Alkeran (Melphalan) – an effective anti-cancer chemotherapy drug

Alkeran (Melphalan) a chemotherapy drug that is used to treat certain types of cancer:

• multiple myeloma
• melanoma
• ovarian cancer
• breast cancer
• Neuroblastoma
• Rhabdomyosarcoma
• Used in some conditioning regimens prior to bone marrow transplant

Generic name: Melphalan

Other names: L-PAM, L-Sarcolysin, Phenylalanine Mustard

Alkeran belongs to a class of drugs known as alkylating agents. It works by slowing or stopping the growth of cancer cells.

Available as:

2 mg & 5 mg tablets.

How this drug is given:

• As a pill by mouth, usually, once a day as directed by your doctor. Tablets come in a 2mg size.
• Your doctor may direct you to take this medication on an empty stomach (1 hour before to 2 hours after meals). Follow your doctor’s directions closely.
• As an injection or infusion into the vein (intravenous).

The dosing of this medication is different for everyone. The amount of Alkeran that you will receive depends on many factors, including your height and weight, your general health or other health problems, and the type of cancer or condition being treated. Also, the dosage is based on your medical condition, response to treatment, and blood counts. Your doctor will determine your dose and schedule.

Unless your doctor instructs you otherwise, drink plenty of fluids while taking this medication. This helps your kidneys to remove the drug from your body and avoid some of the side effects.

Do not increase your dose or take this medication more often than prescribed. Your condition will not improve any faster, and the risk of serious side effects may be increased. Do not stop taking this medication without talking with your doctor, even if you feel nauseated or experience vomiting. If you vomit shortly after a dose, or if you miss a dose, contact your doctor immediately.

It may take several months before you see a benefit from this drug.

Missed dose:

Contact your doctor or pharmacist immediately for advice if you miss a dose.

What side effects are possible with Alkeran?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time. Contact your doctor if you experience these side effects and they are severe or bothersome:

• Hair loss. (rare with regular dosing, common with high-dose used for bone marrow transplant).
• loss of appetite
• loss of menses in women
• Nausea and vomiting (mild with regular dosing, can be severe with high-dose therapy; side effect are common and occurring in greater than 30%).
• Low blood counts. Your white and red blood cells and platelets may temporarily decrease. This can put you at increased risk for infection, anemia, and/or bleeding. This effect may be prolonged and cumulative (side effects are common and occurring in greater than 30%).

These side effects are less common (occurring in about 10-29%) of patients receiving Alkeran:

• Allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
• Mouth sores (mild with regular dosing, can be severe with high-dose therapy).
• Diarrhea (mild with regular dosing, can be severe with high-dose therapy).
• Loss of fertility. Meaning, your ability to conceive or father a child may be affected by Alkeran.
• Nephrotoxicity: uncommon with regular doses, seen when melphalan is given in high-doses used for bone marrow transplant.
• Arrhythmias: uncommon with regular doses, seen when melphalan is given in high-doses used for bone marrow transplant.
• Swelling of feet or lower legs
• Redness and/or soreness in arm or leg
• Joint pain

Stop taking the medication and seek immediate medical attention if any of the following occur:

• black, tarry stools or blood in urine or stools
• cough or hoarseness with fever or chills
• fast or irregular heartbeat
• fever of 100.4° F (38° C) or higher, chills (possible signs of infection)
• lower back or side pain with fever or chills
• painful or difficult urination with fever or chills
• pinpoint red spots on the skin
• shortness of breath, wheezing, difficulty breathing, closing up of the throat, swelling of facial features, hives (possible allergic reaction)
• sudden skin rash or itching
• unusual bleeding or bruising
• yellowing of the whites of the eye (jaundice or liver injury)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Delayed effects: There is a slight risk of developing a blood cancer such as leukemia or myelodysplasia after taking melphalan. Talk to your doctor about this risk.

Precautions:

1. Before using this medication, tell your doctor or pharmacist your medical history, especially of: blood problems (e.g., bone marrow depression), previous cancer chemotherapy, kidney problems, radiation treatment.
2. Before starting Alkeran treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.).
3. Do not receive any kind of immunization or vaccination without your doctor’s approval while taking Alkeran.
4. Since this drug can be absorbed through the skin and lungs, women who are pregnant or who may become pregnant should not handle this medication or breathe the dust from the tablets. All people should wash their hands carefully after handling this drug.
5. For both men and women: Do not conceive a child (get pregnant) while taking Alkeran. There is a possibility of birth defect if either the man or the woman is taking melphalan at the time of conception, or if it is taken during pregnancy. Barrier methods of contraception, such as condoms, are recommended. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy.
6. Do not breastfeed while taking this medication. This medication passes into breast milk. If you are a breastfeeding mother and are taking Alkeran, it may affect your baby.
7. To lower your risk of getting cut, bruised, or injured, use caution with sharp objects.
8. Fertility: Sterility may occur with the use of melphalan.
9. Gout: This medication may cause high levels of uric acid in the blood, making gout more likely to occur.
10. Alkeran may cause serious blood disorders (decreased bone marrow function leading to a low number of white blood cells/platelets and anemia). It can lower your body’s ability to fight infection and increase your risk of bleeding. Avoid contact with people with contagious infections. Higher doses and taking this medication more frequently increase the chance of these side effects. Your doctor will monitor you and perform blood tests, usually weekly at first. Your dose and any further treatment will be based on your blood tests. Keep all medical/lab appointments.
11. Alkeran may increase your risk of certain cancers (e.g., leukemia, carcinoma). Your doctor will monitor you carefully.

Self-care tips:

• If taking melphalan pills take on an empty stomach 1 hour before or 2 hours after meals.
• Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
• You may be at risk of infection so try to avoid crowds or people with colds and those not feeling well, and report fever or any other signs of infection immediately to your health care provider.
• Wash your hands often.
• To help treat/prevent mouth sores, use a soft toothbrush, and rinse three times a day with 1/2 to 1 teaspoon of baking soda and/or 1/2 to 1 teaspoon of salt mixed with 8 ounces of water.
• Use an electric razor and a soft toothbrush to minimize bleeding.
• Avoid contact sports or activities that could cause injury.
• This medication when taken as pills causes little nausea.  But if you should experience nausea, take anti-nausea medications as prescribed by your doctor, and eat small frequent meals.  Sucking on lozenges and chewing gum may also help.
• Avoid sun exposure.  Wear SPF 15 (or higher) sunblock and protective clothing.
• In general, drinking alcoholic beverages should be kept to a minimum or avoided completely.  You should discuss this with your doctor.
• Get plenty of rest.
• Maintain good nutrition.
• If you experience symptoms or side effects, be sure to discuss them with your health care team.  They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Storage:

Store in the refrigerator between 36-46 ° F (2-8 ° C) away from light and moisture. Keep all medicines away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed.