Generic Name

Melphalan

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Classification

FDA Approved Indications

• Multiple myeloma
• Ovarian carcinoma

Mechanism of Action

Melphalan is an alkylating agent that causes cross-linking of DNA strands, leading to defective DNA synthesis and cell death, particularly in rapidly dividing cancer cells.

Dosage and Administration

Adult: Dose varies based on indication; typically 0.2-0.25 mg/kg/day for multiple myeloma, administered orally or intravenously, often in cycles.

Pediatric: Not commonly used; dosage and safety are not well established.

Geriatric: Adjustments may be necessary based on renal function and overall health.

Renal Impairment: Use with caution; dose adjustments may be required depending on renal function.

Hepatic Impairment: No specific guidelines; use cautiously and monitor hepatic function.

Pharmacokinetics

Absorption: Well absorbed orally.

Distribution: Widely distributed throughout body tissues; crosses the blood-brain barrier minimally.

Metabolism: Extensively hepatic via hydrolysis and conjugation.

Excretion: Primarily renal.

Half Life: Approximately 2-3 hours.

Contraindications

• Hypersensitivity to melphalan
• Myelosuppression (active or severe)

Precautions

• Bone marrow suppression risk
• Infection risk
• Pregnancy and lactation (category C): use only if the potential benefit justifies the risk
• Monitoring liver and kidney function during therapy

Adverse Reactions - Common

• Myelosuppression (Very common)
• Nausea (Common)
• Mucositis (Common)

Adverse Reactions - Serious

• Severe myelosuppression leading to infection, bleeding (Serious/Common)
• Secondary malignancies (leukemia, other cancers) (Rare)
• Alopecia (Common)

Drug-Drug Interactions

• Other myelosuppressive agents
• Cytotoxic chemotherapies
• Radiation therapy

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Patient/Family Teaching

• Report signs of infection, bleeding, or unusual bruising immediately.
• Use effective contraception during and for some months after therapy.
• Avoid pregnancy; discuss fertility concerns with healthcare provider.
• Expect side effects like nausea and hair loss; manage symptoms as advised.
• Maintain good nutrition and hydration.

Special Considerations

Black Box Warnings:

• Myelosuppression can be severe and life-threatening
• Secondary malignancies

Genetic Factors: No specific genetic markers influence melphalan response.

Lab Test Interference: May cause false-positive urinary catecholamine tests.

Overdose Management

Signs/Symptoms: Severe myelosuppression, bleeding, infection, nausea, vomiting.

Treatment: Supportive care; no specific antidote. Hematopoietic growth factors or stem cell support may be considered in severe cases.

Storage and Handling

Storage: Store at controlled room temperature, protected from light.

Stability: Stable when stored properly; discard unused portions according to protocols.