Melphalan
Cytostatic · Alkylating agent
Indications
Multiple myeloma, advanced ovarian adenocarcinoma.
Dosage
Dose should always be adjusted to patient response and weekly blood counts. ORAL: Adults: Multiple myeloma: 6 mg/day initially adjusted as indicated or 0.15 mg/kg/day for 7 days or 0.25 mg/kg/day for 4 days; repeat at 4 to 6 wk intervals. Ovarian carcinoma: 0.2 mg/kg/day for 5 days; repeat at 4 to 5 wk. Children: 4-20 mg/m²/day for 1-21 days. INFUSION: IV infusion administered as a single dose over 15-20 min. Adults: Central line IV bolus dose of 17-200 mg/m² have been infused over 2-20 min. Peripheral line IV bolus dose of 2-23 mg/m² have been infused over 1-4 min.
Administration
IV: Due to limited stability, complete administration of IV dose should occur within 60 min of reconstitution. IV infusion: IV dose is FDA approved for administration as a single infusion over 15-20 min. IV bolus: Central line: IV bolus doses of 17-200 mg/m2 have been infused over 2-20 min. Peripheral line: IV bolus doses of 2-23 mg/m2 have been infused over 1-4 min. Concentration of 5 mg/mL. Immediately dilute dose in NS to a concentration =0.45 mg/mL. If the solution is highly unstable, administration should occur within 1 hour of dissolution. Compatibility: Incompatible with D5W, LR.
Adverse Effects
Leukopenia and thrombocytopenia, irreversible bone marrow failure, alopecia, GI upset, suppression of ovarian function leading to amenorrhoea in many women.
Risk Factor (Pregnancy/Lactation)
Pregnancy: Positive evidence of risk: Use only when no safer alternative exists for a serious problem. Lactation: Contraindicated or not recommended. Contraindications: Hypersensitivity, severe bone marrow suppression. Precautions: Melphalan is mutagenic, carcinogenic and teratogenic; produces amenorrhoea. Use with caution in patients with bone marrow suppression, impaired renal function or who have received prior chemotherapy. Monitor blood counts; interrupt treatment if abnormally large fall in leucocyte or platelet counts.
Interactions
Cyclosporin, cimetidine and H2 antagonists, live vaccines, nalidixic acid.
Advice to Patient
Take oral forms atleast 1 hour before or 2 hours after meals. Contact prescriber if there is difficulty or pain on urination, unusual fatigue, chest pain, palpitations, difficulty in breathing, pain, redness, unusual bruising or bleeding. Avoid alcohol during therapy. Take small, frequent meals to maintain good nutritional status. Avoid highly crowded places to prevent infection. Avoid sharp knives, scissors and use soft toothbrush, cotton swabs to prevent bruising or bleeding.
Pharmacokinetics
Absorption: Oral: Variable and incomplete. Metabolism: Hepatic. Bioavailability: Oral: Variable; 56% to 93%; exposure is reduced by 36% to 54% with a high-fat meal. Half-life elimination: Terminal: IV: Approx. 75 minutes; Oral: 1.5 ± 0.83 hours. Time to peak, serum: Oral: Approx. 1 to 2 hours. Excretion: Feces (20% to 50%); urine (approx. 10% as unchanged drug).
Brands with this active ingredient
Compiled by Healify Pharmacy from published drug references. How we compile it →
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