Classifications: antineoplastic; alkylating agent; Therapeutic:antineoplastic; alkylating agent
Pregnancy Category: D
2 mg tablets; 50 mg/vial injection
Forms a highly reactive carbonium ion which causes cross-linking and abnormal base-pairing in DNA, thereby interfering with
DNA as well as RNA replication and protein synthesis.
Strong immunosuppressive and myelosuppressive effects.
Chiefly for palliative treatment of multiple myeloma. Also many other neoplasms, including Hodgkin's disease and carcinomas
of breast and ovary.
Severe bone marrow suppression; hepatic disease; renal impairment, renal failure; severe electrolyte imbalance; lactation;
pregnancy (category D); men and women of childbearing age.
Recent treatment with other chemotherapeutic agents; concurrent administration with radiation therapy; severe anemia, neutropenia,
Route & Dosage
Adult: PO 6 mg/d for 23 wk, drug then withdrawn for 45 wk, restart at 2 mg/d when WBC and platelet counts start to rise IV 16 mg/m2 over 15 min q2wk for 4 doses
Epithelial Ovarian Cancer
Adult: PO 0.2 mg/kg/d for 5 d as single course, may repeat course q45wk
- Give with meals to reduce nausea and vomiting. An antiemetic may be ordered.
PREPARE: IV Infusion: Reconstitute melphalan powder by RAPIDLY injecting 10 mL of the provided diluent into the vial to yield 5 mg/mL. Shake vigorously until clear. Immediately dilute
further with NS to a concentration of 0.45 mg/mL or less. Note: 45 mg in 100 mL yields 0.45 mg/mL. Do not refrigerate reconstituted
solution prior to infusion.
ADMINISTER: IV Infusion: Give over ≥15 min. Administration MUST be completed within 60 min of reconstitution of drug because both reconstituted and diluted solutions are unstable.
INCOMPATIBILITIES Solution/Additive: D5W, Ringer's lactate. Y-site: Amphotericin B, chlorpromazine.
- Store at 15°30° C (59°86° F) in light-resistant, airtight containers.
Adverse Effects (≥1%)Hematologic: Leukopenia, agranulocytosis, thrombocytopenia, anemia
, acute nonlymphatic leukemia. Body as a Whole:
Uremia, angioneurotic peripheral edema. GI:
Nausea, vomiting, stomatitis
. Respiratory: Pulmonary
Increases risk of nephrotoxicity with cyclosporine, cimetidine
may decrease efficacy
Food decreases absorption.
Incompletely and variably absorbed from GI tract. Peak:
2 h. Distribution:
Widely distributed to all tissues. Metabolism:
By spontaneous hydrolysis in plasma
2550% in feces; 2530% in urine. Half-Life:
Assessment & Drug Effects
- Lab tests: Monitor WBC and platelet counts 23 times/wk during dosage adjustment period; determine WBC each week for
68 wk during maintenance therapy. Monitor serum uric acid levels.
- Monitor laboratory reports to anticipate leukopenic and thrombocytopenic periods.
- A degree of myelosuppression is maintained during therapy so as to keep leukocyte count in range of 30003500/mm3.
- Assess for flank and joint pains that may signal onset of hyperuricemia.
Patient & Family Education
- Be alert to onset of fever, profound weakness, chills, tachycardia, cough, sore throat, changes in kidney function, or prolonged
infections and report to physician.
- Understand that reversible hair loss is an expected adverse effect.