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Black Box Warnings .
admin. only under supervision of physician experienced in cancer chemotherapy
severe myelosuppression leading to infection or bleeding may occur; incr. myelosuppression w/ IV formulation compared to oral formulation
occur in 2% of pts receiving IV formulation, incl. anaphylaxis
incl. acute nonlymphocytic leukemia
produces chromosomal aberrations in vitro and in vivo, thus consider potentially mutagenic in humans
Adult Dosing .
Dosage forms: IV
- [uses, dosing may vary]
- Info: refer to institution protocols and pkg insert prior to prescribing for uses and dosing incl. toxicity-related dose adjustments
multiple myeloma, palliative tx
- [IV route]
- Dose: 16 mg/m^2 IV x1 on day 1 of 28-day cycle, starting cycle 5; Start: 16 mg/m^2 IV x1 on day 1 of 14-day cycle x4 cycles
- [adjust dose amount]
- mod-severe impairment: decr. start dose, amount not defined; HD/PD: not defined
- [not defined]
- hepatic impairment: caution advised
Peds Dosing .
Peds dosing is currently unavailable or not applicable for this drug.
- hypersens. to drug/class/compon.
- prior melphalan resistance
- pregnancy 1st trimester
- caution if CLL
- caution if renal impairment, mod-severe
- caution if hepatic impairment
Drug Interactions .
alkylating agent, nitrogen mustard
- immuno-myelosuppressive chemo
- adenovirus vaccine, live
- BCG live intravesical
- influenza nasal vaccine, live
- measles/mumps/rubella vaccine, live
- rotavirus vaccine, live
- smallpox vaccine (live vaccinia virus)
- typhoid vaccine, live
- varicella vaccine, live
- yellow fever vaccine, live
- zoster vaccine, live
- radium Ra 223 dichloride
- interferon alfacon-1
- interferon beta 1a
- mycophenolate mofetil
- mycophenolic acid
- anthrax vaccine
- diphtheria/tetanus and/or pertussis vaccine
- Haemophilus b conjugate vaccine
- hepatitis A vaccine
- hepatitis B vaccine
- human papillomavirus vaccine
- influenza H5N1 vaccine (avian flu)
- influenza vaccine
- Japanese encephalitis vaccine
- meningococcal vaccine
- pneumococcal vaccine
- poliovirus vaccine
- rabies vaccine
- typhoid vi polysaccharide vaccine
Adverse Reactions .
- hypersensitivity rxn
- secondary malignancy (long-term use)
- acute nonlymphocytic leukemia (long-term use)
- myeloproliferative syndrome (long-term use)
- bone marrow failure
- anemia, hemolytic
- cardiac arrest
- hepatic veno-occlusive dz
- interstitial pneumonitis
- pulmonary fibrosis
- extravasation/tissue damage (IV use)
- infertility (long-term use)
- injection site rxn (IV use)
- maculopapular rash
- ALT, AST elevated
- pulmonary infiltrates
Cr at baseline; CBC w/ diff at baseline, prior to each dose, and periodically
Look/Sound-Alike Drug Names
melphalan confused with: Mellaril; Myleran
Metabolism: plasma; CYP450: unknown
Excretion: feces 20-50%, urine (10% unchanged); Half-life: 60-90min
Subclass: Alkylating Agents 1: Nitrogen Mustards
Mechanism of Action
alkylates and cross-links DNA, inhibiting nucleic acid and protein synthesis
Approximate Retail Price
This information is currently not available for this drug.
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