Melphalan Zentiva (Melphalan Hydrochloride)

• Melphalan is used as an antineoplastic agent in several malignancies that rely on DNA synthesis pathways.
• Multiple myeloma: helps reduce malignant plasma cell proliferation and prolongs remission when combined with other chemotherapy regimens.
• Ovarian cancer: used as part of high‑dose chemotherapy protocols to target rapidly dividing tumor cells.
• Malignant melanoma: employed in selected cases where conventional therapies have failed, aiming to induce tumor cell death.

• Melphalan is an alkylating agent that forms covalent cross‑links between DNA strands at the N7 position of guanine residues. These interstrand and intrastrand bonds impede DNA unwinding, blocking replication and transcription. The resulting DNA damage triggers cell‑cycle arrest and apoptosis, preferentially affecting rapidly proliferating cancer cells while sparing most normal tissues at therapeutic concentrations. The alkylation also interferes with DNA repair mechanisms, enhancing cytotoxicity in tumor cells.

Melphalan may cause a range of adverse reactions, varying from mild to severe, that are monitored during therapy.

Common Side Effects

• Nausea and vomiting: gastrointestinal upset commonly reported during infusion.
• Bone marrow suppression: decreased white blood cells, red cells and platelets leading to anemia, infection risk and bleeding tendency.
• Fatigue: generalized tiredness that may affect daily activities.

Serious or Rare Side Effects

• Severe neutropenia: profound drop in neutrophils increasing risk of life‑threatening infections.
• Pulmonary toxicity: interstitial pneumonitis or fibrosis presenting with cough and dyspnea.
• Secondary malignancies: rare development of therapy‑related leukemias or other cancers.

• Prior to initiating Melphalan therapy, clinicians should evaluate several safety considerations to minimize risks.
• Renal function: assess creatinine clearance because impaired kidneys can increase drug exposure.
• Hepatic function: monitor liver enzymes as hepatic impairment may affect metabolism.
• Infection risk: perform baseline blood counts and consider prophylactic antimicrobials if neutropenia is anticipated.
• Pregnancy and lactation: avoid use unless benefits clearly outweigh potential fetal or neonatal harm.
• Store at ambient temperature: keep vials in original packaging, protect from light and moisture, and do not freeze.

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

Major Interactions (Avoid)

• Live vaccines: concurrent use may cause uncontrolled infection due to immunosuppression.
• Strong CYP inducers (e.g., rifampin): may reduce melphalan plasma levels, decreasing therapeutic effect.

Moderate Interactions (Monitor Closely)

• Antiemetics (e.g., ondansetron): may be needed to manage nausea but can affect QT interval; monitor cardiac status.
• Myelosuppressive agents (e.g., cyclophosphamide): combined use can exacerbate bone marrow suppression; adjust dosing and monitor blood counts.