Melphalan (Alkeran, Medphalan, Merphalan, Sarcolysin)

Class of Drugs: Alkylating agent

Manufacturer: Glaxo Wellcome, Inc.

Information on Patient Assistance program: Patient Assistance Program, (800) 722-9294

Description: Alkeran (Melphalan) is supplied as white tablets imprinted with "ALKERAN" and "A2A".

Ingredient: Melphalan

Use:
For the treatment of advanced breast cancer in postmenopausal women whose disease has progressed following tamoxifen therapy.

Warnings:

Patients should be informed that the major toxicities of melphalan are related to bone marrow suppression, hypersensitivity reactions, gastrointestinal toxicity, and pulmonary toxicity. The major long-term toxicities are related to infertility and secondary malignancies. Patients should never be allowed to take the drug without close medical supervision and should be advised to consult their physician if they experience skin rash, vasculitis, bleeding, fever, persistent cough, nausea, vomiting, amenorrhea, weight loss, or unusual lumps/masses. Women of childbearing potential should be advised to avoid becoming pregnant.

Other drugs such as cyclosporine (Sandimmune®), nalidixic acid (NegGram®), ciprofloxacin (Cipro®), norfloxacin (Noroxin®), ofloxacin (Floxin®) and cimetidine (Tagamet®) may interact with melphalan. Tell your doctor if you are taking these or any other drugs as the dose may need to be changed. Check with your doctor or pharmacist before you start taking any new drugs.

Side Effects:

As with other nitrogen mustard drugs, excessive dosage will produce marked bone marrow suppression.Your white blood cells will decrease 10-21 days after you begin taking melphalan. They will return to normal 18-40 days after you stop taking melphalan. White blood cells protect your body by fighting bacteria (germs) that cause infection. When they are low, you are at greater risk of having an infection. Bone marrow suppression, is the most significant toxicity associated with Melphalan in most patients. Therefore, the following tests should be performed at the start of therapy and prior to each subsequent course of melphalan: platelet count, hemoglobin, white blood cell count, and differential. Thrombocytopenia and/or leukopenia are indications to withhold further therapy until the blood counts have sufficiently recovered. Frequent blood counts are essential to determine optimal dosage and to avoid toxicity.

Hypersensitivity reactions, including anaphylaxis, have occurred rarely.

Carcinogenesis

Secondary malignancies, including acute nonlymphocytic leukemia, myeloproliferative syndrome, and carcinoma have been reported in patients with cancer treated with alkylating agents (including melphalan). Some patients also received other chemotherapeutic agents or radiation therapy. In one study, the 10-year cumulative risk of developing acute leukemia or myeloproliferative syndrome after melphalan therapy was 19.5% for cumulative doses ranging from 730 mg to 9,652 mg. In this same study, as well as in an additional study, the 10-year cumulative risk of developing acute leukemia or myeloproliferative syndrome after melphalan therapy was less than 2 for cumulative doses under 600 mg. This does not mean that there is a cumulative dose below which there is no risk of the induction of secondary malignancy. You must weigh the potential benefits from melphalan therapy against the possible risk of a second malignancy.

Melphalan causes suppression of ovarian function in premenopausal women, resulting in amenorrhea in a significant number of patients. Reversible and irreversible testicular suppression have also been reported. If you become pregnant melphalan may cause fetal harm.  

Your mouth and lips or throat may develop sores with higher doses. There are several medications that you rdocyor can prescribe to ease the discomfort. Brush your teeth gently after eating and at bedtime with a very soft toothbrush. If your gums bleed, use gauze or your finger instead of a brush. Make a mouthwash with ½ teaspoon baking soda or salt in 1 cup warm water and rinse several times a day. Try chilled or frozen yogurt and soft, bland food. Avoid spicy, crunchy or acidic food. Your skin may darken after you have taken melphalan for a while. This occurs most often in pressure areas such as elbows, knees and skin creases.

Return to Drug Index

This information is intended as reference and not as medical advice. All treatment decisions should be made with your team of medical professionals and prescriptions must be given by your doctor. See TERMS AND CONDITIONS.