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Generic Name: melphalan (mel FAH lan)
Brand Names: Alkeran, Alkeran I.V.

What is Alkeran (melphalan)?

Melphalan is a cancer medication. Melphalan interferes with the growth of cancer cells and slows their growth and spread in the body.

Melphalan is used to treat multiple myeloma (a type of blood cancer), cancer of the ovary, and breast cancer.

Melphalan may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about Alkeran (melphalan)?

Melphalan can cause serious side effects, including: decreased bone marrow function and blood problems (easy bruising or bleeding, unusual weakness, fever, chills, body aches, flu symptoms, bloody or black stools, pale or yellowed skin, confusion or weakness); breathing problems; or liver damage (nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice [yellowing of the skin or eyes]). Call your doctor at once if you have any of these side effects.

In some cases, second cancers have been reported to occur during and after treatment with melphalan. Talk to your doctor about your individual risk and benefit of this medication.

What should I discuss with my healthcare provider before using Alkeran (melphalan)?

Before using melphalan, tell your doctor if you have:

• kidney disease; or

• decreased bone marrow (from other diseases or medications).

If you have any of these conditions, you may not be able to use melphalan, or you may need a dosage adjustment or special tests during treatment.

This medication can affect fertility (your ability to have children), whether you are a man or a woman.

How should I take Alkeran (melphalan)?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger or smaller amounts, or take it for longer than recommended by your doctor.

Your doctor may occasionally change your dose to make sure you get the best results from this medication.

Melphalan injection is given through a needle placed into a vein. Your doctor, nurse, or other healthcare provider will give you this injection in a clinic or hospital setting.

Melphalan is usually given for a few weeks at a time, followed by a 4-week period off the drug, during which your blood is tested to see how your body responded to the medication. Your doctor will determine how often you use melphalan and for how long. Follow your doctor's instructions carefully.

Melphalan can lower the blood cells that help your body fight infections. This can make it easier for you to bleed from an injury or get sick from being around others who are ill. To be sure your blood cells do not get too low, your blood will need to be tested on a regular basis. It is important that you not miss any scheduled visits to your doctor.

What happens if I miss a dose?

Contact your doctor if you miss a dose of melphalan.

What happens if I overdose?

Symptoms of a melphalan overdose may include severe nausea, vomiting, diarrhea, mouth sores, bloody or black stools, coughing up blood or vomit that looks like coffee grounds.

What should I avoid while taking Alkeran (melphalan)?

Avoid contact with people who have colds, the flu, or other contagious illnesses. Contact your doctor immediately if you develop signs of infection.

Do not receive a "live" vaccine while you are being treated with melphalan, and avoid coming into contact with anyone who has recently received a live vaccine. There is a chance that the virus could be passed on to you.

Alkeran (melphalan) side effects

• easy bruising or bleeding, unusual weakness;

• fever, chills, body aches, flu symptoms;

• nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);

• missed menstrual periods;

• unusual lumps or masses;

• red skin rash, rapid pulse, pain, weight loss;

• breathing problems or a cough that won't go away; or

• pale or yellowed skin, dark colored urine, confusion and weakness.

Other less serious side effects may be more likely to occur, such as:

• mild nausea, vomiting, diarrhea;

• white patches or sores inside your mouth or on your lips;

• temporary hair loss; or

• mild skin itching and rash.

In some cases, second cancers have been reported to occur during and after treatment with melphalan. Talk to your doctor about your individual risk and benefit in using this medication.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect Alkeran (melphalan)?

Before taking melphalan, tell your doctor if you are being treated with any other medicines that weaken your immune system, such as:

• cyclosporine (Gengraf, Neoral, Sandimmune);

• radiation therapy;

• steroids (prednisone and others); or

• another chemotherapy medicine.

If you are using any of these drugs, you may not be able to use melphalan, or you may need dosage adjustments or special tests during treatment.

There may be other drugs not listed that can affect melphalan. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

• Your pharmacist has additional information about melphalan written for health professionals that you may read.

What does my medication look like?

Melphalan is available with a prescription under the brand name Alkeran for both tablets and injection. Other brand or generic formulations may also be available. Ask your doctor or pharmacist any questions you have about this medication, especially if it is new to you.

• Alkeran 2 mg-round, white tablets

• Alkeran 50mg -dry powder vial for injection

• Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
• Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.