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Melphalan: Warning and Precautions

Updated: Oct 17, 2022



Melphalan (Alkacel) 50mg Injection is a chemotherapy pharmaceutical medicinal product and a class of drugs called alkylating agents. The medicine melphalan hydrochloride is known as an active constituent. It is used for the treatment of multiple myeloma (a type of blood cancer that occurs in bone marrow cells, that helps the body fight infection), skin cancer, advanced ovarian cancer, and soft tissue sarcoma (cancer of soft tissues that is mostly found in chest, legs, abdomen).


Melphalan can also be used for the treatment of childhood neuroblastoma, cancer that occurs in immature nerve tissue. It can develop in the neck, adrenal glands, chest, abdomen or spine. Let your physician know if you have kidney/liver disorders, blood clot problems, epilepsy, have had radiotherapy, chemotherapy, or vaccination recently or are about to have any vaccines prior to receiving melphalan 50 mg Injection.


Warnings and Precautions

Bone Marrow Suppression: For those receiving Melphalan as part of a conditioning regimen, myeloablation appears in all patients. Do not start the conditioning regimen in case a stem cell product does not exist for rescue. Complete blood counts (CBCs) need to be monitored. Provide supportive care for infections, anemia and thrombocytopenia until there is apt hematopoietic recovery.


Gastrointestinal Toxicity: For those receiving Melphalan as part of a conditioning regimen, vomiting, mucositis, nausea, and diarrhea may occur in beyond 50 percent of patients. Use prophylactic antiemetic medicine. Supportive care for vomiting, nausea, diarrhea, and mucositis should be monitored. The frequency of grade 3/4 mucositis in clinical studies was 13 percent. Provide nutritional support and analgesics for those with severe mucositis.


Hypersensitivity: Acute hypersensitivity reactions, including anaphylaxis, may occur in about 2 percent of patients who received melphalan injection. Symptoms may include pruritus, edema, urticaria, and skin rashes and, in some patients, bronchospasm, tachycardia, dyspnea, and hypotension. Discontinue treatment for serious hypersensitivity reactions.


Hepatotoxicity: Certain hepatic disorders that range from abnormal liver function tests to clinical manifestations such as jaundice and hepatitis may occur after treatment with the medicine melphalan. Hepatic veno-occlusive disease has also been reported. Monitor liver chemistries.


Secondary Malignancies: Secondary malignancies such as acute leukemia or myeloproliferative syndrome may occur in multiple myeloma (MM) patients treated with melphalan-containing chemo regimens. The potential benefit of this therapy should be considered against the probable risk of the induction of a secondary malignancy.


Embryo-Fetal Toxicity: Melphalan can be responsible for causing fetal harm if administered to a pregnant woman. Instruct pregnant women of the probable risk to the fetus. Females of reproductive age should use effective contraception during therapy with Melphalan and for six months after the final dose. Males with female partners of reproductive potential should use apt contraception during treatment and for three months after the final dose.


Infertility: Melphalan-based chemo regimens may cause suppression of ovarian function in premenopausal women, resulting in persistent amenorrhea in around 9% of patients. Reversible/irreversible testicular suppression may also occur.


Adverse Events:

  • The most common melphalan side effects that occurred in at least 50 percent of patients with MM treated with melphalan were white blood cell count decreased, neutrophil count decreased, lymphocyte count decreased, diarrhea, platelet count decreased, nausea, fatigue, hypokalemia, anemia, and vomiting.

  • For myeloablative conditioning in MM patients undergoing ASCT, twelve (20 percent) patients experienced serious side effects while on study. The most common serious side effects (>1 patient, 1.6 percent) were hematochezia, pyrexia, febrile neutropenia, and renal failure. Treatment-related serious side effects reported in >1 patient were pyrexia (n=2, 3 percent), febrile neutropenia (n=2, 3 percent), and hematochezia (n=2, 3 percent).


Drug Interactions:

No formal drug interaction evaluations have been conducted. When nalidixic acid and IV (Intravenous) Melphalan are administered simultaneously, the incidence of severe hemorrhagic necrotic enterocolitis may increase in pediatric patients.


Use in Specific Populations:

Lactation: Advise females not to breastfeed throughout treatment with Melphalan and for one week (7 days) after the final dose.


Price and Availability

Please contact at 1800-889-1064 or send your enquiry to info@theindianpharma.com to find the best melphalan price in India. The Indian Pharma (TIP) is WHO GDP and ISO 9001 2015 Certified Pharmaceutical Wholesaler/ Supplier/ Exporter/ Importers from India of Melphalan Injection IP 50 mg which is also known as Alkacel and manufactured by Celon Laboratories Ltd. and available in a dosage strength of 50mg per mL.

At TIP, all temperature-sensitive pharmaceutical medicinal products are transported under temperature-controlled conditions in order to maintain product integrity.



Note: The piece of information provided about Melphalan: Warning and Precautions in this article are just for informational purposes and is not served as a substitute for the medical treatment, consultation, or diagnosis of a qualified healthcare practitioner.




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