Chemotherapy Patient Resource Area

Melphalan/Alkeran^®

Drug
Melphalan (generic name) is manufactured as Alkeran^® (trade name) (GlaxoSmithKline, Research Triangle Park, NC).

Action
Melphalan slows or stops the growth of cancer cells. It is in the class of drugs known as alkylating agents and is used to treat multiple myeloma and ovarian cancer.

What does the drug look like?
Melphalan is supplied as 2-mg, round, white tablets.

How long will I take the drug?
The length of treatment varies and depends on your diagnosis and how well your body responds to treatment.

How do I take the drug?
Melphalan is taken by mouth once a day on an empty stomach for several weeks. Some patients receive maintenance dosing for prolonged periods of time. The dose of melphalan is determined by your doctor, and your doctor and pharmacist will tell you how many tablets to take each day. Be sure to read the label on your medicine vial closely so that you take the dose you need. Swallow each tablet whole; do not chew them. If you miss a dose, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses. If you accidentally take too many pills or someone else accidentally takes your medicine, contact your doctor or the nearest emergency room immediately.

Storage
Store this medicine in the refrigerator. Keep your medication in its original container and keep the vial tightly closed and out of the reach of children or pets. Do not keep outdated medication that you no longer need. Ask your nurse or pharmacist how you should dispose of any medicine you do not use.

• Melphalan lowers the number of white blood cells in your blood, increasing your chance of getting an infection. Avoid crowds and people who have infections. Call your doctor immediately if you develop a temperature higher than 100.5^oF or have chills, a cough, or painful urination. Your complete blood count (CBC) will be monitored frequently throughout treatment, and dosage adjustments (or stopping treatment for a few days) may be needed.
• Melphalan also lowers the number of platelets in your blood, which are necessary for proper blood clotting. DO NOT take aspirin or aspirin-containing products. Call your doctor immediately if you notice unusual bleeding or bruising, have black or tar-like stools, see blood in your urine, or develop pinpoint red spots on your skin. Use a soft toothbrush, and use care when flossing. Your healthcare providers may give you suggestions on how to care for your mouth, and these directions should be followed carefully.
• Melphalan may cause mild to moderate nausea and vomiting. Eat small frequent meals and bland foods, and notify your doctor if the nausea and vomiting is severe. An antinausea medication can be prescribed if needed.
• Rarely, melphalan causes allergic reactions, usually after multiple courses of treatment. If you develop shortness of breath, itchy skin, or a rash, notify your doctor immediately. If symptoms are severe, notify emergency services (call 911).
• Melphalan may interfere with the normal menstrual cycle (period) in women and may stop sperm production in men. However, you must use a reliable method of birth control and not assume that you cannot get pregnant or get someone else pregnant. Women who are pregnant or would like to become pregnant need to discuss this with their doctors before taking this drug.
• Secondary cancers, including leukemia and myeloproliferative syndrome, have occurred in people who have taken melphalan. Some of the people also received other chemotherapy agents or radiation therapy, and the precise risk of developing a secondary cancer after taking melphalan is not known. The potential benefits of melphalan therapy must be weighed on an individual basis against the possible risk of inducing a second malignancy.

Drug interactions
Let your doctor know what medications you are taking. Also, if you are taking vitamins, herbs, or nutritional supplements, be sure to let your doctor know.

• Symptoms of an allergic reaction (sudden onset of shortness of breath, chest pain, rash, or itchy skin)
• Temperature (fever) higher than 100.5^oF
• Any signs of infection, such as chills or cough
• Painful urination
• Moderate to severe nausea and vomiting
• Any bleeding, such as from your nose or gums or in your urine
• Dark-colored (black or tar-like) stools
• Unusual bruising
• Pinpoint red spots on your skin