melphalan
Melphalan (Alkeran) is an anticancer medication used to improve the quality of life (palliative care) for people with multiple myeloma or ovarian cancer. It’s a convenient pill that’s taken by mouth. This medication can also be given as an infusion into the vein (IV) for people with multiple myeloma. Melphalan (Alkeran) can raise your risk for serious infections and bleeding, so your provider will check your blood work closely.
What is Melphalan (Alkeran)?
What is Melphalan (Alkeran) used for?
Multiple myeloma - tablet and IV form
Ovarian cancer - tablet form only
How Melphalan (Alkeran) works
Melphalan (Alkeran) is a type of anticancer medication called an alkylating agent. It works by damaging the cancer cells’ genetic material, leading to cell death.
Drug Facts
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What are the side effects of Melphalan (Alkeran)?
Common Side Effects
- Low blood cell counts
- Nausea
- Vomiting
- Diarrhea
- Mouth ulcers
Other Side Effects
- Liver problems
- Rash
Serious Side Effects
- Serious infections: repeated fevers, chills, cough, trouble breathing, severe diarrhea, vomiting, painful or frequent urination
- Serious bleeds: bleeding or bruising that doesn’t stop or go away, large amount of bleeding, blood in the urine, throwing up blood, bloody or black and tarry stool
- Allergic reactions: throat tightness, trouble breathing, cough, itching or hives, flushing, swelling, chest pain, fast heartbeat, dizziness, fainting
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Infection—fever, chills, cough, sore throat, wounds that don't heal, pain or trouble when passing urine, general feeling of discomfort or being unwell
- Low red blood cell level—unusual weakness or fatigue, dizziness, headache, trouble breathing
- Unusual bruising or bleeding
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
Pros and cons of Melphalan (Alkeran)
Pros
Available as a pill that you take by mouth
Can be given IV for people with multiple myeloma who have trouble swallowing tablets
Cons
Can raise your risk for infections, bleeding, or bruising
Need to get blood work often during treatment
Can affect your ability to have children in the future
Pharmacist tips for Melphalan (Alkeran)
Follow your provider’s instructions on which days to take melphalan (Alkeran) during each treatment cycle. It’s important to take this medication exactly as directed to make sure it’s as safe for you as possible.
You’ll need to get blood work done regularly during melphalan (Alkeran) treatment. Follow the lab schedule your provider gives you. This is so your provider can keep track of your blood cell counts. Melphalan (Alkeran) can lower your blood cell counts and put you at risk for bleeding or developing infections. Tell your care team if you develop a fever.
Keep the melphalan (Alkeran) tablets in the refrigerator at 36°F to 46°F (2°C to 8°C). Keep the tablets in the original bottle or amber bottle to protect them from light.
Before getting any vaccinations, let your healthcare provider or pharmacist know you’re taking melphalan (Alkeran). They can make sure it's safe for you to get the vaccine. Melphalan (Alkeran) can lower your immune system, which can affect how your body reacts to certain vaccines.
If you’re a woman who can have children, speak with your provider about ways to avoid becoming pregnant while taking melphalan (Alkeran). Let your provider know right away if you or your partner becomes pregnant during treatment. This medication can harm an unborn baby.
Ask your healthcare provider or pharmacist about the best way to handle and dispose of the melphalan (Alkeran) tablets. This medication can be hazardous to people who handle or come into contact with them.
Frequently asked questions about Melphalan (Alkeran)
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What are the risks and warnings for Melphalan (Alkeran)?
Melphalan (Alkeran) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Must be given by a trained healthcare provider
Melphalan (Alkeran) must be given by or under the supervision of a healthcare provider who's trained in caring for people taking chemotherapy medications. You must receive treatment at a clinic, hospital, or care facility that’s able to closely check for side effects and give you proper medical care, if needed.
