Melphalan Zentiva (Melphalan Hydrochloride)

• Melphalan is an alkylating chemotherapy agent used in the treatment of various hematologic and solid tumors.
• Multiple myeloma: reduces malignant plasma cells and prolongs survival.
• Ovarian cancer: incorporated into combination regimens to target tumor growth.
• Melanoma: administered as part of salvage therapy for advanced disease.
• Other solid tumors: employed where alkylating agents are indicated to inhibit tumor proliferation.

• Melphalan exerts its antineoplastic effect by forming covalent cross‑links at the N7 position of guanine bases in DNA. This alkylation interferes with DNA replication and transcription, leading to strand breaks, inhibition of cell division, and ultimately apoptosis of rapidly dividing cancer cells.

Melphalan may cause a range of adverse reactions, which are categorized by frequency and severity.

Common Side Effects

• Nausea and vomiting
• Myelosuppression (decreased white blood cells, red blood cells, and platelets)
• Mucositis (inflammation of the mouth lining)
• Fatigue or general weakness

Serious or Rare Side Effects

• Secondary malignancies such as therapy‑related leukemia
• Severe pulmonary toxicity (interstitial pneumonitis)
• Renal impairment or acute kidney injury
• Life‑threatening infections due to profound neutropenia

• Before initiating therapy, clinicians should evaluate patient‑specific risk factors and monitor laboratory parameters closely.
• Baseline blood counts: obtain complete blood count and differential.
• Renal function assessment: check serum creatinine and calculate clearance.
• Hepatic function: evaluate liver enzymes and bilirubin levels.
• Pregnancy and lactation: avoid use unless benefits clearly outweigh risks.
• Concomitant myelosuppressive agents: adjust dosing or increase monitoring frequency.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

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

Major Interactions (Avoid)

• Concurrent use of other alkylating agents: may increase cumulative bone‑marrow suppression.
• Strong CYP450 inducers (e.g., rifampin): may reduce plasma concentrations.
• High‑dose radiotherapy: synergistic toxicity to normal tissues.

Moderate Interactions (Monitor Closely)

• Antiemetics (e.g., ondansetron): may affect melphalan clearance.
• Nephrotoxic drugs (e.g., cisplatin, aminoglycosides): increase risk of renal injury.
• Anticoagulants (e.g., warfarin): monitor coagulation parameters due to potential platelet count changes.