{"id":4187,"date":"2025-03-31T18:12:00","date_gmt":"2025-03-31T18:12:00","guid":{"rendered":"https:\/\/kidneydiseaseclinic.net\/kdc\/melphalan-txt\/"},"modified":"2025-03-31T18:12:00","modified_gmt":"2025-03-31T18:12:00","slug":"melphalan-txt","status":"publish","type":"post","link":"https:\/\/kidneydiseaseclinic.net\/kdc\/melphalan-txt\/","title":{"rendered":"Melphalan.txt"},"content":{"rendered":"

CLINICAL USE <\/H3>
\nAlkylating agent:Myelomas Solid tumours Lymphomas Polycythaemia vera

DOSE IN NORMAL RENAL FUNCTION <\/H3>Orally: 150\u2013200 micrograms\/kg daily Polycythaemia vera: 6\u201310 mg daily, reduced after 5\u20137 days to 2\u20134 mg daily, then further reduced to 2\u20136 mg per weekIV administration: 16\u2013200 mg\/m 2 according to indication and local protocol

PHARMACOKINETICS <\/H3>
  • Molecular weight &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :305.2<\/li>\n
  • %Protein binding &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :60\u201390<\/li>\n
  • %Excreted unchanged in urine &nbsp &nbsp : 11<\/li>\n

  • Volume of distribution (L\/kg) &nbsp &nbsp &nbsp :0.5<\/li>\n

  • half-life \u2013 normal\/ESRD (hrs)&nbsp &nbsp &nbsp :0.5\u20132.5\/4\u20136

    DOSE IN RENAL IMPAIRMENT <\/H3>

    GFR (mL\/MIN)<\/H4>
  • 20 to 50 &nbsp &nbsp : See \u2018Other Information\u2019
  • 10 to 20 &nbsp &nbsp : See \u2018Other Information\u2019
  • <10 &nbsp &nbsp &nbsp &nbsp &nbsp : See \u2018Other Information\u2019

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES <\/H3>
  • CAPD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp:Unknown dialysability. Dose as in GFR <10 mL\/min <\/p>\n
  • HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :Not dialysed. Dose as in GFR <10 mL\/min
  • HDF\/high flux &nbsp :Unknown dialysability. Dose as in GFR <10 mL\/min
  • CAV\/VVHD &nbsp &nbsp &nbsp:Unknown dialysability. Dose as in GFR 10 to 20 mL\/min

    IMPORTANT DRUG INTERACTIONS <\/H3>Potentially hazardous interactions with other drugs\n
  • Antipsychotics: avoid concomitant use with clozapine (increased risk of agranulocytosis)\n
  • Ciclosporin: increased risk of nephrotoxicity

    ADMINISTRATION <\/H3>

    Reconstition<\/H4>10 mL of provided diluent

    Route <\/H4>IV, oral

    Rate of Administration <\/H4>Inject slowly into a fast running infusion solution or via an infusion bag

    Comments<\/H4>Further dilution with sodium chloride 0.9%

    OTHER INFORMATION <\/H4>Melphalan clearance, though variable, is decreased in renal impairmentIncomplete and variable oral absorption \u2013 25\u201389% post oral dose; AUC decreased by 39% when taken with foodSpontaneous degradation rather than enzymatic metabolism; Percentage of dose excreted in the urine as active or toxic moiety ranges from 11\u201393%;
  • 20 to 50<\/LI>% excreted in the faeces within 6 daysCurrently available pharmacokinetic data do not justify an absolute recommendation on dosage reduction when administering melphalan tablets to patients with renal impairment, but it may be prudent to use a reduced dosage initially until tolerance is established When melphalan injection is used at conventional IV dosage (8\u201340 mg\/m2 BSA) in patients with moderate to severe renal impairment, it is recommended that the initial dose should be reduced by 50% and subsequent dosage be determined by the degree of haematological suppressionFor high IV doses of melphalan (100\u2013 240 mg\/m2 BSA), the need for dose reduction depends upon the degree of renal impairment, whether autologous bone marrow stem cells are re-infused, and therapeutic need. High dose melphalan is not recommended in patients with more severe renal impairment (EDTA clearance less than 30 mL\/minute)It should be borne in mind that dose reduction of melphalan in renal impairment is somewhat arbitrary. At moderate doses, where melphalan is used as part of a combined regimen, dosage reductions of up to 50% may be appropriate. However, at high doses, e.g. conditioning for bone marrow transplant, there is a risk of under-dosing the patient and not achieving the desired therapeutic effect, so the dose should be reduced with caution in these instancesAdequate hydration and forced diuresis may be necessary in patients with poor renal functionIn myeloma patients with renal damage, temporary but significant increases in blood urea levels have been observed during melphalan therapy.
    \n","protected":false},"excerpt":{"rendered":"

    CLINICAL USE Alkylating agent:Myelomas Solid tumours Lymphomas Polycythaemia vera DOSE<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[7],"class_list":["post-4187","post","type-post","status-publish","format-standard","hentry","category-blog","tag-post-by-auto-php"],"_links":{"self":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts\/4187","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/comments?post=4187"}],"version-history":[{"count":0,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts\/4187\/revisions"}],"wp:attachment":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/media?parent=4187"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/categories?post=4187"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/tags?post=4187"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}