Parenteral Manual

Melphalan (NON-FORMULARY)

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
ALKERAN
Classification: 
Antineoplastic (alkylating agent) - CYTOTOXIC
Original Date: 
December 2008
Revised Date: 
June 2015
Indications: 
  • Advanced stage/salvage therapy for non-Hodgkin's  lymphoma

  • Bone-marrow transplant conditioning

  • Multiple myeloma, ovarian carcinoma, malignant melanoma

THIS MEDICATION IS TO BE ADMINISTERED BY A CHEMO-TRAINED NURSE. IF THE NURSE IS NOT CHEMO-TRAINED, THEY ARE TO CONTACT THE UNIT NURSE EDUCATOR OR ADVANCED PRACTICE NURSE.

Reconstitution and Stability: 
  • Store unopened vials at room temperature.
  •  Protect from light
  • Reconstitute 50 mg vial with 10 mL provided diluent for a final concentration of  5mg/mL; shake vigorously to dissolve
  • Stable only 2 hours at RT; do not refrigerate (precipitates under refrigeration)
  • Further dilute with Normal saline to < 0.45 mg/mL for peripheral line; to < 2 mg/mL for central line
  • Limited stability  -  prepare immediately prior to use
Compatibility: 

- Solution Compatible:  0.9% NaCl

- Additives/Above Cassette Compatible: No information

- Y-site Compatible:  dexamethasone, ondansetron, diphenhydramine, metoclopramide, potassium chloride, sodium bicarbonate; contact pharmacy for other compatibility information

Incompatible:   D5W, Ringer's Lactate

 

 

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM NO
IV Direct NO
IV Intermittent Infusion YES,  over 15-30 minutes at a rate not to exceed 10mg/minute
IV Continuous Infusion NO, not stable in solution long enough

 

Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Pediatric:

  •  high dose melphalan with BMT:  70 - 100 mg/m2/day IV x 2 days; or 140-220 mg/m2 x 1 day; or 50 mg/m2 x 3 days; or 70 mg/m2 x 3 days

Adults:

  • Adults:  Salvage therapy for non-Hodgkin's lymphoma:  30 mg/m2 IV x 1 day

Dose adjustment in renal failure:

  • Creatinine clearance 10 - 50 mL/min:  75% dosing
  • Creatinine clearance < 10 mL/min:  50% dosing

** dosage may vary according to protocol

Potential hazards of parenteral administration: 

Immediate (within a few minutes to hours):

  • VESICANT - extravasation may cause tissue necrosis - refer to policy and procedure for administration of vesicant chemotherapy; also refer to protocol for treatment of extravasation of chemotherapy (Section H, Infusion Therapy Manual). If extravasation occurs, click HERE for treatment guidelines.   
  • Mild thrombophlebitis at injection site
  • Hypersensitivity reactions (anaphylactoid; rare)
  • Nausea and Vomiting

 Early (days to weeks):

  • Anemia, neutropenia, thrombocytopenia  
  • Stomatitis   
  • Diarrhea         
  • Hyperuricemia; elevated serum creatinine; elevated liver function  
  • Interstitial pneumonitis  
  • Hepatic veno-occlusive disease

 Delayed (weeks to months)

  • Pulmonary fibrosis   
  • Infertility

Treatment for unusual side effects are available through the study chair identified on the front page of the protocol and/or pharmacy

 

Notes: 
  •       Monitor: haematological, renal and liver function
  •       Avoid contact with skin.  Wash spills with copious amounts of water
  •       Baseline pulmonary function testing
  •       Consult pharmacy for information about potential drug interactions

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