Melphalan Medications

Melphalan is an alkylating agent chemotherapy drug that damages DNA in rapidly dividing cancer cells. It is mainly employed in the treatment of multiple myeloma and as part of conditioning regimens.

Alkacel

Melphalan

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About Melphalan

Melphalan is an alkylating chemotherapy agent most commonly prescribed for multiple myeloma and certain ovarian cancers. Belonging to the nitrogen-mustard class, it interferes with DNA replication, leading to cancer cell death. The drug is marketed under brand names such as Alkeran and Phephlamestr, and generic tablets and injections are widely available through our online pharmacy. While its primary indication is hematologic malignancies, clinicians employ melphalan off-label for conditioning before stem-cell transplantation. Understanding its mechanism, dosing nuances, and safety profile helps patients make informed choices when they decide to buy melphalan online.

What is Melphalan?

Melphalan (L-phenylalanine mustard) is classified as an alkylating agent within the broader nitrogen-mustard family. The U.S. FDA first approved it in 1958 for the treatment of multiple myeloma, and the European Medicines Agency (EMA) later extended its labeling to include ovarian carcinoma. In Singapore, the Health Sciences Authority (HSA) permits melphalan for similar oncologic indications, reflecting international standards.

At the molecular level, melphalan forms covalent bonds with the N7 position of guanine bases, creating intra- and inter-strand DNA cross-links. These lesions prevent DNA unwinding and replication, triggering apoptotic pathways in rapidly dividing tumor cells. Because the drug targets DNA indiscriminately, it also affects normal proliferating tissues, accounting for its toxicity profile.

Both branded and generic formulations of melphalan are listed in the Singapore Health Product Register, and patients can obtain them through licensed channels without sacrificing quality.

How Melphalan Works

Mechanism of Action

Melphalan’s melphalan mechanism of action involves bifunctional alkylation of DNA. After entering the cell, it is hydrolyzed to an active bifunctional electrophile that covalently attaches to guanine residues, generating cross-links that obstruct transcription and replication. The resulting DNA damage activates p53-dependent apoptosis in malignant cells.

Therapeutic Effects

The DNA cross-linking translates into tumor-specific cytoreduction. In multiple myeloma, melphalan reduces plasma-cell proliferation, leading to decreased monoclonal protein levels and improved marrow function. When used as part of high-dose regimens before autologous stem-cell rescue, the drug eradicates residual disease, allowing transplanted stem cells to re-populate the marrow.

Onset and Duration

Clinical improvement typically emerges within 2-3 weeks of starting therapy, as measured by reductions in serum M-protein. The drug’s half-life is approximately 1.5 hours for oral dosing and 90 minutes for intravenous infusion, but the cytotoxic effects persist because DNA cross-links are not rapidly repaired. Protective marrow recovery usually requires 4-6 weeks after a high-dose cycle.

Approved Uses and Applications

Approved Indications

Multiple Myeloma: First-line and salvage therapy, often combined with steroids or novel agents (U.S. FDA, 1958; HSA, 2022).
Ovarian Cancer: Used in refractory or recurrent disease, usually after platinum-based regimens (EMA, 2004).
Neuroblastoma (high-risk pediatric): Part of multi-modal conditioning protocols (Lancet Oncology, 2019).
Bone Marrow Transplant Conditioning: High-dose melphalan prepares patients for autologous stem-cell rescue (NEJM, 202).

Off-Label Uses

Some oncologists employ melphalan for:

Chronic lymphocytic leukemia in resistant cases.
Plasma cell leukemia as part of intensive combination therapy.

These applications are not officially sanctioned by regulatory agencies, and their use relies on specialist judgment and institutional protocols.

Clinical Efficacy

In the pivotal IFM 2005-02 trial, high-dose melphalan followed by autologous transplant achieved a 5-year overall survival of 73 % versus 61 % with conventional therapy (NEJM, 2008). A separate phase III study in ovarian carcinoma reported a 30 % response rate in heavily pre-treated patients (Lancet, 2011). Such data underpin current guideline recommendations.

Buying Melphalan from Our Online Pharmacy

Why Choose Our Service

Access to melphalan can be challenging due to limited stocks in some local pharmacies. Our online pharmacy bridges that gap, offering discreet ordering and direct shipping to Singapore addresses while complying with HSA import regulations.

Brand Names and Generic Options

Alkeran® (IV injection) - marketed for high-dose transplant protocols.
Phephlamestr® (tablet) - oral formulation used in maintenance regimens.
Generic melphalan (tablet and powder for injection) - cost-effective alternatives with identical bioavailability.

Choosing the generic version typically saves 35 -45 % compared with brand-name products, and our pharmacy service highlights these savings on each product page.

Quality & Safety

We partner with licensed international pharmacies that operate under stringent Good Manufacturing Practice (GMP) standards and are inspected by the WHO pre-qualification programme. All shipments include batch numbers and authentication codes for patient verification.

Pricing & Access

Competitive pricing is displayed transparently; a 140 mg melph vial is listed at SGD 210, while the same dosage in a brand formulation exceeds SGD 350. Through our platform you receive a lifetime 10 % discount on all reorders, reducing the financial burden of long-term therapy.

Discreet Delivery

Orders are packaged in unmarked, tamper-evident containers. Express shipping arrives within ~7 days, while standard delivery takes up to 3 weeks, both with full tracking.

