Melphalan (Alkeran®, Evomela®)
About This Drug
Melphalan is used to treat cancer and in the process of stem cell transplantation. It is given in the vein (IV) and orally (by mouth).
Possible Side Effects
- Bone marrow suppression. This is a decrease in the number of white blood cells, red blood cells, and platelets. This may raise your risk of infection, make you tired and weak (fatigue), and raise your risk of bleeding.
- Soreness of the mouth and throat. You may have red areas, white patches, or sores that hurt.
- Nausea and vomiting (throwing up)
- Diarrhea (loose bowel movements)
- Changes in your liver function
- Low potassium
- Thickening and/or inflammation (swelling) of the lung tissues. You may have a dry cough or trouble breathing.
- Hair loss. Hair loss is often temporary, although with certain medicine, hair loss can sometimes be permanent. Hair loss may happen suddenly or gradually. If you lose hair, you may lose it from your head, face, armpits, pubic area, chest, and/or legs. You may also notice your hair getting thin.
Note: Not all possible side effects are included above. These side effects may be more severe if you are receiving high doses of this medication included in pre-transplant chemotherapy.
Warnings and Precautions
- Severe bone marrow suppression
- Allergic reactions, including anaphylaxis are rare but may happen in some patients. Signs of allergic reaction to this drug may be swelling of the face, feeling like your tongue or throat are swelling, trouble breathing, rash, itching, fever, chills, feeling dizzy, and/or feeling that your heart is beating in a fast or not normal way. If this happens, do not take another dose of this drug. You should get urgent medical treatment.
- Severe changes in your liver function and blockage of small veins in the liver, which can cause liver failure and be life-threatening.
- This drug may raise your risk of getting a second cancer
Note: Some of the side effects above are very rare. If you have concerns and/or questions, please discuss them with your medical team.
- Talk to your doctor before receiving any vaccinations during your treatment. Some vaccinations are not recommended while receiving melphalan.
How to Take Your Medication
- For oral administration: Take this drug by mouth without food, at least 1 hour before you eat or 2 hours after you eat.
- Missed dose: If you vomit or miss a dose, take your next dose at the regular time, and contact your physician. Do not take 2 doses at the same time and do not double up on the next dose.
- Handling: Wash your hands after handling your medicine, your caretakers should not handle your medicine with bare hands and should wear latex gloves.
- This drug may be present in the saliva, tears, sweat, urine, stool, vomit, semen, and vaginal secretions. Talk to your doctor and/or your nurse about the necessary precautions to take during this time.
- Storage: Store tablets in the refrigerator, between 36°F to 46°F (2°C to 8°C). Do not freeze. Protect from light.
- Disposal of unused medicine: Do not flush any expired and/or unused medicine down the toilet or drain unless you are specifically instructed to do so on the medication label. Some facilities have take-back programs and/or other options. If you do not have a take-back program in your area, then please discuss with your nurse or your doctor how to dispose of unused medicine.
Treating Side Effects
- Manage tiredness by pacing your activities for the day.
- Be sure to include periods of rest between energy-draining activities.
- To decrease the risk of infection, wash your hands regularly.
- Avoid close contact with people who have a cold, the flu, or other infections.
- Take your temperature as your doctor or nurse tells you, and whenever you feel like you may have a fever.
- To help decrease the risk of bleeding, use a soft toothbrush. Check with your nurse before using dental floss.
- Be very careful when using knives or tools.
- Use an electric shaver instead of a razor.
- To help with hair loss, wash with a mild shampoo and avoid washing your hair every day.
- Avoid rubbing your scalp, pat your hair or scalp dry.
- Avoid coloring your hair.
- Limit your use of hair spray, electric curlers, blow dryers, and curling irons.
- If you are interested in getting a wig, talk to your nurse. You can also call the American Cancer Society at 800-ACS-2345 to find out information about the “Look Good, Feel Better” program close to where you live. It is a free program where women getting chemotherapy can learn about wigs, turbans and scarves as well as makeup techniques and skin and nail care.
- Drink plenty of fluids (a minimum of eight glasses per day is recommended).
- If you throw up or have loose bowel movements, you should drink more fluids so that you do not become dehydrated (lack of water in the body from losing too much fluid).
