Melfalan Zentiva (Melphalan Hydrochloride)

Melfalan Zentiva, a melphalan‑based alkylating chemotherapy, is used in several malignant disease pathways.

• Multiple myeloma: incorporated into combination regimens to achieve disease control and extend survival.
• Ovarian cancer: employed in high‑dose or salvage protocols to reduce tumor burden.
• Melanoma: administered in advanced stages to induce tumor regression.

• Melphalan is a nitrogen‑mustard alkylating agent that covalently binds to the N7 position of guanine residues, creating intra‑ and inter‑strand DNA cross‑links. These cross‑links obstruct DNA replication and transcription, triggering cell‑cycle arrest and apoptosis preferentially in rapidly dividing tumor cells while sparing most normal tissues. The drug also interferes with DNA repair mechanisms, enhancing cytotoxicity, and its effect is dose‑dependent, with higher concentrations producing greater cross‑linking and tumor cell kill.

Melfalan Zentiva may cause a range of adverse reactions, varying from mild to severe.

Common Side Effects

• Nausea and vomiting: gastrointestinal upset commonly observed during infusion.
• Myelosuppression: reduced white blood cells, red cells and platelets.
• Alopecia: temporary hair loss affecting scalp and body hair.
• Fatigue: generalized tiredness and reduced stamina.

Serious or Rare Side Effects

• Severe neutropenia: profound drop in neutrophils increasing infection risk.
• Pulmonary fibrosis: progressive scarring of lung tissue leading to respiratory impairment.
• Secondary malignancies: emergence of new cancers such as leukemia after treatment.

Prior to initiating therapy with Melfalan Zentiva, several safety considerations should be observed.

• Baseline blood counts: obtain complete blood count to assess marrow reserve.
• Renal function: evaluate creatinine clearance as melphalan is renally excreted.
• Hepatic function: monitor liver enzymes for potential toxicity.
• Hypersensitivity: avoid in patients with known allergy to melphalan or other nitrogen mustards.
• Contraception: require effective birth control for both sexes during treatment and for a defined period after.
• Store at ambient temperature: keep below 25 °C in original packaging, protected from moisture and light.

Melphalan can interact with other medicines, altering its efficacy or toxicity.

Major Interactions (Avoid)

• Other alkylating agents: additive bone‑marrow suppression.
• High‑dose radiation therapy: increased risk of tissue injury.
• Live vaccines: compromised immune response may lead to infection.

Moderate Interactions (Monitor Closely)

• Nephrotoxic drugs (e.g., cisplatin): may exacerbate renal impairment.
• Anticoagulants (e.g., warfarin): enhanced bleeding risk due to thrombocytopenia.
• Granulocyte‑colony stimulating factors: may mask myelosuppression severity.
• CYP450 modulators: potential alteration of melphalan metabolism (though limited).