Melphalan

Melphalan is a prescription medication used to treat multiple myeloma (a type of cancer of the bone marrow). It may also be used to treat a certain type of ovarian cancer (cancer that begins in the female reproductive organs where eggs are formed). Melphalan belongs to a group of drugs called alkylating agents. It works by stopping or slowing the growth of cancer cells in your body.

This medication comes in tablet form and is usually taken once a day. 

This medication is also available in an injectable form to be given directly into a vein (IV) by a healthcare professional.

Common side effects include nausea, vomiting, diarrhea, and mouth ulcers. Melphalan can also make you feel tired. Do not drive or drive heavy machinery until you know how this medication affects you. 

Melphalan is a prescription medication used to treat multiple myeloma (a type of cancer of the bone marrow). It may also be used to treat a certain type of ovarian cancer (cancer that begins in the female reproductive organs where eggs are formed).

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

Melphalan may be found in some form under the following brand names:

• Alkeran

• Evomela

Common side effects of melphalan include the following:

• nausea
• vomiting
• diarrhea
• mouth ulcers
• fatigue (feeling tired)
• a decrease in blood counts
• low potassium
• dizziness
• decrease in appetite 
• stomach pain

This is not a complete list of melphalan side effects. Ask your doctor or pharmacist for more information.

Tell your doctor if you have any side effect that bothers you or that does not go away.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Tell your doctor about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take:

• cyclosporine (Gengraf, Sandimmune, Neoral)
• carmustine (BiCNU, Gliadel)
• cisplatin

This is not a complete list of melphalan drug interactions. Ask your doctor or pharmacist for more information.

Serious side effects have been reported with melphalan including the following:

• Lowered blood counts. This is medically known as bone marrow suppression. Your doctor may monitor for bone marrow suppression, as it can lead to thrombocytopenia, anemia, and leukopenia
  • Thrombocytopenia. This is a condition in which your blood has a lower than normal number of blood cell fragments called platelets. Tell your healthcare provider right away if you have the following signs and symptoms of thrombocytopenia:
    • mild to serious bleeding
    • purple, brown, and red bruises (purpura)
    • small red or purple dots on your skin (petechiae)
    • prolonged bleeding, even from minor cuts
    • bleeding or oozing from the mouth or nose, especially nosebleeds or bleeding from brushing your teeth
    • abnormal vaginal bleeding (especially heavy menstrual flow)
    • blood in the urine or stool or bleeding from the rectum. Blood in the stool can appear as red blood or as a dark, tarry color. Taking iron supplements also can cause dark, tarry stools.
    • headaches and other neurological symptoms. These problems are very rare, but you should discuss them with your doctor.
  • Anemia. This is a condition in which your blood has a lower than normal number of red blood cells. Tell your healthcare provider right away if you have the following signs and symptoms of anemia:
    • shortness of breath
    • dizziness
    • headache
    • coldness in the hands and feet
    • pale skin
    • chest pain
  • Neutropenia. This is when there is an abnormally low number of white blood cells. These cells, which are called neutrophils, help the body fight infection. Those who develop neutropenia are more likely to have fevers and infections.
• Serious skin reactions such as rash or skin tissue death
• Inflammation of the blood vessels
• Hair loss
• Severe allergic reaction. Tell your healthcare provider about any signs or symptoms of hypersensitivity, which include the following:
  • chest pain
  • swelling of the face, eyes, lips, tongue, arms, or legs
  • difficulty breathing or swallowing
  • rash
• Pulmonary fibrosis. This is a condition in which the tissue deep in your lungs becomes scarred over time. This tissue gets thick and stiff. That makes it hard for you to catch your breath, and your blood may not get enough oxygen.
• Interstitial pneumonitis. This is when the lungs are inflamed and become scarred. The inflammation and scarring make it hard to get enough oxygen.
• Redness and sores of the lining of the mouth, lips, throat, stomach, and genitals (mucositis). Discomfort or pain due to mucositis may happen during treatment with melphalan. Your doctor will tell you about ways to maintain nutrition and help control the discomfort from mucositis.
• Nausea, vomiting, and diarrhea are common with melphalan and can sometimes be serious. Tell your doctor if you get nausea, vomiting, or diarrhea. Your doctor may prescribe medicines to help prevent or treat these side effects.
• Liver problems. Your doctor will check you for liver problems during treatment with melphalan. Tell your doctor right away if you get any of the following signs or symptoms:
  • yellowing of your skin or the whites of your eyes
  • severe nausea or vomiting
  • pain on the right side of your stomach-area (abdomen)
  • dark urine (tea colored)
• Secondary cancers. New cancers have happened in people who have been treated with melphalan.
• Infertility. Melphalan may cause fertility problems in males and females. Talk to your doctor if this is a concern for you.
• Melphalan may interfere with the normal menstrual cycle (period) in women and may temporarily or permanently stop sperm production in men.

