Melphalan (ALKERAN)

Collapse All

Send in Email Print Collapse All Expand All

Indication

Multiple Myeloma

Dose

Multiple Myeloma

Oral: Multiple dosing schedules and doses exist, such as weight-based dosing, body surface area based dosing, and flat dosing (same dose regardless of patient). Please refer to local protocol being used.
Given in combination with chemotherapy

Supplied

Available as 2mg film-coated tablets. Tablets should NOT be crushed or opened. Store in refrigerator.

Pharmacological Category

Alkylating Agent

Administration

Take on an empty stomach at least 1 hour before or 2 hours after food

Missed Dose

If a dose is missed, patients should be instructed to take it as soon as they can if it is within 12 hours of the missed dose. If it is over 12 hours since the missed dose, patients should skip the missed dose and resume with the next scheduled dose.

Adverse Effects

Common: Nausea, Vomiting, Sore mouth, Fatigue, Diarrhea, Neutropenia, Thrombocytopenia.

Less Common: Hypersensitivity reactions, Pulmonary fibrosis, Interstitial pneumonitis.

The adverse effects listed above are not exhaustive. Please refer to the relevant product monograph for full details.

Monitoring Parameters

Baseline before treatment: CBC & differential, platelets, creatinine, urea, sodium, potassium, total bilirubin, ALT, alkaline phosphatase, calcium, albumin, beta-2 microglobulin, LDH, HCAb, HBsAg, HBcoreAb.

Every 4 weeks during treatment: CBC & differential, platelets, creatinine, urea, sodium, potassium, total bilirubin, ALT, alkaline phosphatase, calcium, albumin, beta-2 microglobulin, LDH.

Drug Interactions

Current drug interaction databases should be consulted for more information.

Clinical Pearls

Avoid in pregnancy and lactation.

References

BC Cancer. BC Cancer Drug Manual. Melphalan. Vancouver, British Columbia: BC Cancer Agency. Available at: http://www.bccancer.bc.ca/drug-database-site/Drug%20Index/Melphalan%20monograph.pdf. Updated February 1, 2024. Accessed February 2, 2024.

Lexicomp.Melphalan Monograph. In: Lexi-Drugs. Hudson, Ohio: Lexi-Comp, Inc. Available at: https://online-lexi-com.qe2a-proxy.mun.ca/lco/action/doc/retrieve/docid/patch_f/7238?cesid=1FVKumRuXR9&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3DMelphalan%26t%3Dname%26acs%3Dfalse%26acq%3DMelphalan. Updated January 16, 2024. Accessed January 26, 2024.

Cancer Care Ontario. Melphalan Monograph. Drug Formulary. Toronto, Ontario: Cancer Care Ontario. Available at: https://www.cancercareontario.ca/en/drugformulary/drugs/monograph/43801. Updated June 2019. Accessed January 22, 2024.

GlaxoSmithKline. ALKERAN® Product Monograph. Mississauga, Ontario. Updated February 12, 2019.