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Drug Formulary
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melphalan

( MEL-fa-lan )
Other Name(s): Alkeran®
Appearance: Oral tablets; Injection - clear liquid mixed into larger bags of fluids
pdf download melphalan patient.pdf
pdf download melphalan pour le patient.pdf

Medication Information Sheet
melphalan (MEL-fa-lan)
This document provides general information about your medication. It does not replace the advice of your health care professional. Always discuss your therapy with your health care professional and refer to the package insert for more details.

Other Name: Alkeran®, L-PAM (Other Name)

Appearance:
Oral tablets; Injection - clear liquid mixed into larger bags of fluids

What is this medication for?
  • For treating blood cancers such as multiple myeloma and lymphomas, skin cancer (melanoma) and ovarian cancer.

What should I do before I have this medication?
  • Tell  your doctor if you have/had significant medical condition(s), especially if you have any allergies.
  • People with cancer have a higher risk of getting other cancers or developing blood clots. Some cancer medications may increase these risks, especially if used for a long period of time. Discuss any concerns about this medication with your health care team.
How will this medication affect sex, pregnancy and breastfeeding?
  • The use of this medication in men or women may cause harm to the unborn baby if pregnancy occurs. Let your health care team know if you or your partner is pregnant, becomes pregnant during treatment, or if you are breastfeeding
  • If there is ANY chance that you or your partner may become pregnant, you and your partner together must:►Use 2 effective forms of birth control at the same time while taking this drug: Keep using birth control until 6 months after the last dose (general recommendation). Discuss with your healthcare team.
  • Tell your doctor right away if you or your partner becomes pregnant.
  • Do not breastfeed while on melphalan treatment.
  • Effects on Fertility: Probable
How is this medication given?

Tablets:

  • Take it exactly as directed by your doctor. Make sure you understand the instructions. 
  • Swallow whole with a glass of water on an empty stomach, one hour before or two hours after a meal.

Injection form: 

  • Given by injection into a vein.
What else do I need to know while on this medication?

  • This medication can interact with other medications and can result in the treatment not working as well or cause severe side effects.

  • Make sure your health care team knows about all your medications (prescription, over-the-counter, herbals and supplements). Check with your health care team before starting or stopping any of them.

  • For mild aches and pain or fever:

    • If you feel unwell, take your temperature before taking any medications for pain or fever. They may hide a fever. 
       
    • You may take acetaminophen (Tylenol®) tablets. Ask your health care team about the right dose for you. 
       
    • Ibuprofen (Advil®, Motrin®), naproxen (Aleve®) or aspirin (acetylsalicylic acid, ASA), including low dose aspirin for heart conditions, may increase your chance of bleeding. Talk to your health care team before you start or stop these medications.
       
    • Talk to your health care team or go to the closest emergency room right away if you have a fever.  See the Fever pamphlet for more information.

  • Drinking alcohol and smoking during your treatment may increase some side effects and make your medication less effective. Speak to your health care team about smoking and drinking alcohol while on treatment.

How should I safely store this medication?
Tablets:
  • Keep refrigerated, but do not freeze.  Keep out of reach of children and pets.
  • Do not throw out any unused drugs at home. Bring them to your pharmacy for safe disposal.

 

What are the side effects of this medication?

Common side effects usually occur in more than 1 out of every 10 patients. Other side effects are less common, but may be severe. You may not have all of the side effects below. You may have side effects that are not listed.

Side effects and what to do When to contact doctor?
More Common Side Effects

Diarrhea (with high doses of the drug)

  • May occur days to weeks after the drug is given / after treatment starts
  • Drink plenty of clear fluids. Limit hot, spicy, fried foods, foods/drinks with caffeine, orange or prune juice. 
  • Try a low-fiber BRAT diet (Bananas, white Rice, Apple sauce, Toast made with white bread).
  • Take anti-diarrhea drug(s) if given to you by your doctor.
  • Also see Diarrhea pamphlet.*
 Contact your health care team if no improvement or if severe

Mouth sores (with high doses of the drug)