Do not take melphalan if you are allergic to melphalan, to any of its ingredients, or if you have experienced resistance to this medication.

Medications can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of melphalan, there are no specific foods that you must exclude from your diet when receiving this medication.

Before taking melphalan, tell your doctor about all of your medical conditions. Especially tell your doctor if you:

• if you are allergic to melphalan or to any of its ingredients as well as any other medications.
• if you have taken melphalan before, but your cancer did not respond to the medication. Your doctor will probably tell you not to take melphalan.
• if you have received radiation therapy or other chemotherapy recently or if you have or have ever had kidney disease.
• have liver or kidney problems
• have an infection
• have nausea, vomiting or diarrhea
• are pregnant or plan to become pregnant. Melphalan may cause infertility (difficulty becoming pregnant); however, you should not assume that you cannot get pregnant or that you cannot get someone else pregnant. Because melphalan may harm the fetus, it is recommended not to plan to have children while receiving chemotherapy or for a while after treatments. Use a reliable method of birth control to prevent pregnancy.
• are breastfeeding or plan to breastfeed. It is not known if melphalan passes into your breast milk. 
• have received vaccinations recently or are planning to receive vaccinations.

Tell your doctor about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

Tell your doctor if you are pregnant or plan to become pregnant.

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.

This medication falls into category D. It has been shown that use of melphalan in pregnant women caused some babies to be born with problems.

Based on its mechanism of action, melphalan can cause fetal harm when administered to a pregnant woman. 

You should not become pregnant during and after treatment with melphalan. Tell your doctor right away if you become pregnant during treatment with melphalan.

• Females who are able to become pregnant should use effective birth control during and after treatment with melphalan. Talk with your doctor about how long to use birth control after treatment with melphalan.
• Males who have female partners who are able to become pregnant should use effective birth control during and after treatment with melphalan. Talk with your doctor about how long to use birth control after treatment with melphalan.

However, in some serious situations, the benefit of using this medication may be greater than the risk of harm to the baby.

Tell your doctor if you are breastfeeding or plan to breastfeed. 

It is not known whether this drug is excreted in human milk. Melphalan should not be given to nursing mothers.

Take melphalan exactly as prescribed. 

Your doctor will do blood tests before and during your treatment with melphalan. 

Your doctor may prescribe medicines to help prevent nausea.

Oral:

• This medication comes in tablet form and is usually taken once a day. 
• The response may be very gradual over many months; it is important that repeated courses or continuous therapy be taken since improvement may continue slowly over many months, and the maximum benefit may be missed if treatment is abandoned too soon.

Injectable:

• This medication is available in an injectable form to be given directly into a vein (IV) by a healthcare professional.
• It will be administered over 15 to 20 minutes or between 15 to 30 minutes (depending on the product)

The dose your doctor prescribes will depend on many factors such as:

• the condition being treated
• which formulation you are taking (tablets or the intravenous formulation)
• how well your kidney works
• your body weight
• how you respond to the medication

The tablet form is usually taken once a day. 

The injectable form is to be given directly into a vein (IV) by a healthcare professional. Depending on the product, it will be administered over 15 to 20 minutes or between 15 to 30 minutes

With this medications, the response is gradual and may require repeated courses to realize the benefit. 

If you take too much this medication, call your healthcare provider or local Poison Control Center, or seek emergency medical attention right away.

If this medication is administered by a healthcare provider in a medical setting, it is unlikely that an overdose will occur. However, if an overdose is suspected, seek emergency medical attention.

• Store tablets at controlled room temperature 15° to 30°C (59° to 86°F). Protect from light.
• Store injectable in a refrigerator, 2° to 8°C (36° to 46°F). Protect from light.
• Keep this and all medications out of the reach.

Melphalan should be administered under the supervision of a qualified physician experienced in the use of cancer chemotherapeutic agents. Severe bone marrow suppression with resulting infection or bleeding may occur.

Melphalan is leukemogenic in humans. Melphalan produces chromosomal aberrations in vitro and in vivo and, therefore, should be considered potentially mutagenic in humans.

Injection:

Controlled trials comparing intravenous (IV) to oral melphalan have shown more myelosuppression with the IV formulation. Hypersensitivity reactions, including anaphylaxis, have occurred in approximately 2% of patients who received the IV formulation.