Melphalan Tablets: Expert Guide To Dosage, Side Effects, And Uses
Comprehensive guide to melphalan tablets: uses, dosage, side effects, and essential patient information for safe treatment.
Melphalan tablets are a cytotoxic chemotherapy medication primarily used to treat cancers and conditions involving rapid cell division, such as multiple myeloma and polycythaemia vera. As an alkylating agent, melphalan interferes with DNA replication in cancer cells, slowing their growth and spread.
About Melphalan Tablets
Melphalan belongs to the class of alkylating agents, a cornerstone of chemotherapy that works by attaching alkyl groups to DNA, preventing cell division particularly in rapidly proliferating malignant cells. It is most commonly prescribed for multiple myeloma, a bone marrow cancer affecting plasma cells, leading to abnormal antibody production and bone damage. Other indications include polycythaemia vera, a myeloproliferative disorder causing excessive red blood cell production, resulting in thickened blood, dizziness, and shortness of breath. Melphalan is also used for advanced ovarian adenocarcinoma, advanced breast carcinoma, and sometimes in combination therapies for conditions like AL amyloidosis.
In multiple myeloma treatment, melphalan often combines with steroids like prednisone or dexamethasone, or immunomodulators such as lenalidomide and thalidomide, enhancing efficacy but requiring careful risk assessment due to potential secondary malignancies. For polycythaemia vera, it controls blood cell overproduction when other therapies fail. The medication is administered orally as 2 mg tablets, offering convenience for outpatient management under specialist supervision.
Clinical use demands precise dosing tailored to body surface area, blood counts, and response, with regular monitoring to balance efficacy and toxicity. Long-term use heightens risks like bone marrow suppression, necessitating blood tests before each cycle.
Before Taking Melphalan Tablets
Consult your doctor if you have active infections, as melphalan suppresses immunity, exacerbating risks. Avoid if you have porphyria, a rare blood disorder, or recent chickenpox/shingles exposure, which could lead to severe complications. History of allergic reactions to melphalan or similar drugs warrants avoidance.
Inform your healthcare provider of all medications, including over-the-counter, herbal, and complementary therapies, due to interactions. Melphalan may potentiate effects of other cytotoxics, vaccines, or prothrombotic agents, especially in combinations with lenalidomide or thalidomide, increasing thromboembolism and secondary cancer risks. Patients with low white blood cells (leukopenia), low platelets (thrombocytopenia), or bone marrow suppression face worsened conditions.
Pregnancy and breastfeeding are contraindications; melphalan is teratogenic and mutagenic. Use effective contraception during and post-treatment. Effects on driving remain unstudied, but fatigue or nausea may impair ability—proceed cautiously.
- Infection risk: Low white cells increase susceptibility; avoid sick contacts and live vaccines.
- Bleeding risk: Low platelets heighten bruising/bleeding; use soft toothbrush, electric razor.
- Thromboembolism: Prophylaxis recommended for first 5 months in high-risk combinations.
How to Take Melphalan Tablets
Melphalan is prescribed by cancer specialists experienced in its use. Dosage varies by condition: for multiple myeloma, typical regimens include 6-10 mg daily for 7-10 days every 4-6 weeks, or high-dose pulses adjusted by blood counts. Polycythaemia vera may use 6-10 mg daily for 7 days every 4 weeks. Always follow the label; do not adjust without advice.
Take orally with water on an empty stomach—1 hour before or 2 hours after food—to optimize absorption. Swallow tablets whole; do not chew, crush, or break. Administer at the same time daily for consistency. If forgotten, skip—do not double dose. Overdose requires immediate medical attention; bring the pack.
| Condition | Typical Dose | Schedule |
|---|---|---|
| Multiple Myeloma | 0.15 mg/kg or 6 mg/m² daily | 4 days every 6 weeks, or continuous low-dose |
| Polycythaemia Vera | 6-10 mg daily | 7 days every 4 weeks |
| Advanced Ovarian Cancer | 0.2 mg/kg daily | 5 days every 4-6 weeks |
Blood tests precede doses to ensure counts recover. Anti-sickness drugs may accompany. Store in fridge; protect from light/moisture.
Possible Side Effects of Melphalan Tablets
Melphalan causes bone marrow suppression, peaking 4-6 weeks post-dose, leading to anemia, infections, and bleeding. Monitor via regular complete blood counts.
Common (1 in 10): Nausea, vomiting, diarrhea, mouth sores, hair loss (reversible), fatigue.
Serious: Severe infection (fever, chills, sore throat), bleeding (bruising, blood in stool/urine), allergic reactions (rash, swelling), secondary cancers (leukemia after years).
- Infection precautions: Wash hands, avoid crowds, no live vaccines; report fever >38°C immediately.
- Bleeding precautions: No aspirin/NSAIDs, report unusual bleeding.
- GI effects: Use anti-emetics; maintain hydration/nutrition.
Rare: Lung fibrosis, liver toxicity, infertility. Thromboembolism in combinations—discontinue if occurs, initiate anticoagulation. Report persistent or worsening symptoms.
How to Cope with Melphalan Tablet Side Effects
Nausea/vomiting: Take anti-emetics as prescribed; eat small bland meals, ginger tea. Avoid triggers.
Fatigue: Rest, light exercise, balanced diet. Pace activities.
Mouth sores: Saltwater rinses, soft foods, avoid alcohol/tobacco.
Hair loss: Wigs/scarves; regrows post-treatment.
Infection prevention: Hygiene, cooked foods, pet litter avoidance. Fever protocol: paracetamol only, seek urgent care.[10]
Bleeding: Gentle grooming, no contact sports. Seek help for bleeds.
Nutritional support vital; consult dietitian if appetite loss persists.
How to Store Melphalan Tablets
Store in refrigerator (2-8°C); do not freeze. Keep original pack, away from children/pets. Discard expired/outdated via pharmacy take-back. Handle carefully—cytotoxic.
Frequently Asked Questions (FAQs)
Who should not take melphalan?
Avoid if pregnant, breastfeeding, active infection, porphyria, or recent live vaccines. Discuss all conditions/medications with your doctor.
Can melphalan be taken with food?
No—take on empty stomach for best absorption. Wait 1 hour before or 2 after meals.
What if I miss a dose?
Skip it; do not double. Contact your team for advice.
Does melphalan cause hair loss?
Yes, commonly but reversibly.
How long until side effects appear?
Nausea soon; blood count drops in 1-2 weeks, nadir 4-6 weeks.
Is melphalan safe long-term?
Risks secondary cancers; specialist monitors closely.
References
- Melphalan tablets – Patient.info — Patient.info. 2023. https://patient.info/medicine/melphalan-tablets
- Melphalan 2 mg Tablets – Patient Information Leaflet (PIL) — medicines.org.uk. 2023-10-01. https://www.medicines.org.uk/emc/product/3806/pil
- Melphalan (oral route) – Mayo Clinic — Mayo Clinic. 2024-05-01. https://www.mayoclinic.org/drugs-supplements/melphalan-oral-route/description/drg-20064651
- Melphalan Tablets: Uses & Side Effects – Cleveland Clinic — Cleveland Clinic. 2023. https://my.clevelandclinic.org/health/drugs/20961-melphalan-tablets
- Melphalan: MedlinePlus Drug Information — MedlinePlus (U.S. National Library of Medicine). 2024. https://medlineplus.gov/druginfo/meds/a682220.html
- Melphalan Tablets – Macmillan Cancer Support — Macmillan Cancer Support. 2023. https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/melphalan
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