Dangerous Drug: Melphalan (L-Pam, L-Phenylalanine Mustard, L-Sarcolysin)(mel’ fa lan)
Alkeran
PREGNANCY CATEGORY D
Drug Classes
Alkylating drug
Antineoplastic
Nitrogen mustard
Therapeutic Actions
Cytotoxic: Alkylates cellular DNA, thus interfering with the replication of susceptible cells, causing cell death; cell-cycle nonspecific.
Indications
Treatment of multiple myeloma, nonresectable epithelial ovarian carcinoma; use IV only when oral therapy is not possible
Unlabeled uses: Breast cancer, testicular cancer, bone marrow transplantation, polycythemia vera
Contraindications and Cautions
Contraindicated with allergy to melphalan, prior resistance to melphalan, lactation.
Use cautiously with radiation therapy, chemotherapy, pregnancy (potentially mutagenic and teratogenic; avoid use in the first trimester).
Available Forms
Tablets—2 mg; powder for injection—50 mg
Dosages
Individualize dosage based on hematologic profile and response.
Adults
Oral
Multiple myeloma: 6 mg/day PO. After 2–3 wk, stop drug for up to 4 wk, and monitor blood counts. When blood counts are rising, institute maintenance dose of 2 mg/day PO. Response may occur gradually over many months (many alternative regimens, some including prednisone, are used).
Epithelial ovarian carcinoma: 0.2 mg/kg/day PO for 5 days as a single course. Repeat courses every 4–5 wk, depending on hematologic response.
IV
Multiple myeloma: 16 mg/m2 administered as a single IV infusion over 15–20 min; administered at 2-wk intervals for 4 doses, then at 4-wk intervals.
Pediatric patients
Safety and efficacy not established.
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