Composition
Tab 2 mg/5 mg: Melphalan 2 mg/5 mg. Inj: Melphalan 100 mg.
Indications & Dosage
Multiple myeloma: ORAL: Adult: 6 mg/day initially adjusted as indicated or 0.15 mg/kg/day for 7 days or 0.25 mg/ kg/day for 4 days; repeat at 4 to 6 wk intervals. Children: 4-20 mg/m2/day for 1-21 days (consult product literature). BY IV INJ, OR BY IV INF: Adult: Central line IV bolus dose of 17-200 mg/m2have been infused over 2-20 min. Peripheral line IV bolus dose of 2-23 mg/m2 have been infused over 1-4 min (consult product literature). Polycythaemiavera: Adult: Initially 6-10 mg daily for 5-7 days, thenreduced to 2-4 mg daily until satisfactory response, then reduced to 2-6 mg once weekly. Ovarian carcinoma: Adult: 0.2 mg/kg/day for 5 days; repeat at 4 to 5 week. localized malignant melanoma of the extremities, localized soft-tissue sarcoma of the extremities: BY REGIONAL ARTERIAL PERFUSION: Adult: (consult product literature).
Administration
Due to limited stability, complete administration of IV dose should occur within 60 min of reconstitution. IV infusion: IV dose is FDA approved for administration as a single infusion over 15-20 min.IV Bolus: Con-centration of 5 mg/ml. Immediately dilute dose in NS to a concentration 0.45 mg/ml. If the solution is highly unstable, administration should occur within 1 hour of dissolution.
Compatibility
Incompatible with DSW, LR
Contraindications
Hypersensitivity, severe bone marrow suppression, acute porphyrias
Precautions
Melphalan is mutagenic, carcinogenic, and ter-atogenic; produces amenorrhoea. Use with caution in patients with bone marrow suppression, impaired renal function or who have received prior chemotherapy.
Interactions
Cyclosporin, cimetidine and H2 antagonists.
Pregnancy
Positive evidence of risk: Avoid
Lactation
Contraindicated. Discontinue breast-feeding
Side Effects
Alopecia, bone-marrow suppression (delayed), hyperuricaemia, male sterility, nausea, oral mucositis, premature menopause, secondary malignancy, thromboembolism, tumourlysis syndrome, vomiting, extravasation (with IV use). Rare: Interstitial pneumonitis, life threatening pulmonaryfibrosis