Melphalan

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Generic Name of Melphalan - Learn More

Melphalan

Melphalan Precaution - What You Need to Know

Before initiating treatment with Melphalan, patients must consult their healthcare provider to ensure it is safe for their specific condition. It is essential to consider the following precautions:

- Bone Marrow Suppression: Melphalan is a potent chemotherapy drug that can lead to bone marrow suppression, causing a decrease in blood cell production, which increases the risk of infections, anemia, and bleeding. Regular blood tests to monitor blood cell counts are necessary during treatment.
- Liver Function: Melphalan is metabolized by the liver, and caution is required in patients with existing liver dysfunction. Adjustments in the dose or monitoring may be needed for patients with liver disease (e.g., cirrhosis or hepatitis).
- Infections: Due to its effect on the immune system, patients are more susceptible to infections during treatment with Melphalan. Prophylactic antibiotics or antiviral medications may be required, depending on the patient's immune status.
- Pregnancy and Breastfeeding: Melphalan is teratogenic (harmful to a fetus) and should not be used during pregnancy. Women of childbearing age should use effective contraception while undergoing treatment with this drug. It is also contraindicated during breastfeeding as it can pass into breast milk and harm the infant.
- Cardiovascular Disease: Patients with heart conditions may need closer monitoring, as Melphalan can cause cardiotoxicity and impact heart function in certain individuals, especially when used in high doses or as part of a combination therapy.
- Renal Impairment: Patients with renal dysfunction should be monitored closely as impaired kidney function can affect drug clearance and increase the risk of side effects.

Melphalan Indication - Uses and Benefits

Melphalan is primarily used in the treatment of several types of cancers, especially in hematological malignancies and solid tumors:

- Multiple Myeloma: Melphalan is commonly used in combination with other drugs in the treatment of multiple myeloma, a cancer of the bone marrow that affects plasma cells.
- Ovarian Cancer: It is also indicated for the treatment of ovarian cancer, especially in patients who have not responded well to other chemotherapy drugs.
- Breast Cancer: Melphalan may be used for treating breast cancer, particularly in cases of metastatic disease or when other treatments have failed.
- Hodgkin’s Lymphoma and Non-Hodgkin’s Lymphoma: In combination with other chemotherapy agents, Melphalan is used in the treatment of lymphoma, a cancer of the lymphatic system.
- Alkylating Agent for Bone Marrow Transplantation: It is part of the chemotherapy regimen used before stem cell transplants for hematologic cancers.

Melphalan Contraindications - Important Warnings

Melphalan should not be used under the following conditions:

- Hypersensitivity: It is contraindicated in patients who have had an allergic reaction to Melphalan or any of its ingredients.
- Severe Bone Marrow Suppression: Patients with severe bone marrow suppression (e.g., neutropenia, thrombocytopenia, or anemia) should not receive Melphalan, as it can exacerbate these conditions.
- Active Infections: Individuals with active infections (especially those requiring systemic treatment) should not be treated with Melphalan until the infection is resolved, as the drug suppresses immune function.
- Severe Liver Impairment: Melphalan is contraindicated in patients with severe liver dysfunction (e.g., cirrhosis), as the liver plays a role in metabolizing the drug, and impaired liver function can result in drug accumulation and toxicity.
- Pregnancy and Lactation: As mentioned above, Melphalan is teratogenic and should not be used during pregnancy or breastfeeding.

Melphalan Side Effects - What to Expect

Common side effects of Melphalan include:

- Bone Marrow Suppression: This can lead to anemia, neutropenia (low white blood cells), and thrombocytopenia (low platelets), which increases the risk of bleeding, infection, and fatigue.
- Gastrointestinal Issues: Nausea, vomiting, diarrhea, and mouth sores are common side effects. Anti-nausea medications may be prescribed to help manage these symptoms.
- Hair Loss: Temporary hair loss is a common side effect due to the drug's effect on rapidly dividing cells, including those in hair follicles.
- Fatigue and Weakness: Patients often feel extremely tired or weak due to the bone marrow suppression and the overall effects of chemotherapy.
- Liver Toxicity: Symptoms of liver dysfunction, such as yellowing of the skin or eyes (jaundice), abdominal pain, or dark urine, may occur.
- Cardiovascular Effects: Melphalan can cause heart toxicity, which may manifest as arrhythmias (irregular heartbeats) or heart failure in rare cases.

