Melphalan (Oral)

Melphalan is an anti-cancer medication used in the treatment of cancer of the ovary and cancer of the bone marrow.

Overview

The medication kills the cancerous cells by stopping them from dividing and increasing in number. Once the cells die, the cancerous tumor shrinks.

Melphalan is known to cause what is described as 'œdelayed' side effects. These are effects that may show symptoms months or even years after treatment was completed.

Serious delayed side effects include other types of cancers, for example, myelodysplasia and leukemia (blood cancers).

Patients need to take extra precautions while using Melphalan and monitor themselves for side effects way after they completed treatment with this drug.

The medicine may lower white blood cell levels and weaken the immune system. This makes it easier for patients to get infections.

The drug may also reduce blood platelet levels. When this happens, it is difficult for blood to clot causing excess bleeding if certain injuries occur.

This generic drug, Melphalan, is sold in the US as the brand named, Alkeran. It is supplied as an oral tablet which is available to patients by doctor's prescription only. It is also used to treat other conditions and administered in other ways not discussed here.

Type Of Medicine

  • Alkylating agent

Conditions Treated

  • Ovarian cancer
  • Bone marrow cancer

Side Effects

Unwanted symptoms may occur due to taking Melphalan. These are called adverse side effects. Other side effects that occur may be expected or required as the medicine works to treat your ovarian cancer or bone marrow cancer.

Side effects may range from mild to severe. Some of them are transient (go away after a short period of time). Serious or severe side effects usually need urgent medical attention.

You should pay attention to unusual symptoms even after your treatment ends. Patients have experienced side effects of this drug many months or years later. The development of leukemia (blood cancer) is one of the delayed side effects that have occurred in patients.

Call your doctor right away if you experience any of the following side effects:

Less commonly occur

  • Chills
  • Fever
  • Troubled breathing
  • Shortness of breath
  • Stool that is black or tarry
  • Cough or hoarseness (present with chills or fever)
  • Heartbeats that are fast or irregular
  • Pain in the lower back or side (present with chills or fever)
  • Bloodstained urine or stools
  • Pinpoint red spots on the skin
  • Itching or skin rash that comes on suddenly
  • Unusual bruising or bleeding
  • Pain or difficulty urinating (present with chills or fever)

Rarely occur

  • Swelling of the lower legs or feet
  • Joint pain
  • Diarrhea
  • Sores on the lips or in the mouth
  • Difficulty swallowing
  • Redness and/or soreness in arm or leg

There are side effects that may occur that you can manage without having to seek medical attention. Some of them tend to go away on their own as time passes.

The following is a list of such side effects. If any of them occur but get worse, bothersome or do not go away, tell your doctor.

Less commonly occur

  • Nausea and vomiting

Some patients may experience other side effects not listed in this guide. If you notice any unusual symptoms that bother you, let your doctor or healthcare professional know.

You may talk to your doctor or healthcare professional about ways to manage side effects when they occur. They may also tell you how to reduce or prevent them from occurring.

You may report side effects by calling the U.S. Food and Drug Administration (FDA) at 1-800-FDA-1088.

Dosage

Melphalan (Alkeran) is usually supplied as 2 milligram (mg) tablets. The tablets may be given to you by itself or in combination with other drugs. You may have to take several cycles of treatment. Your doctor will decide on a treatment plan and tell you how to follow it.

Your dose, the strength of it, how often you take it, and the time between each dose will vary from other patients. It all depends on the condition you are being treated for and how long your treatment will last.

Follow all directions given to you by your pharmacist, doctor and the prescription label found on the packet of your medicine. You should also read the patient information leaflet that may be inserted into the medicine packet.

If you have any questions about the directions, ask your doctor or pharmacist to explain.

Missed dose

If you missed a dose of your medicine, take it as soon as possible or as directed by your doctor. If it is time to take the next dose, skip the missed dose and continue to take your doses as scheduled. Do not take an extra dose to make up for the missed dose.

Overdose

Call your local poison control center at 1-800-222-1222 if you overdose on this drug. If the patient collapses or is not breathing, call 911.

Interactions

Food, alcohol, tobacco or other substances

Your doctor may take precautions when treating you or give you special instructions regarding the use of food, alcohol, tobacco or other substances during treatment. Follow them carefully.

Other medicines

The following medicines may cause significant adverse interaction when used during treatment with Melphalan. It does not always mean that you must stop taking any of them in order to take Melphalan.

Your doctor may need to take precautions or make changes to ensure you are able to take all your medicines safely.

It is not recommended for you to use any of the following medicines with Melphalan. Your doctor may still go ahead and treat you with it but may change some of the other medicines you take.

  • Rotavirus Vaccine, Live
  • Measles Virus Vaccine, Live
  • Varicella Virus Vaccine
  • Mumps Virus Vaccine, Live
  • Rubella Virus Vaccine, Live

Usually, it is not recommended for you to use the following medicines during treatment with this cancer drug. If you are required to take any of them with Melphalan, your doctor may change the dose or how often you use any of your medicines.

  • Poliovirus Vaccine, Live
  • Typhoid Vaccine
  • Cholera Vaccine, Live
  • Influenza Virus Vaccine, Live
  • Smallpox Vaccine
  • Bacillus of Calmette and Guerin Vaccine, Live
  • Yellow Fever Vaccine
  • Adenovirus Vaccine

To avoid an increase in the risk of certain side effects, the following drug should not be used together with Melphalan. Your doctor may decide that due to your health it is best for you to use both medicines but may change the dose or how often you use any of them.

  • Buthionine Sulfoximine

There may be other medicines that cause adverse interaction with Melphalan that are not listed here. Speak with your doctor for more information.

