Melfal뿯½n Zentiva (Melphalan Hydrochloride)

Melphalan Hydrochloride is used in chemotherapy regimens targeting specific malignancies.

• Multiple myeloma: reduces malignant plasma‑cell proliferation and improves survival outcomes.
• Ovarian cancer: enhances cytotoxic effect when combined with platinum‑based agents.
• Melanoma: provides alkylating activity for refractory metastatic disease.
• Chronic lymphocytic leukemia: induces DNA cross‑linking to limit leukemic cell growth.

• Melphalan Hydrochloride exerts its antineoplastic activity by forming covalent bonds with the N7 position of guanine bases in DNA. This alkylation creates intra‑ and interstrand cross‑links that impede DNA replication and transcription, ultimately triggering apoptosis in rapidly dividing tumor cells. The nitrogen‑mustard moiety enables these irreversible DNA modifications, making it effective against both hematologic and solid tumors.

Administration of melphalan may be associated with a range of adverse reactions, varying in frequency and severity.

Common Side Effects

• Nausea and vomiting.
• Fatigue and general weakness.
• Myelosuppression manifested as neutropenia, anemia or thrombocytopenia.
• Mucositis or oral ulceration.
• Alopecia (hair loss).

Serious or Rare Side Effects

• Secondary malignancies such as therapy‑related leukemia.
• Severe infections due to profound neutropenia.
• Pulmonary toxicity, including interstitial pneumonitis.
• Renal impairment or acute kidney injury.
• Hepatotoxicity with elevated liver enzymes.

Before initiating therapy, clinicians should evaluate baseline organ function and monitor patients closely throughout treatment.

• Blood Count Monitoring: Perform complete blood counts regularly to detect myelosuppression.
• Renal Function Assessment: Check serum creatinine and adjust dosing if renal impairment is present.
• Hepatic Function Assessment: Evaluate liver enzymes and bilirubin before and during therapy.
• Hypersensitivity Awareness: Discontinue if signs of allergic reaction such as rash, pruritus or anaphylaxis occur.
• Protective Handling: Use appropriate personal protective equipment to avoid occupational exposure.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze.

Melphalan may interact with other medicines, altering efficacy or increasing toxicity.

Major Interactions (Avoid)

• Concurrent use with other alkylating agents (e.g., cyclophosphamide) due to cumulative bone‑marrow toxicity.
• Co‑administration with nephrotoxic drugs (e.g., cisplatin) can exacerbate renal injury.
• Live vaccines should be avoided because of immunosuppression.

Moderate Interactions (Monitor Closely)

• Anticoagulants (e.g., warfarin) may increase bleeding risk; monitor coagulation parameters.
• Allopurinol can potentiate melphalan toxicity; adjust dose or monitor closely.
• CYP450 inducers or inhibitors may affect melphalan metabolism; observe for altered blood counts.