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
- amyloidosis
- multiple myeloma
- ovarian cancer
- 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
- abdominal pain
- alopecia
- amenorrhea
- anaphylactoid reactions
- anemia
- anorexia
- azotemia
- bleeding
- bone marrow suppression
- bronchospasm
- cardiac arrest
- constipation
- diarrhea
- diarrhea
- dizziness
- dysgeusia
- dyspepsia
- dyspnea
- edema
- elevated hepatic enzymes
- fatigue
- fatigue
- fever
- fever
- GI bleeding
- hemolytic anemia
- hepatitis
- hypokalemia
- hypokalemia
- hypophosphatemia
- hypophosphatemia
- hypotension
- infection
- injection site reaction
- jaundice
- leukopenia
- lymphopenia
- maculopapular rash
- nausea
- nausea
- new primary malignancy
- oral ulceration
- oral ulceration
- peripheral edema
- pneumonitis
- pruritus
- pulmonary fibrosis
- rash
- renal failure (unspecified)
- serious hypersensitivity reactions or anaphylaxis
- sinus tachycardia
- sinusoidal obstruction syndrome (SOS)
- skin necrosis
- skin ulcer
- spermatogenesis inhibition
- stomatitis
- stomatitis
- thrombocytopenia
- urticaria
- vasculitis
- veno-occlusive disease (VOD)
- 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
