Melphalan Chemotherapy: Uses, Dosage, and Side Effects Explained

Summary of Key Points

Melphalan is a chemotherapy drug used to treat various cancers, including multiple myeloma, ovarian cancer, and breast cancer. It works by slowing or stopping the growth of cancer cells. Melphalan is available in different forms, and the dosage depends on the specific condition being treated. Like all chemotherapy medications, it can cause side effects, so it’s important to follow your doctor’s instructions closely.

Names of Medication

US Brand Name: Alkeran (Melphalan)

The generic name refers to the active ingredient in a medication, while the brand name is assigned by the manufacturer. In this case, Melphalan is the generic name.

Pharmacologic Category

Alkylating Agent

Melphalan belongs to a class of chemotherapy drugs known as alkylating agents. These medications work by damaging the DNA of cancer cells, preventing them from growing and dividing.

Melphalan Dosage

Melphalan is used to treat several types of cancer, and the dosing schedule varies depending on the specific condition. Always consult your doctor before making any changes to your dose. If you have concerns, our telemedicine providers are available to assist you.

Melphalan for Multiple Myeloma

For adults with multiple myeloma, the typical dose is 0.15 mg/kg/day, taken orally for 4 days, repeated every 6 weeks. Alternatively, intravenous (IV) administration may be used, with doses of 16 mg/m² given every 2 weeks.

Melphalan for Ovarian Cancer

The usual dose for ovarian cancer is 0.2 mg/kg/day, taken orally for 5 days, repeated every 4 to 6 weeks.

Melphalan for Breast Cancer

For breast cancer, the typical dose is 0.25 mg/kg/day, taken orally for 5 days, repeated every 4 to 6 weeks.

Melphalan for Neuroblastoma

In neuroblastoma, the dose is 0.2 mg/kg/day, taken orally for 5 days, repeated every 4 to 6 weeks.

Melphalan for Waldenström’s Macroglobulinemia

For Waldenström’s macroglobulinemia, the dose is 0.1 mg/kg/day, taken orally for 5 days, repeated every 4 to 6 weeks.

Melphalan for Non-Hodgkin Lymphoma

The dose for non-Hodgkin lymphoma is 0.25 mg/kg/day, taken orally for 5 days, repeated every 4 to 6 weeks.

Melphalan for Hodgkin Lymphoma

For Hodgkin lymphoma, the dose is 0.25 mg/kg/day, taken orally for 5 days, repeated every 4 to 6 weeks.

Melphalan for Melanoma

In melanoma, the dose is 0.25 mg/kg/day, taken orally for 5 days, repeated every 4 to 6 weeks.

Melphalan for Testicular Cancer

For testicular cancer, the dose is 0.25 mg/kg/day, taken orally for 5 days, repeated every 4 to 6 weeks.

Melphalan for Sarcoma

The dose for sarcoma is 0.25 mg/kg/day, taken orally for 5 days, repeated every 4 to 6 weeks.

Dosage Forms and Strengths

Oral tablets: 2 mg

Intravenous (IV) powder for injection: 50 mg

Administration Instructions for Melphalan

Melphalan can be taken orally or administered intravenously, depending on your condition and your doctor’s recommendation. If taking oral tablets, swallow them whole with water. Do not crush or chew the tablets. If receiving Melphalan through an IV, it will be administered by a healthcare professional. Always follow your doctor’s instructions, and if you have any questions, our telemedicine providers are here to help.

Melphalan Side Effects and Adverse Reactions

Like all medications, Melphalan can cause side effects. Some are common, while others are rare but more serious. If you experience any side effects, contact your healthcare provider immediately.

Common Side Effects:

1. Nausea and vomiting: Feeling nauseous or vomiting is a frequent side effect of chemotherapy.
2. Fatigue: Many patients experience unusual tiredness while taking Melphalan.
3. Hair loss: Temporary hair loss may occur during treatment.

Serious Side Effects:

1. Low blood cell counts (myelosuppression): Melphalan can reduce the number of white blood cells, red blood cells, and platelets, increasing the risk of infections, anemia, and bleeding.
2. Allergic reactions: Some patients may experience allergic reactions, including rash, itching, swelling, or difficulty breathing.
3. Secondary cancers: In rare cases, Melphalan may increase the risk of developing other cancers.

Contraindications for Melphalan

A contraindication is a specific condition where a medication should not be used because it may cause harm. If you have any of the following conditions, Melphalan may not be safe for you. Always consult your healthcare provider before starting or stopping any medication, and discuss these conditions with one of our telemedicine providers if applicable.

1. Hypersensitivity to Melphalan: If you are allergic to Melphalan or any of its components, taking it could lead to a severe allergic reaction, including rash, difficulty breathing, or swelling.
2. Severe Bone Marrow Suppression: Melphalan can further suppress bone marrow function, which is responsible for producing blood cells. If you already have low blood cell counts, this could lead to life-threatening complications like infections or bleeding.
3. Pregnancy: Melphalan can harm an unborn baby, potentially causing birth defects or miscarriage. It is contraindicated during pregnancy unless the benefits significantly outweigh the risks.
4. Breastfeeding: Melphalan can pass into breast milk and may harm a nursing infant. It is contraindicated in breastfeeding mothers.
5. Active Infections: If you have an active infection, Melphalan may weaken your immune system further, making it harder for your body to fight the infection.

