melphalan hydrochloride: clinical use

Prescribing considerations

• Restrict prescribing and administration to clinicians experienced in anticancer treatment; intensive therapy requires an appropriately equipped specialist centre.
• Assess renal function, performance status, organ function, previous chemotherapy or radiotherapy and risk of tumour lysis before treatment.
• Account for the formulation's sodium, ethanol and propylene glycol content where clinically relevant.
• Assess thromboembolic risk when melphalan is combined with lenalidomide- or thalidomide-containing treatment.
• Discuss reproductive toxicity, contraception and fertility preservation before treatment.

Contraindications and cautions

• Hypersensitivity to melphalan or any excipient.
• Breastfeeding.

Monitoring

• Frequent full blood counts, recognising that counts may continue to fall after administration.
• Renal function and clinical evidence of excessive toxicity, particularly in renal impairment.
• Infection, bleeding, gastrointestinal mucosal toxicity and tumour-lysis complications.
• Administration site and line patency because extravasation can cause tissue necrosis.
• Clinical evidence of pulmonary, hepatic or thromboembolic complications.

Clinical pharmacology

Melphalan is a bifunctional nitrogen mustard alkylating agent that cross-links DNA through guanine residues. Its degradation is predominantly spontaneous rather than enzyme-mediated; renal impairment may reduce clearance.

Formulation and product differences

• The selected product is an injectable powder supplied with a solvent and is not an oral preparation.
• It contains sodium, ethanol and propylene glycol after reconstitution.
• It is incompatible with dextrose-containing infusion solutions; preparation must follow the product-specific instructions.
• The reconstituted solution has limited stability, should be used promptly and must not be refrigerated.

Injection

Route: Parenteral

Strengths: 50 mg