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Thymidylate synthase inhibitor

Raltitrexed (Specialist drug)

Brand names: Tomudex

Raltitrexed is an intravenous antifolate cytotoxic used as a specialist agent in advanced colorectal cancer and malignant mesothelioma.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

It is a direct and specific inhibitor of thymidylate synthase, depleting thymidine triphosphate and impairing DNA synthesis in dividing cells.

Prescribing in practice

  • It is contraindicated in significant renal impairment, as reduced clearance markedly increases the risk of severe and potentially fatal myelosuppression and gastrointestinal toxicity.
  • Administration is restricted to chemotherapy-experienced specialist oncology services with cytotoxic handling precautions.
  • It is contraindicated in pregnancy and breastfeeding and effective contraception is required.

Monitoring

Monitor full blood count and renal and liver function before each cycle.

Counselling the patient

  • Report fever, mouth ulcers, severe diarrhoea or unusual bleeding without delay.
  • Use reliable contraception during and after treatment as advised.
  • Keep all blood test appointments before each treatment.

Evidence & guidelines

Use is guided by the SPC and established oncology chemotherapy protocols.

Reference: SmPC; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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