Severe side effects, though rare, include:

- Secondary Malignancies: Long-term use of Melphalan can increase the risk of developing other cancers, such as leukemia or solid tumors.
- Severe Allergic Reactions: This includes symptoms such as rash, swelling of the face or throat, and difficulty breathing, indicating anaphylaxis.

Patients should report any unusual or severe side effects to their healthcare provider promptly.

Melphalan Pregnancy Category ID - Safety Information

4

Melphalan Mode of Action - How It Works

Melphalan is an alkylating agent that works by interfering with the DNA of cancer cells. The drug's primary mechanism involves the alkylation of DNA, which leads to cross-linking between DNA strands. This cross-linking prevents the cancer cell from replicating properly and induces cell death. It primarily affects rapidly dividing cells, which is why it is effective in treating cancers like multiple myeloma and ovarian cancer. However, because Melphalan affects both normal and cancerous cells, it also causes significant side effects related to the suppression of healthy cells, such as bone marrow cells.

Melphalan Drug Interactions - What to Avoid

Melphalan may interact with other drugs, foods, or herbal products. It is essential to notify healthcare providers about all medications being taken. Potential interactions include:

- Other Chemotherapy Drugs: Concurrent use of other alkylating agents, such as cyclophosphamide, or platinum-based drugs, can increase the risk of severe bone marrow suppression, gastrointestinal toxicity, and renal dysfunction.
- Live Vaccines: Melphalan can suppress the immune system, making it risky to administer live vaccines during or after treatment (e.g., measles, mumps, rubella, and yellow fever vaccines).
- Anticoagulants: Melphalan may affect the blood's clotting ability, and combining it with anticoagulants (e.g., warfarin) may increase the risk of bleeding. Close monitoring is necessary.
- CYP450 Enzyme Interactions: Melphalan may interact with CYP450 enzyme inhibitors or inducers, which could alter its metabolism. For example, ketoconazole (a CYP450 inhibitor) may increase Melphalan levels in the body, while rifampin (a CYP450 inducer) may reduce its effectiveness.
- Renal Toxicity: Combining Melphalan with drugs that are nephrotoxic, such as cisplatin or aminoglycoside antibiotics (e.g., gentamicin), can increase the risk of kidney damage.

Melphalan Adult Dose - Recommended Dosage

The dosage of Melphalan depends on the type of cancer and the patient’s health status. Typical adult doses include:

- Multiple Myeloma: Melphalan 0.15 mg/kg to 0.25 mg/kg orally per day for 4 to 6 weeks, depending on the treatment protocol.
- Ovarian Cancer: The typical dose is 0.2 mg/kg to 0.3 mg/kg intravenously, given every 3 to 4 weeks as part of a combination chemotherapy regimen.
- Stem Cell Transplantation: For high-dose therapy before bone marrow transplant, the dose is typically 140 mg/m² to 200 mg/m² IV, often combined with other agents.

Melphalan Child Dose - Dosage for Children

Melphalan is not commonly used in pediatric patients except in certain cancer treatment protocols, such as for pediatric bone marrow transplants. The pediatric dose varies based on the condition and treatment regimen, and it must be determined by an oncologist or hematologist with experience in treating children with chemotherapy.

As with all chemotherapy drugs, patients must consult their healthcare provider before starting or adjusting any treatment with Melphalan to ensure proper dosing, safety, and effectiveness tailored to their condition.

Melphalan Renal Dose - Dosage for Kidney Conditions

Melphalan is cleared through the kidneys, and dose adjustments are required in patients with renal impairment. For patients with creatinine clearance below 50 mL/min, the dose may need to be reduced, and close monitoring is essential to avoid toxicity.