Home Drug Guide Melphalan

Drug Guide

Generic Name

Melphalan

Brand Names Alkeran

Classification

Therapeutic: Antineoplastic agent

Pharmacological: Alkylating agent

FDA Approved Indications

  • Multiple myeloma
  • Ovarian carcinoma

Mechanism of Action

Melphalan is an alkylating agent that causes cross-linking of DNA strands, leading to defective DNA synthesis and cell death, particularly in rapidly dividing cancer cells.

Dosage and Administration

Adult: Dose varies based on indication; typically 0.2-0.25 mg/kg/day for multiple myeloma, administered orally or intravenously, often in cycles.

Pediatric: Not commonly used; dosage and safety are not well established.

Geriatric: Adjustments may be necessary based on renal function and overall health.

Renal Impairment: Use with caution; dose adjustments may be required depending on renal function.

Hepatic Impairment: No specific guidelines; use cautiously and monitor hepatic function.

Pharmacokinetics

Absorption: Well absorbed orally.

Distribution: Widely distributed throughout body tissues; crosses the blood-brain barrier minimally.

Metabolism: Extensively hepatic via hydrolysis and conjugation.

Excretion: Primarily renal.

Half Life: Approximately 2-3 hours.

Contraindications

  • Hypersensitivity to melphalan
  • Myelosuppression (active or severe)

Precautions

  • Bone marrow suppression risk
  • Infection risk
  • Pregnancy and lactation (category C): use only if the potential benefit justifies the risk
  • Monitoring liver and kidney function during therapy

Adverse Reactions - Common

  • Myelosuppression (Very common)
  • Nausea (Common)
  • Mucositis (Common)

Adverse Reactions - Serious

  • Severe myelosuppression leading to infection, bleeding (Serious/Common)
  • Secondary malignancies (leukemia, other cancers) (Rare)
  • Alopecia (Common)

Drug-Drug Interactions

  • Other myelosuppressive agents
  • Cytotoxic chemotherapies
  • Radiation therapy

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor CBC, renal and hepatic function, observe for signs of infection or bleeding.

Diagnoses:

  • Risk for infection
  • Risk for bleeding
  • Imbalanced nutrition: less than body requirements

Implementation: Administer as prescribed; monitor blood counts regularly; provide infection control measures.

Evaluation: Assess for adverse effects, effectiveness of therapy, and patient's tolerance.

Patient/Family Teaching

  • Report signs of infection, bleeding, or unusual bruising immediately.
  • Use effective contraception during and for some months after therapy.
  • Avoid pregnancy; discuss fertility concerns with healthcare provider.
  • Expect side effects like nausea and hair loss; manage symptoms as advised.
  • Maintain good nutrition and hydration.

Special Considerations

Black Box Warnings:

  • Myelosuppression can be severe and life-threatening
  • Secondary malignancies

Genetic Factors: No specific genetic markers influence melphalan response.

Lab Test Interference: May cause false-positive urinary catecholamine tests.

Overdose Management

Signs/Symptoms: Severe myelosuppression, bleeding, infection, nausea, vomiting.

Treatment: Supportive care; no specific antidote. Hematopoietic growth factors or stem cell support may be considered in severe cases.

Storage and Handling

Storage: Store at controlled room temperature, protected from light.

Stability: Stable when stored properly; discard unused portions according to protocols.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.