The U.S. labeling directs withholding below CrCl 45. The dated Ontario monograph instructs discontinuation below that threshold. Verify the applicable treatment protocol before deciding whether treatment may resume.
Before applying: Consult the exact cited section and other applicable sources before use.
Use the renal measure and units named by this source. Confirm product, indication, age, stable versus changing kidney function, and exact dialysis modality. The selected summary is not a complete prescribing monograph. Renal method and dosing checklist
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Official source
Alimta - labeled renal guidance
Renal action and limits
Pemetrexed (Alimta), IV lyophilized powder, adults Cockcroft-Gault creatinine clearance, mL/min
Action or finding
Withhold if CrCl is below 45 mL/min. Recheck CrCl before each dose. At 45-79, avoid ibuprofen during the two days before treatment, treatment day and two days afterward.
Limits and monitoring
If ibuprofen cannot be withheld, increase monitoring for marrow suppression, renal injury and GI toxicity.
Before use
The U.S. labeling directs withholding below CrCl 45. The dated Ontario monograph instructs discontinuation below that threshold. Verify the applicable treatment protocol before deciding whether treatment may resume.
DailyMed SPL version 59, effective 2023-05-19; posted Jun 28, 2023 | Selected sections checked 2026-11-07. Independent clinical review pending.
Pemetrexed (Alimta), IV lyophilized powder, adults
Renal measure
Cockcroft-Gault creatinine clearance, mL/min
Source revision
DailyMed SPL version 59, effective 2023-05-19; posted Jun 28, 2023
Retrieved
2026-11-07 (not the revision date)
Restriction or avoidance guidance. Read the specific threshold, age, formulation and dialysis exclusions; do not generalize across products.
Renal guidance: 2.3, 2.5 and 5.2
Withhold if CrCl is below 45 mL/min. Recheck CrCl before each dose. At 45-79, avoid ibuprofen during the two days before treatment, treatment day and two days afterward. If ibuprofen cannot be withheld, increase monitoring for marrow suppression, renal injury and GI toxicity.
Source revision: DailyMed SPL version 59, effective 2023-05-19; posted Jun 28, 2023 | Retrieved: 2026-11-07. Retrieval date is not the revision date.
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Source scope / renal recommendation differences
Alimta - product and source limitations
The U.S. labeling directs withholding below CrCl 45. The dated Ontario monograph instructs discontinuation below that threshold. Verify the applicable treatment protocol before deciding whether treatment may resume.
How to use this: The U.S. labeling directs withholding below CrCl 45. The dated Ontario monograph instructs discontinuation below that threshold. Verify the applicable treatment protocol before deciding whether treatment may resume.
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Official source
Pemetrexed disodium for injection (Alimta) - selected U.S. label sections
ALIMTA lyophilized IV product for the applicable adult oncology indication. Not a ready-to-use preparation instruction.
Method: Cockcroft-Gault creatinine clearance in mL/min
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Exact product and population matter. This added page contains locally stored, source-specific clinical summaries. Historical handbook information, when present, is identified separately and may conflict with U.S. labeling. Confirm indication, population, kidney-function method, monitoring and the full prescribing information before applying a regimen.
U.S. product labeling / DailyMed · ALIMTA lyophilized IV product for the applicable adult oncology indication. Not a ready-to-use preparation instruction.
Renal method: Cockcroft-Gault creatinine clearance in mL/min Source date: Revision not captured; retrieval date is not the revision date. Retrieved: 2026-09-05
Local label summary; independent clinical review pending. Not a two-source validated protocol.
Renal eligibility and monitoring
The labeled regimens apply to Cockcroft-Gault CrCl at least 45 mL/min. Below 45, no dose is recommended. Assess CrCl before each cycle and do not administer below 45. Do not invent a lower-dose substitute.
For CrCl 45-79 mL/min, avoid ibuprofen during the 2 days before pemetrexed, the administration day, and the following 2 days. If concomitant use cannot be avoided, monitor more closely for marrow suppression, renal toxicity and gastrointestinal toxicity.
Selected renal sections only, not a complete monograph. Exact product, indication, patient population, renal method and all other contraindications/interactions remain controlling.
Second independent renal reference and clinician adjudication remain pending; no all-indication, dialysis or pediatric dose may be inferred from an omitted field.
Withhold if CrCl is below 45 mL/min. Recheck CrCl before each dose. At 45-79, avoid ibuprofen during the two days before treatment, treatment day and two days afterward. If ibuprofen cannot be withheld, increase monitoring for marrow suppression, renal injury and GI toxicity.
RDM73-alimta-official-1 · Source locator: Renal guidance: 2.3, 2.5 and 5.2
GlobalRPh RX List / product-label mirror · Pemetrexed (Alimta), IV lyophilized powder, adults
Renal method: Use the renal measure explicitly present in the RX passage. Source date: Mirror revision not established in the reviewed passage. Retrieved: 2026-11-07
Label mirror, not independent corroboration. This is selected locally stored RX List content. Full monograph import and current official-label review are not implied.
Restriction or avoidance guidance. Read the specific threshold, age, formulation and dialysis exclusions; do not generalize across products.
Ontario Health (Cancer Care Ontario) · Adult IV pemetrexed in the Cancer Care Ontario monograph. Local combination protocols can add separate modifications.
Renal method: Creatinine clearance in mL/min. Source date: CCO Formulary, April 2023. Retrieved: 2026-11-07
Restriction or avoidance guidance. Read the specific threshold, age, formulation and dialysis exclusions; do not generalize across products.
The monograph retains the previous pemetrexed dose when CrCl is at least 45 mL/min and directs discontinuation below 45. It calls for particular caution with NSAIDs at 45-79 mL/min. Confirm treatment eligibility and toxicity recovery before each cycle.
RDM73-alimta-professional-1 · Source locator: Dosage with Renal Impairment, page 7 of 11
Additional summaries stored on this page: 2 official-label, 1 RX List, 1 professional, 0 handbook. Empty additional-source groups are not shown. A missing layer is not a no-adjustment recommendation.
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This page is an additional exact-product entry, not a recovered GlobalRPh monograph. Its primary scope text and separately attributed clinical summaries are locally included.
