MELPHALAN 2MG TABLETS 25`S

Melphalan is a bifunctional nitrogen mustard alkylating agent that cross-links DNA strands, preventing cancer cell replication and triggering apoptosis. It is one of the oldest and most established chemotherapy agents, with particular efficacy in plasma cell dyscrasias.

Oral melphalan 2 mg tablets are used for:

•       Multiple myeloma (MM) — oral melphalan-prednisolone (MP) regimen, historically as standard therapy and still used in elderly or frail patients not eligible for novel agents or ASCT.

•       Ovarian cancer — palliative treatment of advanced ovarian carcinoma.

•       Breast cancer — advanced or metastatic breast carcinoma (selected cases).

•       Polycythaemia vera — disease control (less commonly now).

Take on an EMPTY STOMACH — at least 1 hour before food. Food significantly reduces melphalan absorption. The dose and schedule vary by protocol (e.g. MP: melphalan 0.25 mg/kg/day for 4 days every 6 weeks). Swallow tablets whole with water. Handle carefully — do not crush (cytotoxic).

Melphalan is contraindicated in: patients with recent myelosuppressive chemotherapy or radiation without haematological recovery; known hypersensitivity; and pregnancy (teratogenic — effective contraception required during treatment and for 6 months after for both males and females).

•       Ciclosporin: significantly increases melphalan nephrotoxicity — use with caution, monitor renal function.

•       Live vaccines: contraindicated during chemotherapy.

•       Nalidixic acid: potential increased risk of haemorrhagic colitis — avoid.

•       Carmustine: additive pulmonary toxicity.

Store at 2–8°C (refrigerate). Original packaging, protect from light and moisture. Cytotoxic — handle with care, wear gloves. Keep out of reach of children. Return unused tablets to the pharmacy.

Melphalan must be taken on an empty stomach — food can reduce the amount of medicine absorbed, reducing its effectiveness. Take it at least 1 hour before eating your meal.

Bone marrow suppression is the most important side effect. Blood counts will be checked before every treatment cycle. If you develop a fever above 38°C at any time after taking melphalan, go to the emergency department immediately — this may be febrile neutropenia and requires urgent treatment.

Wear gloves when handling the tablets if you are a caregiver. Pregnant women should not handle melphalan.

Oral melphalan is erratically absorbed — bioavailability ranges from 25–89%. Absorption is significantly reduced (by 39–45%) by food; hence the fasting instruction. For myeloma, intravenous high-dose melphalan (HDM — 200 mg/m2) is used as conditioning for autologous stem cell transplant — a separate IV formulation.

The oral 2 mg tablet is used for chronic outpatient treatment in elderly patients. Complete blood count (CBC) nadir occurs at 14–21 days after each cycle — monitoring at day 14 and 21 is standard. Secondary myelodysplasia and acute leukaemia risk increase with cumulative melphalan exposure — typically after 2+ years of continuous treatment.

If I have a fever, why is it an emergency?

After melphalan, your white blood cell count is at its lowest around 2–3 weeks after treatment. A fever at this time may indicate a serious infection (febrile neutropenia) that can be life-threatening without prompt IV antibiotic treatment.

Is melphalan still used now that newer myeloma medicines are available?

Yes — melphalan-prednisolone remains an option for elderly or frail patients with multiple myeloma who cannot tolerate more intensive regimens. For younger, fitter patients, high-dose melphalan with autologous stem cell transplant remains the gold standard consolidation approach.

Can I have melphalan as an infusion instead of tablets?

High-dose IV melphalan is used as conditioning chemotherapy before stem cell transplantation — this is a different, much higher dose than the oral regimen. Your haematologist will determine which formulation is appropriate.

Will my hair fall out?

Alopecia (hair loss) can occur with melphalan, though it is often partial rather than complete. Hair usually regrows after treatment is completed.

Can a caregiver crush the tablet if I have swallowing difficulties?

No — melphalan tablets should never be crushed as this creates cytotoxic dust. If swallowing is difficult, discuss alternatives (IV formulation or other agents) with your haematologist.