MELPHALAN
Background and Date of Approval
Melphalan is an anticancer agent belonging to the alkylating agents class of medications. It received FDA approval in 1964 for use in multiple myeloma, advanced breast cancer, ovarian cancer, polycythemia vera, childhood neuroblastoma, malignant melanoma, and soft tissue sarcoma.
Uses
Melphalan is available as a tablet and injection. It is used to treat multiple myeloma (a type of cancer of the bone marrow). It is also used to treat advanced ovarian cancer. It is also indicated to treat childhood neuroblastoma (cancer of the nervous system), malignant melanoma (skin cancer), and soft tissue sarcoma (cancer of the muscle, fat, fibrous tissue, blood vessels, or other supporting tissues of the body). It is also indicated to treat polycythemia vera ( a disease that increases the number of red cells in your blood. This makes the blood thicken and causes blood clots). It works by reducing the number of abnormal cells your body makes.
How is it administered?
Melphalan is available as a tablet and injection. Melphalan injection will be administered to you by a doctor or other healthcare professional in a hospital setting trained in cancer chemotherapy. This injection can be given as an infusion into your vein, or it will be given as a perfusion to a particular part of your body through an artery. If you are prescribed the tablet. Take the tablet at the same time, with or without food. Do not break, chew, crush, or break the tablet. Swallow the whole tablet with water. Your doctor will decide the dose, route of administration, and duration of the therapy based on your disease status, severity, and other factors such as body weight, other disease conditions, and age.
Side Effects
The common side effects include decreased blood cell count, nausea, vomiting, diarrhea, mouth ulcers, and hair loss. Serious side effects include cardiac arrest, liver inflammation, hypersensitivity skin reactions, acute renal failure, and lung inflammation.
Warnings
This drug is indicated to cause serious allergic reactions. Report to your physician immediately if you have a rash, lumps or hives on the skin, swollen face, eyelids, or lips, sudden wheeziness, and chest tightness after consuming the medicine. Melphalan can cause fetal harm. Inform your physician if you are pregnant or planning to get pregnant during the treatment. This medicine may cause infertility that is due to ovarian or testicular suppression.
Precautions
Inform your physician if you have had radiotherapy or cancer chemotherapy recently or have a kidney problem. Do not take Melphalan if you are allergic to melphalan or any of the other ingredients. Inform your healthcare provider about all the medicines you take, including prescription medications, over-the-counter medications, nutritional and vitamin supplements, and herbal products. Certain medications interact with melphalan and reduce its effectiveness by causing undesirable side effects. Use effective contraception during the treatment. Do not breastfeed during the treatment with this medicine because it may cause harm to the baby. Your healthcare professional may advise you to take certain blood tests to monitor the effectiveness and side effects of the therapy.
Word of Advice
Store melphalan tablets and injection in a refrigerator between 2°C and 8°C. Protect the medicine from light and excessive moisture. Keep the medicine out of reach of children and pets. If you forget to take a tablet, simply take your next dose at the scheduled time. Do not take a double dose to compensate for a forgotten dose. If you miss an injection dose, inform your healthcare professional immediately to reschedule. This medicine may cause changes in your blood levels. Your doctor may advise blood tests during treatment to monitor for unwanted side effects. This medicine may cause you to bleed, bruise, or develop infections more easily. Take precautions to prevent illness and injury.
References
Melphalan 50 mg Powder and Solvent for Solution for Injection/Infusion - Summary of Product Characteristics (SmPC) - (emc) [Internet]. www.medicines.org.uk. [revised on 2020] [cited 2023 Apr 7]. Available from: https://www.medicines.org.uk/emc/product/927/smpc HIGHLIGHTS OF PRESCRIBING INFORMATION - Melphalan injection [revised on 2017] [cited 2023 Apr 7]. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/207155s001lbl.pdf Melphalan 2 mg Tablets - Summary of Product Characteristics (SmPC) - (emc) www.medicines.org.uk. [revised on 2022] [cited 2023 Apr 7]. Available from: https://www.medicines.org.uk/emc/product/3806/smpc ALKERAN ® 2 - melphalan [revised on 2021] [cited 2023 Apr 7]. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2003/14691slr024_alkeran_lbl.pdf KD Tripathi, Essentials of Medical Pharmacology, Anticancer drugs, 7th edition, 2013, 860.
Frequently Asked Questions
Can a patient with kidney problems take melphalan?
Melphalan should be cautiously taken if you have any kidney problems. Dose adjustments are necessary for patients with kidney diseases. Inform your doctor if you are on dialysis and have any kidney disorders.
Does melphalan weaken the immune system?
The medicine can suppress your immune system and increase your chances of getting infections. Take precautions to prevent illness and injury.
What if I overdose or take two doses of melphalan?
If you unknowingly overdosed or took two doses of melphalan, immediately inform your healthcare professional and seek medical advice.
What if I miss a dose of melphalan?
Do not miss your dose. Keep all your appointments with the dosing regularly. In case, if you forget or missed an appointment inform your healthcare professional and reschedule the dosing.
Does melphalan cause hair loss?
Thinning or loss of your hair will usually start within two to four weeks of your first dose of melphalan. You may also have thinning or loss of eyelashes, eyebrows, and other body hair. Consult your doctor if you have excessive hair loss.