Drug to Drug Interactions

Melphalan can interact with other medications, potentially increasing side effects or reducing its effectiveness. It’s important to inform your healthcare provider about all the medications you are taking, including over-the-counter drugs and supplements. Below are some common medications that may interact with Melphalan:

1. Cyclosporine (Neoral, Sandimmune): Combining these drugs may increase the risk of kidney damage and further suppress the immune system.
2. Live Vaccines (MMR, Varivax): Since Melphalan weakens the immune system, live vaccines may be less effective or could lead to infections.
3. Warfarin (Coumadin): Using Melphalan with blood thinners like Warfarin may increase the risk of bleeding.
4. Phenytoin (Dilantin): This anti-seizure medication may reduce the effectiveness of Melphalan.
5. Carboplatin (Paraplatin): When used together, these chemotherapy drugs can heighten the risk of bone marrow suppression.

Melphalan in Pregnancy

Is it Safe to Take Melphalan During Pregnancy?

No, Melphalan is not considered safe during pregnancy. It is classified as a Category D drug by the FDA, meaning there is evidence of risk to human fetuses based on adverse reaction data. Melphalan can cause birth defects or miscarriage. If you are pregnant or planning to become pregnant, it’s crucial to discuss alternative treatments with your healthcare provider. If you are already taking Melphalan and discover you are pregnant, contact your healthcare provider immediately to discuss your options.

Melphalan While Breastfeeding

Is it Safe to Take Melphalan While Breastfeeding?

No, Melphalan is not safe while breastfeeding. The drug can pass into breast milk and may harm a nursing infant. If you are breastfeeding, it’s important to avoid taking Melphalan. Discuss alternative treatments with your healthcare provider, or consider stopping breastfeeding if Melphalan is essential for your treatment.

Estimated Cost of Melphalan

The cost of Melphalan can vary depending on your location, pharmacy, and insurance coverage. Without insurance, a 30-day supply of Melphalan using a GoodRx coupon is estimated to cost between $400 and $600. Prices may fluctuate, so it’s a good idea to check with your pharmacy or use a prescription discount service like GoodRx for the most accurate pricing.

Possible Alternatives to Melphalan

Depending on your condition, alternative treatments or lifestyle changes may help manage your disease. Always consult your healthcare provider before making any changes to your treatment plan. Our telemedicine providers can assist in exploring these alternatives.

1. Multiple Myeloma: Alternatives include chemotherapy drugs like bortezomib (Velcade) or lenalidomide (Revlimid). Stem cell transplants and targeted therapies may also be options.
2. Ovarian Cancer: Alternatives may include carboplatin (Paraplatin) or paclitaxel (Taxol). Surgery and radiation therapy are also common treatments.
3. Breast Cancer: Hormonal therapies like tamoxifen or aromatase inhibitors, and targeted therapies like trastuzumab (Herceptin), may be alternatives.
4. Neuroblastoma: Other chemotherapy drugs like cyclophosphamide or radiation therapy may be considered. Immunotherapy is another option.
5. Waldenström’s Macroglobulinemia: Rituximab (Rituxan) and ibrutinib (Imbruvica) are common alternatives. Plasmapheresis may also help manage symptoms.
6. Non-Hodgkin Lymphoma: Alternatives include rituximab (Rituxan) and chemotherapy regimens like CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone).
7. Hodgkin Lymphoma: ABVD chemotherapy (Adriamycin, bleomycin, vinblastine, dacarbazine) is a common alternative. Radiation therapy may also be used.
8. Melanoma: Immunotherapy drugs like pembrolizumab (Keytruda) or nivolumab (Opdivo) are alternatives. Surgery and targeted therapies may also be considered.
9. Testicular Cancer: Cisplatin-based chemotherapy or surgery may be alternative treatments.
10. Sarcoma: Alternatives include doxorubicin or ifosfamide. Surgery and radiation therapy are also common treatments.

Recent Updates on Melphalan Research

Recent research on Melphalan has focused on improving delivery methods to reduce side effects and enhance its effectiveness. One promising area is the use of high-dose Melphalan in combination with autologous stem cell transplantation for multiple myeloma patients, which has shown improved survival rates in some cases. Researchers are also exploring the use of Melphalan alongside newer immunotherapy drugs to boost the immune system’s ability to fight cancer. Ongoing clinical trials are investigating Melphalan’s role in treating other cancers, such as ovarian cancer and neuroblastoma, in combination with targeted therapies.

If you’re interested in learning more about new treatment options or participating in clinical trials, discuss these possibilities with your healthcare provider. Our telemedicine providers can guide you through your options and connect you with the latest research.

James Kingsley

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