  • Maintain good mouth hygiene. Regular teethbrushing with a soft toothbrush or Toothette®, and  regular use of mouthwashes, especially after meals and at bedtime. Use alcohol-free mouthwashes.
  • Instead, try a homemade mouthwash: 
    Mix 1 teaspoonful of baking soda and 1 teaspoonful of salt in 4 cups (1L) of water.
  • Avoid hot, spicy, acidic, hard or crunchy foods.
  • Check with your doctor or nurse as soon as you notice sores in mouth/lips or pain with swallowing. Your doctor may prescribe a prescription mouthwash to relieve mouth sores and prevent infection.
  • Also see Mouth Care pamphlet.*
 Contact your health care team as soon as possible

Unusual bleeding or bruising

You may have black stools, cough up blood, blood in your urine, purple or red dots on your skin or bleeding that will not stop. 

Fever, chills, infection

You have a fever if your temperature taken in your mouth (oral temperature) is:

  • 38.3°C (100.9°F) or higher at any time OR
  • 38.0°C (100.4°F) or higher for at least one hour.

While you are getting chemotherapy treatments:

  • Keep a digital thermometer at home and take your temperature if you feel hot or unwell (for example, chills).
  • Avoid taking medications that treat a fever before you take your temperature (for example, Tylenol®, acetaminophen, Advil® or ibuprofen) as they may hide a fever.
  • Do not eat or drink anything hot or cold right before taking your temperature.
  • Wash your hands often.
  • Check with your doctor before getting any vaccines, surgeries or visiting your dentist.

If you have a fever, talk to your health care team or go to the closest emergency room. 
See our Neutropenia (Low white blood cell count) pamphlet for more information.

 

 Get emergency medical help right away

Nausea and vomiting

  • May occur in hours to days after the dose is given/ after treatment starts.
  • Drink clear fluids and avoid large meals. Get fresh air and rest.
  • Limit spicy, fried foods or foods with a strong smell.
  • Take anti-nausea drug(s) exactly as directed by your doctor. It is easier to prevent nausea than to treat it.
  • Contact your doctor if nausea lasts more than 1 day or if any vomiting occurs.
  • Also see Nausea & Vomiting pamphlet.*
 Contact your health care team if no improvement or if severe

Side effects and what to do When to contact doctor?
Less Common Side Effects, but may be Severe

Rapid killing of cancer cells when you start treatment may lead to build up of cell waste products

  • If mild, this may cause gout, with joint pains, but if severe, may cause fevers, kidney failure, confusion and be life-threatening.
  • You MUST take the preventive medicines given by your doctor AND
  • Drink plenty of fluids (6-8 glasses per day) and void (urinate) frequently.
 Get emergency medical help right away

Lung problems
(increased cough, breathing problems, chest pain, coughing blood)

 Get emergency medical help right away

Breakdown of muscle cells, may lead to kidney problems
(severe muscle pain or weakness, dark urine)

 Get emergency medical help right away

Inflammation of blood vessels
(may have symptoms such as numbness/weakness, muscle & joint pain, fever, fatigue, weight loss, loss of appetite)

 Get emergency medical help right away

Liver problems
(including weight gain, tender right side of belly, yellowing of the eyes)

 Get emergency medical help right away

For more links on how to manage your symptoms go to www.cancercareontario.ca/symptoms.

The information set out in the medication information sheets, regimen information sheets, and symptom management information (for patients) contained in the Drug Formulary (the "Formulary") is intended to be used by health professionals and patients for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or side effects of a certain drug, nor should it be used to indicate that use of a particular drug is safe, appropriate or effective for a given condition.

A patient should always consult a healthcare provider if he/she has any questions regarding the information set out in the Formulary. The information in the Formulary is not intended to act as or replace medical advice and should not be relied upon in any such regard. All uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information provided in the Formulary.

Funding & Reimbursement

Several payment sources exist for cancer drugs in Ontario, depending on the drug, disease indication, and how and where it is delivered.

View Funding & Reimbursement

Symptom Management

Many people living with cancer experience nausea, diarrhea and other symptoms from their treatment or disease.

View Symptom Management

Drug Safety and Administration

Find documents on drug safety and administration for healthcare providers, including calculations and recommendations.

View Drug Safety and Administration