Melphalan hydrochloride

Melphalan hydrochloride Brand Names- Alkeran | Evomela

What is Melphalan

Melphalan hydrochloride is a bifunctional alkylating agent that causes interstrand cross-linking with DNA.

Melphalan was approved by the FDA in 1964. Melphalan (Alkeran) tablets are approved for use in the palliative treatment of multiple myeloma; the injectable Alkeran formulation for IV use is reserved for patients with multiple myeloma who cannot take oral therapy.

Oral Alkeran is also indicated for the palliative treatment of unresectable, epithelial ovarian cancer.

In March 2016, a propylene glycol-free injectable formulation of melphalan (Evomela) was approved by the FDA for use as a high-dose conditioning treatment prior to an autologous stem-cell transplant in patients with multiple myeloma and for the palliative treatment of patients with multiple myeloma for whom oral therapy is not appropriate.

Indications

  1. amyloidosis
  2. multiple myeloma
  3. ovarian cancer
  4. stem cell transplant preparation

For the treatment of multiple myeloma

NOTE: Melphalan injection for intravenous administration has been designated by the FDA as an orphan drug for the treatment of patients with multiple myeloma for whom oral therapy is inappropriate.

Side Effects

  1. abdominal pain
  2. alopecia
  3. amenorrhea
  4. anaphylactoid reactions
  5. anemia
  6. anorexia
  7. azotemia
  8. bleeding
  9. bone marrow suppression
  10. bronchospasm
  11. cardiac arrest
  12. constipation
  13. diarrhea
  14. diarrhea
  15. dizziness
  16. dysgeusia
  17. dyspepsia
  18. dyspnea
  19. edema
  20. elevated hepatic enzymes
  21. fatigue
  22. fatigue
  23. fever
  24. fever
  25. GI bleeding
  26. hemolytic anemia
  27. hepatitis
  28. hypokalemia
  29. hypokalemia
  30. hypophosphatemia
  31. hypophosphatemia
  32. hypotension
  33. infection
  34. injection site reaction
  35. jaundice
  36. leukopenia
  37. lymphopenia
  38. maculopapular rash
  39. nausea
  40. nausea
  41. new primary malignancy
  42. oral ulceration
  43. oral ulceration
  44. peripheral edema
  45. pneumonitis
  46. pruritus
  47. pulmonary fibrosis
  48. rash
  49. renal failure (unspecified)
  50. serious hypersensitivity reactions or anaphylaxis
  51. sinus tachycardia
  52. sinusoidal obstruction syndrome (SOS)
  53. skin necrosis
  54. skin ulcer
  55. spermatogenesis inhibition
  56. stomatitis
  57. stomatitis
  58. thrombocytopenia
  59. urticaria
  60. vasculitis
  61. veno-occlusive disease (VOD)
  62. vomiting

Monitoring Parameters

  • CBC with differential
  • LFTs
  • serum creatinine/BUN

Contraindications

  • anemia
  • bleeding
  • bone marrow suppression
  • breast-feeding
  • contraception requirements
  • diarrhea
  • extravasation
  • geriatric
  • hepatitis
  • hepatotoxicity
  • infection
  • infertility
  • leukopenia
  • male-mediated teratogenicity
  • melphalan hypersensitivity
  • nausea/vomiting
  • neutropenia
  • new primary malignancy
  • pregnancy
  • radiation therapy
  • renal disease
  • renal impairment
  • reproductive risk
  • requires an experienced clinician
  • serious hypersensitivity reactions or anaphylaxis
  • thrombocytopenia
  • vaccination

Interactions

  • Alpha interferons
  • Amlodipine; Celecoxib
  • Antithymocyte Globulin
  • Azelastine; Fluticasone
  • Beclomethasone
  • Betamethasone
  • Budesonide
  • Budesonide; Formoterol
  • Carbamazepine
  • Celecoxib
  • Ciclesonide
  • Clozapine
  • Corticosteroids
  • Cortisone
  • Cyclosporine
  • Daclizumab
  • Deflazacort
  • Dexamethasone
  • Diclofenac
  • Diclofenac; Misoprostol
  • Diflunisal
  • Digoxin
  • Diphenhydramine; Ibuprofen
  • Diphenhydramine; Naproxen
  • Echinacea
  • Esomeprazole; Naproxen
  • Etodolac
  • Famotidine; Ibuprofen
  • Febuxostat
  • Fenoprofen
  • Fludrocortisone
  • Flunisolide
  • Flurbiprofen
  • Fluticasone
  • Fluticasone; Salmeterol
  • Fluticasone; Umeclidinium; Vilanterol
  • Fluticasone; Vilanterol
  • Formoterol; Mometasone
  • Hydrocodone; Ibuprofen
  • Hydrocortisone
  • Ibuprofen
  • Ibuprofen; Oxycodone
  • Ibuprofen; Pseudoephedrine
  • Indomethacin
  • Interferon Alfa-2a
  • Interferon Alfa-2b
  • Interferon Alfa-2b; Ribavirin
  • Interferon Alfa-n3
  • Interferon Alfacon-1
  • Ketoprofen
  • Ketorolac
  • Lansoprazole; Naproxen
  • Live Vaccines
  • Meclofenamate Sodium
  • Mefenamic Acid
  • Meloxicam
  • Methylprednisolone
  • Mometasone
  • Mycophenolate
  • Nabumetone
  • Naproxen
  • Naproxen; Pseudoephedrine
  • Naproxen; Sumatriptan
  • Nonsteroidal antiinflammatory drugs
  • Oxaprozin
  • Palifermin
  • Peginterferon Alfa-2a
  • Peginterferon Alfa-2b
  • Penicillamine
  • Piroxicam
  • Prednisolone
  • Prednisone
  • Rofecoxib
  • Sirolimus
  • Sulindac
  • Tacrolimus
  • Tolmetin
  • Triamcinolone
  • Tuberculin Purified Protein Derivative, PPD
  • Valdecoxib
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