Melphalan Amarox (Melphalan)

Melphalan is an alkylating chemotherapy drug used in the management of malignant diseases that are responsive to DNA‑cross‑linking agents.

• Multiple myeloma: helps achieve disease control and prolong survival in eligible patients.
• Ovarian cancer: used as part of combination regimens to reduce tumour burden.
• Malignant melanoma: employed in selected cases where conventional therapies have failed.

• Melphalan forms covalent cross‑links between DNA strands, preventing DNA replication and transcription. The resulting DNA damage triggers cell‑cycle arrest and apoptosis, preferentially affecting rapidly dividing cancer cells while sparing most normal tissues.

Melphalan may cause a range of adverse reactions that vary in frequency and severity.

Common Side Effects

• Nausea and vomiting: gastrointestinal upset occurring during or after infusion.
• Myelosuppression: reduced white blood cells, neutrophils, platelets and red cells.
• Alopecia: hair loss that is usually reversible after treatment.
• Fatigue: generalized tiredness that may persist for weeks.
• Mucositis: inflammation of the mouth and gastrointestinal lining.

Serious or Rare Side Effects

• Secondary malignancies: development of new cancers after prolonged exposure.
• Severe infection: due to profound neutropenia.
• Pulmonary fibrosis: scarring of lung tissue leading to respiratory compromise.
• Renal toxicity: impaired kidney function requiring monitoring.
• Anaphylactic reaction: rare but potentially life‑threatening hypersensitivity.

Careful monitoring and patient education are essential when using Melphalan.

• Blood count monitoring: perform complete blood counts before each dose and regularly during therapy.
• Renal function assessment: evaluate serum creatinine and adjust dosing if needed.
• Hepatic function assessment: check liver enzymes as melphalan is partially metabolised hepatically.
• Avoid use in patients with known hypersensitivity to melphalan or related nitrogen‑mustard compounds.
• Contraception: both male and female patients should use effective contraception during treatment and for a defined period after the last dose.
• Store at controlled room temperature: keep in original packaging, protect from light and moisture.

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

Major Interactions (Avoid)

• Concurrent myelosuppressive agents (e.g., other alkylating drugs, high‑dose cytarabine): increase risk of severe bone‑marrow suppression.
• High‑dose radiation therapy: may potentiate tissue damage.
• Live attenuated vaccines: risk of uncontrolled infection due to immunosuppression.

Moderate Interactions (Monitor Closely)

• Anticoagulants (e.g., warfarin): enhanced bleeding risk; monitor INR.
• Nephrotoxic drugs (e.g., cisplatin, aminoglycosides): may worsen renal impairment.
• NSAIDs and other renal‑excreting drugs: monitor renal function and adjust dosage if needed.