  • second cancers later in life

Other side effects

If you have side effects that aren't listed on this page, you can look at the individual drug pages:

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know?

Other medicines, foods and drink

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Non steroidal anti inflammatory drugs (NSAIDS)

Do not take non steroidal anti inflammatory drugs (NSAIDS) such as ibuprofen or aspirin for 2 days before, on the day and 2 days after treatment with pemetrexed. NSAIDS can make the pemetrexed side effects worse.


You may not be able to become pregnant or get someone pregnant after treatment with these drugs. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.    

Contraception and pregnancy

This treatment might harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you're having treatment and for a few months afterwards.

Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner falls pregnant while having treatment.


It is not known whether this drug comes through into the breast milk. Doctors usually advise that you don’t breastfeed during this treatment.

Treatment for other conditions

Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment. For example, if you need treatment for anything else, including teeth problems.


Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.

You can have:

  • other vaccines, but they might not give you as much protection as usual
  • the flu vaccine (as an injection)
  • the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system Open a glossary item recovers from treatment.

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information about this treatment

For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

This page is due for review. We will update this as soon as possible.

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