Precautions and Warnings With Melphalan

Melphalan may increase your risk of bone marrow depression or other types of cancer. To help ensure your safety, talk to your healthcare provider about your medical history before starting treatment with melphalan. Other warnings and precautions with melphalan extend to people who have problems with their kidneys, liver, or blood cell counts.

What Should I Tell My Healthcare Provider?

You should talk with your healthcare provider prior to taking melphalan (Alkeran®) if you have:
 
  • Kidney disease, such as kidney failure (renal failure)
  • Liver disease, such as hepatitis, cirrhosis, or liver failure
  • Low levels of white blood cells
  • Anemia
  • Low levels of platelets
  • Had radiation treatment or previous chemotherapy
  • Plans to receive a vaccination
  • Lung disease
  • Any allergies, including to foods, dyes, or preservatives.
 
Also, let your healthcare provider know if you are:
 
  • Breastfeeding
  • Pregnant or thinking of becoming pregnant.
 
You should also tell your healthcare provider about all other medications you are taking, including prescription and nonprescription medicines, vitamins, and herbal supplements.
 

Specific Melphalan Precautions and Warnings

Some warnings and precautions to be aware of prior to using this medication include the following:
 
  • Melphalan can cause significant side effects. It should only be given under the supervision of a healthcare provider who has experience using the medication. Your healthcare provider will weigh the risks and benefits of using this medicine before recommending treatment for your particular situation.
 
  • When given as an injection into a vein (an intravenous, or IV, injection), melphalan can cause tissue damage if it leaks from the vein during administration. Tell your healthcare provider right away if you experience stinging, burning, pain, redness, or swelling at your injection site. He or she will stop your injection and begin certain treatments to help prevent serious problems.
 
  • Like other chemotherapy medicines, melphalan can cause significant bone marrow depression (when the bone marrow is unable to make normal amounts of red blood cells, white blood cells, and platelets). This can lead to serious problems, such as:
 
Your healthcare provider will monitor your blood cell counts during treatment, and adjust your dose or delay treatment if your blood cell counts become too low.
  • Although rare, this medicine can cause a life-threatening allergic reaction known as anaphylaxis. Anaphylaxis can even occur after you have received multiple doses of the medicine without any problems. Let your healthcare provider know right away if you develop any signs of an allergic reaction, such as:
 
    • A rash
    • Hives
    • Itching
    • Swelling of the mouth, face, or throat
    • Wheezing
    • Difficulty breathing or swallowing.
 
  • Treatment with melphalan may increase your risk for developing other types of cancer, including leukemia. These cancers may develop years after melphalan treatment. Any amount of melphalan can increase your risk for developing other types of cancer; however, the risk is thought to increase with longer treatment and higher cumulative doses. Your cumulative dose is the total dose you receive over the course of your treatment.
 
  • Melphalan can impair fertility (the ability to conceive a child). It may cause an irregular menstrual cycle (menstrual period) or a complete absence of menstrual periods in women. It may also cause a man to stop producing sperm. These effects may not be reversible, even after treatment ends.
 
  • People with kidney disease may need lower melphalan doses.
 
  • Melphalan has been reported to cause lung problems which, in some cases, have caused death. Let your healthcare provider know immediately if you develop any signs of lung problems, such as:
 
    • Shortness of breath
    • Chest pain
    • A new or persistent cough.
 
  • You should not receive a live vaccine during treatment with this medicine (see Drug Interactions With Melphalan). Talk to your healthcare provider before getting a vaccination.
 
 
  • It is unknown if melphalan passes through breast milk. Therefore, if you are breastfeeding or plan to start, discuss this with your healthcare provider prior to using the drug (see Alkeran and Breastfeeding).
 
  • Melphalan is a pregnancy Category D medication. This means it is probably not safe for use during pregnancy (see Alkeran and Pregnancy).
 
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