Low blood cell counts
Risk factors: Already having low blood cell counts from previous radiation or chemotherapy
Melphalan (Alkeran) can cause your red blood cell, white blood cell, and platelet counts to drop. When the number of these cells are lower than normal, you’re at risk of developing anemia, infections, and bleeding or bruising. In some cases, your blood cell counts might be low for a while. This is because your chemotherapy medications can weaken your bone marrow and affect its ability to make new blood cells like normal.
Your provider will closely check your blood counts through routine lab work when you’re taking melphalan (Alkeran). Let your provider know as soon as possible if you experience extreme tiredness, rapid breathing, fevers, chills, or bleeding and bruising that doesn’t stop or go away.
Risk for developing other cancers
Although rare, it’s possible that you can develop other types of cancers, such as blood cancers (e.g., leukemias), when you take melphalan (Alkeran). Talk to your provider if you’re concerned about your risk for other cancers.
Allergic reactions
While rare, melphalan (Alkeran) can cause allergic reactions, which can be serious. These reactions can happen after several courses of treatment or if you’ve had a reaction after receiving melphalan (Alkeran) infusion into your vein in the past. Contact your provider or get medical help right away if you experience any throat tightness, trouble breathing, hives or rashes, swelling of the arms or legs (edema), fast heartbeat, or dizziness.
Harm to unborn baby and effects on fertility
Based on findings from animal studies, melphalan (Alkeran) can harm an unborn baby. If you’re a woman who can have children, you should avoid becoming pregnant while taking this medication. Let your provider know right away if you or your partner becomes pregnant during treatment.
Melphalan (Alkeran) might also affect your ability to have a baby. If you or your partner are thinking about having a child in the future, talk to your provider about your different options before starting melphalan (Alkeran), such as sperm banking or egg freezing.
Melphalan (Alkeran) dosage forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 2mg | 50 tablets | $437.93 | $8.76 |
Typical dosing for Melphalan (Alkeran)
Multiple myeloma
Tablets: The typical dose is 6 mg by mouth once a day for 2 to 3 weeks, followed by an off period for up to 4 weeks. You’ll need to get lab work done regularly during this time so your provider can check your blood cell counts. Once your blood cell counts are trending up, the recommended maintenance dose is 2 mg daily.
Intravenous (IV): Your provider will calculate your dose of melphalan (Alkeran) using your body surface area (BSA, in units of m2), which takes into account your body weight and height. The typical dose is 16 mg/m2 given as an infusion through the vein every 2 weeks for 4 doses, followed by an off period. Once your blood cell counts are trending up, you’ll receive melphalan (Alkeran) every 4 weeks.
Ovarian cancer
Tablets: The dose depends on your weight. One typical dosing regimen is 0.2 mg/kg by mouth once a day for 5 days per cycle. Each cycle is repeated every 4 to 5 weeks depending on your blood cell counts.
Your dose might differ if you have kidney problems.
How much does Melphalan (Alkeran) cost?
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References
Best studies we foundActavis Pharma, Inc. (2022). MELPHALAN HYDROCHLORIDE kit [package insert]. DailyMed.
American Cancer Society. (2018). What is multiple myeloma?
American Cancer Society. (2018). What is ovarian cancer?
American Cancer Society. (2019). Chemotherapy safety.
American Cancer Society. (2020). Low platelet count (bleeding).
American Cancer Society. (2020). Preserving fertility in males with cancer.
American Cancer Society. (2023). Low red blood cell counts (anemia).
American Cancer Society. (2023). Low white blood cell counts (neutropenia).
American Society of Hematology. (n.d.). Blood cancers.
ApoPharma USA, Inc. (2023). Alkeran- melphalan tablet, film coated [package insert]. DailyMed.
Centers for Disease Control and Prevention. (n.d.). What you need to know: Neutropenia and risk for infection.
Flint, B., et al. (2023). Body surface area. StatPearls.
InformedHealth.org. (2016). Causes and signs of edema. Institute for Quality and Efficiency in Health Care.
National Cancer Institute. (n.d.). Alkylating agent.
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