Other Medical Problems

Ensure you tell your doctor if you have any other medical conditions, since they may be affected while you are taking the cancer treatment.

Let your doctor know especially if you have the following conditions as the medicine may cause them to become worse:

  • Low white blood cells in the blood (Leukopenia)
  • Bone marrow suppression
  • Low platelets in the blood (Thrombocytopenia)

To avoid an increase in side effects due to the slow removal of the medicine from their body, the medicine should be used with caution in patients with the following condition:

  • Kidney disease

Having the following conditions while being treated with Melphalan may increase the risk of developing severe diseases in other parts of the body:

  • Chickenpox (or recent exposure to)
  • Herpes zoster (shingles)

The drug may increase uric acid levels in the body and cause the following conditions in patients being treated for ovarian or bone marrow cancers:

  • Kidney stones (or history of)
  • Gout (or history of)

Melphalan may reduce the body's ability to fight off the following condition:

  • Infections

Warnings

  • Do not use Melphalan unless it was prescribed for you by your doctor.
  • Do not use it if you are allergic to it, to any of its inactive ingredients, or to any other medications.
  • Do not use the medicine if you are pregnant, plan to become pregnant or become pregnant while taking it. Call your doctor right away if you become pregnant during treatment. The medicine can harm an unborn baby.
  • Your doctor may advise you to take birth control. This advice may be given to either a male or a female patient. Follow your doctor's recommendation on forms of birth control that may work best.
  • If you are breastfeeding, tell your doctor. There is a chance the medicine could pass through your breastmilk and harm your breastfeeding infant.
  • The medicine may be safely used in children and elderly patients without causing any specific side effects different from those seen in younger adults. Use and dose in children must be determined by their doctor.
  • The drug may affect fertility (the ability to have children) in women and men. Speak with your doctor about precautions you can take to reduce the risk of this happening.
  • The use of the medicine may affect normal cells in the body and cause other side effects or medical problems. 'œDelayed' side effects may also occur months or even years after the medicine was used.
  • Therefore, call your doctor right away if you notice any unusual symptoms that bother you.
  • Melphalan is known to weaken the immune system of some patients, making it less able to fight off infections. Avoid contact with persons who have infections.
  • Call your doctor right away if you notice symptoms of an infection such as body aches, chills, fever or pain or difficulty urinating.
  • Do not take immunizations during or after treatment before talking to your doctor. Because the medicine weakens the immune system, there is a risk of you getting the infection the immunization is intended to prevent.
  • Avoid people who took the oral polio vaccine. This includes people in your household. Household members could pass the polio virus to you if they took the vaccine within several months before you began treatment with Melphalan.

To prevent this, avoid being in close contact with them, such as being in the same room for long periods. If this is not practical, you should wear a protective mask to cover your nasal and buccal cavities (nose and mouth).

  • The medicine may also lower the blood platelet levels in your body causing blood clotting to become difficult.

To reduce the risk of bruising or bleeding, your doctor may advise you to clean your teeth and gums in ways other than by using a toothbrush, toothpick, or dental floss.

  • Also, use sharp devices such as razors or finger or toenail cutters with care to avoid cutting yourself.
  • Avoid any activity, such as contact sport, which increases your risk for bruising or injury.
  • Check with your doctor before doing any dental procedure.
  • Take Melphalan only as directed by your doctor. Do not take more or less of it, do not take it more often, and do not take it for a longer period than your doctor ordered.
  • If you vomit after taking your dose, call your doctor for directions on what to do next. You may have to take it again.
  • Before taking this cancer medication, let your doctor know if you have or have a history of any other medical conditions.
  • Let your doctor know, especially if you have or have a history of liver or kidney disease, a weakened immune system due to certain diseases or from taking certain medication.
  • To avoid adverse interaction with Melphalan, tell your doctor of all medicines you are taking or plan to take. These include prescription and over-the-counter (OTC) medicines, and health products such as multivitamins, nutritional supplements or herbal products.
  • Let your doctor know, especially if you are taking or plan to take medicines such as cyclosporine, cimetidine, interferon alfa, carmustine or cisplatin.
  • If you have a history of taking radiation or chemotherapy, let your doctor know.
  • Keep all follow-up appointments with your doctor or lab to keep track of side effects and your progress during and after treatment.
  • If you are taking Melphalan together with other medicines, ensure you take each of them at the proper time. Your doctor may help you create a plan for taking all your medicines regularly and on time.

Storage

Store the medicine in a closed container, at room temperature. Keep away from moisture, heat, and direct light. Keep from freezing.

Keep out of the reach of children.

Using a safe method of disposal, throw away the medicine once it expires or is no longer needed.

You may ask your doctor, pharmacist or local waste disposal agency about safe ways to dispose of your medicines.

Summary

Melphalan is an effective medicine for the treatment of cancers such as ovarian cancer or cancer in the bone marrow.

But, it is not safe to use in pregnant women due to the risk of harm to an unborn baby. In addition, the cancer drug may cause problems with fertility in both men and women. The use of birth control becomes necessary to reduce the chance of infertility.

Despite its effectiveness, Melphalan causes post-treatment or 'œdelayed' side effects. Serious delayed side effects include other types of cancer, for example, myelodysplasia or leukemia (blood cancers).

These delayed effects may show up months or even years after treatment has ended. Due to this, patients are required to carefully monitor their symptoms during and after treatment with this medication.

Because the medicine decreases the number of white blood cells in the body, it becomes easier for patients to get infections. It also reduces the body's ability to fight off infections due to a weakened immune system.

Easy bruising and blood clotting problems are known to affect some patients. This may increase the risk of excessive bleeding if the patient suffers certain injuries.