Melphalan

What is melphalan?

Melphalan is a medicine that is used to kill cancer cells. It may also be used to prepare the body for bone marrow or stem cell transplant.

You may hear melphalan called L-PAM or by its brand name, Alkeran. Melphalan comes in tablet and injection forms.

Before giving melphalan to your child

Tell your child's doctor if your child has ever reacted badly to melphalan or to any other medications, foods, preservatives, or colouring agents.

Talk with the doctor or pharmacist if your child has any of the following conditions. This medicine may not be right for your child if they have:

• infection or recent exposure to infection (for example, chickenpox)
  
• kidney problems
  
• very low blood counts

How should you give your child melphalan?

Melphalan is usually given by injection. It is a clear liquid given by needle into your child's vein (intravenously or IV). Your child will be given this form of melphalan in the hospital clinic or on a nursing unit.

If your child is taking melphalan by mouth, follow these instructions when you give your child this medicine:

• Give your child melphalan at the same times every day, exactly as your child's doctor or pharmacist tells you. Pick a time that is easy for you to remember so that you do not miss doses.
  
• Give your child melphalan on an empty stomach, at least 1 hour before meals or 2 hours after meals, with a full glass of water.
  
• Give your child melphalan for as long as the doctor or pharmacist tells you, even if your child seems completely well. Talk to your child's doctor before you stop giving melphalan for any reason.
  
• If your child throws up within 1 hour after swallowing the medicine, call your child's doctor or main nurse (called the contact nurse). Ask them if you should give the melphalan again.
  
• If your child is not taking a full tablet or has trouble swallowing tablets, review the options and how to give this medication with the pharmacist.

What should you do if your child misses a dose of melphalan?

• Give the missed dose as soon as you remember.
  
• If it is almost time for the next dose, skip the missed dose. Give the next dose at the regular time.
  
• Do not give your child two doses to make up for one missed dose.

What are the possible side effects of melphalan?

Your child may have some of these side effects while they take melphalan. Check with your child's doctor if your child continues to have any of these side effects and they do not go away, or they bother your child:

• nausea (upset stomach) and vomiting (throwing up)
  
• diarrhea (loose, watery bowel movements)
  
• hair loss

Call your child's doctor during office hours if your child has any of these side effects:

• trouble swallowing
  
• joint pain, such as the knees, shoulders, or knuckles
  
• sores on the mouth and lips
  
• sudden weight gain or swelling of the feet or lower legs

Most of the following side effects are not common, but they may be a sign of a serious problem. Call your child's doctor right away or take your child to Emergency if your child has any of these side effects:

• black tarry stools
  
• blood in urine or stools
  
• cough or sore throat
  
• fever or chills
  
• fast or uneven heartbeat
  
• severe abdominal (stomach) pain
  
• lower back or side pain
  
• painful or trouble urination
  
• pinpoint red spots on skin
  
• redness or soreness at the site of injection
  
• shortness of breath or trouble breathing
  
• unusual bleeding or bruising
  
• rash
  
• yellow skin or eyes

What safety measures should you take when your child is using melphalan?

If melphalan leaks out of the vein through which it is being given, it can cause severe damage. Tell the nurse right away if you or your child notice redness, pain, or swelling at the place of injection.

Your child may lose their hair. It will grow back once your child is no longer receiving melphalan. Its color and texture may change. Use a gentle shampoo and a soft brush.

Your child's skin may darken while receiving melphalan, especially on the elbows and knees and in skin creases. If this happens, it will slowly fade once your child stops taking melphalan.

Your child will receive medicine to prevent upset stomach and throwing up caused by melphalan.

Melphalan may cause sores in the mouth. Rinse your child's mouth with a mouthwash made from baking soda to help keep it clean. Your nurse or pharmacist can review this with you. Avoid store-bought mouthwash containing alcohol, as it may sting and cause dry mouth.

Melphalan can lower the number of white blood cells in the blood temporarily, which increases your child's chances of getting an infection. Your child can take the following precautions to prevent infections, especially when the blood count is low:

• Avoid people with infections, such as a cold or the flu.
  
• Avoid places that are very crowded with large groups of people.
  
• Be careful when brushing or flossing your child's teeth. Your doctor, nurse or dentist may suggest different ways to clean your child's mouth and teeth.
  
• You and your child shouldn't touch your child's eyes or inside their nose without washing hands first.
  
• Your child's nurse will review with you what to do in case of fever.

Your child should not receive any immunizations (vaccines) without your child's doctor's approval. Your child or anyone else in your household should not get oral polio vaccine while your child is being treated for cancer. Tell your child's doctor if anyone in your household has recently received oral polio vaccine. Your child should avoid contact with anyone who has recently received this vaccine.

Melphalan can lower the number of platelets in the blood, which increases your child's risk of bleeding. You can take the following precautions:

• Be careful not to cut your child when using a razor, fingernail scissors, or toenail clippers.
  
• Your child should avoid contact sports where bruising or injury could occur.
  
• Before your child has surgery, including dental surgery, inform the doctor or dentist that your child is taking melphalan.
  
• Your child should not receive a permanent tattoo or any kind of body piercing.

There is a chance that melphalan may cause birth defects if it is taken at the time of conception or if it is taken during pregnancy. If your child is sexually active, it is best that they use some kind of birth control while receiving melphalan. Tell the doctor right away if your child may be pregnant.

After receiving melphalan your child may not be able to have children or have more difficulty having children. Your child's doctor will discuss this in more detail with you/your child.

After your child stops receiving melphalan, it may still cause side effects. These delayed effects may include certain types of cancer. Your child's doctor will be able to give you more details about this.

Melphalan may interact with other medications. Check with your child's doctor or pharmacist before giving your child any other medicines (prescription, non-prescription, herbal, or natural products).

What other important information should you know about melphalan?

• Keep a list of all medications your child is on and show this list to the doctor or pharmacist.
• Do not share your child's medicine with others. Do not give anyone else's medicine to your child.
• Make sure you always have enough melphalan to last through weekends, holidays, and vacations. Call your pharmacy at least 2 days before your child runs out of medicine to order refills. Not all pharmacies will carry this medication.
• Keep melphalan tablets in the refrigerator. Do not freeze this medicine.
• Do not keep any medicines that are out of date. Check with your pharmacist about the best way to throw away outdated or leftover medicines.
  

Keep melphalan out of your child’s sight and reach and locked up in a safe place. If your child takes too much melphalan, call your local Poison Information Centre at one of these numbers. These calls are free. 

• Call 1-844 POISON-X, or 1-844-764-7669, from anywhere in Canada except Quebec.
• Call 1-800-463-5060 if you live in Quebec.