- Drugs List
- Therapeutic Indications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
Melphalan oral formulations
Breast cancer - advanced
Myeloma - multiple
Treatment of carcinoma of the ovary
Treatment of polycythemia vera
Due to the complexity and specialist nature of dosage regimens for the treatment of malignant disease, specific dosing information on this agent is not included.
Doses may vary significantly if this agent is used as monotherapy or different combinations.
When using this agent, specialist literature, national guidelines, cancer networks protocols and Trust chemotherapy protocols should be consulted.
Melphalan is very rarely indicated in children and dosage guidelines have not been established.
Patients with Renal Impairment
Moderate to Severe renal impairment (creatinine clearance 30 to 50 ml/minute)
Initial dose may be reduced then escalated according to response.
Children under 12 years
Precautions and Warnings
Administration of live vaccines is not recommended
Give pre-treatment counselling and consideration of sperm cryopreservation
Treatment to be prescribed under the supervision of a specialist
Consult local policy on the safe use of oral anti-cancer drugs
Monitor blood counts regularly
Monitor closely patient with pre-existing renal impairment
Dose reduction may be required in myelosuppression &/or bone marrow aplasia
Interrupt therapy if leukocyte and platelet counts fall significantly
Consider dose reduction in renal impairment
Male & female: May cause infertility
Male & female: Ensure adequate contraception during treatment
Alkylating agents are not recommended for use in patients with porphyria. However N.A.P.O.S - The Drug Database for Acute Porphyria, classify melphalan as probably not porphyrinogenic.
Patients with renal impairment should be closely observed as they may also have uraemic marrow suppression. Dosage reduction may be necessary for such patients. A clinically significant rise in blood urea may occur in patients with pre-existing renal impairment.
Pregnancy and Lactation
Melphalan is contraindicated during pregnancy.
Melphalan is mutagenic and structurally similar to known teratogenic compounds. It is possible that melphalan could cause congenital defects in the offspring of patients treated with the drug. The potential hazard to the foetus must be balanced against the expected benefit to the mother.
The effect of concurrent therapies must also be considered.
The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14-17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Contraindicated in breastfeeding.
Due to the low molecular weight of melphalan, excretion into the breast milk is likely. Therefore there is the potential for severe toxicity in the nursing infant.
The effect of concurrent therapies must also be considered.
Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1
Abnormal liver function tests
Blood urea increased
Bone marrow depression
Sterility (male, permanent)
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Last Full Review Date: July 2013
British National Formulary, 65th Edition (2013) Pharmaceutical Press, London.
BNF for Children (2012-2013) Pharmaceutical Press, London.
Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.
Summary of Product Characteristics: Melphalan Tablets 2mg. Aspen Pharma Trading. Revised November 2011
The Renal Drug Handbook. 3rd edition. (2009) ed. Ashley, C and Currie, Radcliffe Publishing Ltd, Abingdon.
N.A.P.O.S - The Drug Database for Acute Porphyria
Last Reviewed 8th July 2010
Last Accessed 16th July 2013
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Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content
FDB Disclaimer : FDB Multilex is intended for the use of healthcare professionals and is provided on the basis that the healthcare professionals will retain FULL and SOLE responsibility for deciding what treatment to prescribe or dispense for any particular patient or circumstance.