- To help with nausea and vomiting, eat small, frequent meals instead of three large meals a day. Choose foods and drinks that are at room temperature. Ask your nurse or doctor about other helpful tips and medicine that is available to help stop or lessen these symptoms.
- Mouth care is very important. Your mouth care should consist of routine, gentle cleaning of your teeth or dentures and rinsing your mouth with a mixture of 1/2 teaspoon of salt in 8 ounces of water or 1/2 teaspoon of baking soda in 8 ounces of water. This should be done at least after each meal and at bedtime.
- If you have mouth sores, avoid mouthwash that has alcohol. Also avoid alcohol and smoking because they can bother your mouth and throat.
- If you have diarrhea, eat low-fiber foods that are high in protein and calories and avoid foods that can irritate your digestive tracts or lead to cramping.
- Ask your nurse or doctor about medicine that can lessen or stop your diarrhea.
- If you get a rash do not put anything on it unless your doctor or nurse says you may. Keep the area around the rash clean and dry. Ask your doctor for medicine if your rash bothers you.
Food and Drug Interactions
- There are no known interactions of melphalan with food however this medication should be taken on an empty stomach.
- This drug may interact with other medicines. Tell your doctor and pharmacist about all the prescription and over-the-counter medicines and dietary supplements (vitamins, minerals, herbs and others) that you are taking at this time. Also, check with your doctor or pharmacist before starting any new prescription or over-the-counter medicines, or dietary supplements to make sure that there are no interactions.
When to Call the Doctor
Call your doctor or nurse if you have any of these symptoms and/or any new or unusual symptoms:
- Fever of 100.4° F (38° C) or higher
- Tiredness that interferes with your daily activities
- Feeling dizzy or lightheaded
- Easy bleeding or bruising
- Pain in your chest
- Dry cough
- Trouble breathing
- Nausea that stops you from eating or drinking and/or is not relieved by prescribed medicines
- Throwing up more than 3 times a day
- Pain in your mouth or throat that makes it hard to eat or drink
- Diarrhea, 4 times in one day or diarrhea with lack of strength or a feeling of being dizzy
- Signs of possible liver problems: dark urine, pale bowel movements, bad stomach pain, feeling very tired and weak, unusual itching, or yellowing of the eyes or skin
- New rash and/or itching
- Rash that is not relieved by prescribed medicines
- Signs of allergic reaction: swelling of the face, feeling like your tongue or throat are swelling, trouble breathing, rash, itching, fever, chills, feeling dizzy, and/or feeling that your heart is beating in a fast or not normal way. If this happens, call 911 for emergency care.
- If you think you may be pregnant or may have impregnated your partner
- Pregnancy warning: This drug can have harmful effects on the unborn baby. Women of childbearing potential and men with female partners of childbearing potential should use effective methods of birth control during your cancer treatment. Let your doctor know right away if you think you may be pregnant or may have impregnated your partner.
- Breastfeeding warning: It is not known if this drug passes into breast milk. For this reason, women should not breastfeed during treatment because this drug could enter the breast milk and cause harm to a breastfeeding baby.
- Fertility warning: In men and women both, this drug may affect your ability to have children in the future. Talk with your doctor or nurse if you plan to have children. Ask for information on sperm or egg banking.
- In women, menstrual bleeding may become irregular or stop while you are getting this drug. Do not assume that you cannot become pregnant if you do not have a menstrual period.
Revised July 2019
This patient information was developed by Via Oncology, LLC © 2019. This information is not intended to be used as a substitute for professional medical advice, diagnosis, or treatment. You should not rely entirely on this information for your health care needs. Ask your own doctor or health care provider any specific medical questions that you have.
CLIENT acknowledges that the Via Pathways and Via Portal are information management tools only, and that Via Oncology, LLC has not represented the Via Pathways or Via Portal as having the ability to diagnose disease, prescribe treatment, or perform any other tasks that constitute the practice of medicine. The clinical information contained in the Via Pathways and Via Portal are intended as a supplement to, and not a substitute for, the knowledge, expertise, skill, and judgment of physicians, pharmacists and other healthcare professionals involved with patient care at CLIENT facilities.