Dosing, Formulations & Administration

Available Formulations

Oral tablets: 2 mg, 4 mg, 6 mg. Injectable powder for reconstitution: 25 mg, 50 mg, 140 mg vials.

Typical Dosing Ranges

For adults with multiple myeloma, clinicians often initiate treatment at 4 mg/m² orally daily for 4 days, or a 140 mg/m² intravenous dose on day -1 of transplant conditioning. Dosage adjustments are made based on renal function, hematologic parameters, and treatment response. In ovarian cancer, a common schedule is 100 mg/m² IV every 28 days for up to six cycles.

Administration Guidelines

Oral melphalan should be taken on an empty stomach, at least one hour before or two hours after meals, to maximize absorption.
Intravenous infusion is administered over 30 minutes under continuous cardiac monitoring.
Patients are advised to stay well-hydrated and avoid concurrent nephrotoxic agents unless necessary.

The exact dose and schedule must be determined by a qualified healthcare professional who considers individual disease status and organ function.

Safety Profile & Considerations

Common Side Effects

Myelosuppression (neutropenia, thrombocytopenia) - observed in >80 % of patients (clinical trial data).
Nausea & vomiting - moderate to severe in ~60 % without anti-emetic prophylaxis.
Mucositis - oral and gastrointestinal ulceration in roughly 40 % of recipients.
Alopecia - hair loss occurs in 30 %-50 % of patients.

Serious Adverse Events

Febrile neutropenia requiring hospitalization.
Renal toxicity manifested by rising serum creatinine, especially with high-dose regimens.
Secondary malignancies such as therapy-related myelodysplastic syndrome, noted in long-term survivors (<5 % incidence).

Prompt medical evaluation is warranted if fever, persistent diarrhea, or unexplained bleeding develop.

Contraindications

Known hypersensitivity to melphalan or other nitrogen-mustard agents.
Severe bone-marrow failure (ANC < 500 µL⁻¹, platelets < 25 × 10⁹/L).
Pregnant or breastfeeding women (category D).

Drug Interactions

CYP2C9 inhibitors (e.g., fluconazole) may increase melphalan exposure.
Concurrent anthracyclines heighten cardiotoxic risk.
Serotonergic drugs (e.g., SSRIs) have no direct interaction, but overlapping nausea control agents should be coordinated.

Special Populations

Pregnancy & lactation: Teratogenic; contraindicated.
Elderly: Dose reductions by 25 % are common due to reduced renal clearance.
Renal impairment: Adjust dose if creat clearance < 30 mL/min.
Hepatic dysfunction: No formal dose alteration required, but monitor closely for increased toxicity.

Always discuss medical history, current medications, and organ function with a healthcare provider before initiating melphalan.

Frequently Asked Questions

How does melphalan differ from cyclophosphamide? Melphalan forms direct DNA cross-links, whereas cyclophosphamide requires hepatic activation to produce alkylating metabolites. This results in a more predictable exposure profile for melphalan but also a higher rate of myelosuppression.
What is the typical timeframe for melphalan to produce noticeable effects in multiple myeloma? Laboratory markers such as M-protein often decline within 2-3 weeks; however, clinical response assessment is usually performed after at least four treatment cycles.
Can I take melphalan with food? Oral melphalan should be taken on an empty stomach; food can reduce its absorption by up to 30 %, potentially diminishing efficacy.
What should I do if I experience severe nausea after melphalan? Contact your oncology team promptly. Prescription anti-emetics (5-HT₃ antagonists, NK₁ blockers) are effective, and dose adjustments may be considered.
Are there specific foods I need to avoid while on melphalan? Grapefruit juice can inhibit drug metabolism and should be avoided. Additionally, high-protein meals may interfere with absorption if taken within an hour of the dose.
How long does melphalan stay in my system after the last dose? The plasma half-life is short, but DNA adducts persist for several days, and bone-marrow suppression can continue for 2-4 weeks.
Is melphalan safe for patients with mild kidney disease? Mild impairment (creatinine clearance > 50 mL/min) generally does not require dose change, but renal function should be monitored regularly.
What monitoring is required during melphalan therapy? Full blood counts weekly, renal and hepatic panels bi-weekly, and periodic imaging to assess disease response.
Can melphalan be used as part of a stem-cell transplant conditioning regimen? Yes; high-dose melphalan (140 mg/m²) is a standard component of autologous transplant protocols for multiple myeloma and certain lymphomas.
What information should I provide my doctor when discussing melphalan?
- Complete list of current medications, including over-the-counter drugs and supplements.
- Detailed medical history, especially prior chemotherapy, kidney or liver disease.
- Any past allergic reactions to chemotherapy agents.
- Goals of therapy and concerns about side effects.

Disclaimer

The information provided about melphalan is for general knowledge only. It does not replace professional medical consultation or the official prescribing information for medications containing this ingredient. All treatment decisions, including dosing, formulation selection, and monitoring, should be made under the supervision of a qualified healthcare provider who can assess individual medical history, current medications, and specific health needs. We assume all readers are responsible adults capable of making informed decisions about their health. Our online pharmacy offers access to medications containing melphalan for individuals who may have limited availability through traditional pharmacies, prescription-based insurance schemes, or who are seeking affordable generic alternatives. Always consult your doctor before starting, changing, or discontinuing any medication containing melphalan.