Alkeran Tablet: Uses, Dosage, Side Effects, Precautions and Alternates

Quick overview

Alkeran Tablet contains the active ingredient melphalan, a medicine from the alkylating agent class. It is a prescription chemotherapy medicine used to treat multiple myeloma, advanced ovarian cancer, and sometimes advanced breast cancer or polycythaemia rubra vera. It works by damaging the DNA of cancer cells to stop them from growing and spreading. It must be used exactly as directed by a cancer specialist, with regular blood test monitoring.

What is Alkeran Tablet

Alkeran is a prescription cancer medicine (chemotherapy) that contains the active ingredient melphalan. It belongs to a group of medicines called alkylating agents.

Alkeran Tablet uses

• Treatment of multiple myeloma (a cancer of plasma cells in the bone marrow)
• Treatment of advanced ovarian cancer (adenocarcinoma)
• Sometimes used for advanced breast cancer
• Sometimes used for polycythaemia rubra vera (a blood disorder with too many red blood cells)

Benefits of Alkeran Tablet

• Can help slow the growth of cancer cells in multiple myeloma
• Can help control symptoms and disease in advanced ovarian cancer
• May have a therapeutic effect on some patients with advanced breast cancer
• Can help control polycythaemia rubra vera in some patients

How Alkeran Tablet works

Melphalan attaches to the DNA inside cancer cells and links the two strands of DNA together. This stops the cells from copying themselves and growing, which kills them or stops them from spreading.

Alkeran Tablet dosage

Take this medicine exactly as your doctor tells you, following the specific treatment schedule for your type of cancer. Taking the tablets right after food can delay how quickly the medicine is absorbed and can lower the total amount that gets into your blood, so your doctor's instructions about timing with meals should be followed carefully. Do not break, crush, or chew the tablets. Follow your doctor's instructions on which days to take the medicine during each treatment cycle, since doses are often given on an on-and-off schedule. You will need regular blood tests during treatment so your doctor can check your blood cell counts and adjust treatment if needed. Use in children is rare and there are no set dosing guidelines. There is no specific extra dosing information for elderly patients, but it is often used at the usual adult dose in this group.

Available forms and strengths

• Film-coated tablets
• Powder for solution/injection (other brands/forms)

Side effects of Alkeran Tablet

Common

• Nausea and vomiting
• Diarrhea
• Low blood cell counts
• Mouth ulcers or sores
• Hair loss (alopecia)
• Liver problems
• Skin rash
• Feeling hot or tingling at the application site
• Muscle pain, muscle wasting, or increased muscle enzyme levels

Serious

• Severe bone marrow suppression leading to serious infection or bleeding
• Low white blood cells (leukopenia), low platelets (thrombocytopenia), or anemia
• Unusual bleeding or bruising, black tarry stools, blood in urine or stools, pinpoint red spots on skin
• Fever, chills, cough or hoarseness, lower back or side pain, or painful urination (signs of infection)
• Sudden skin rash or itching, swelling of face/lips/tongue, trouble breathing (allergic reaction)
• Fast or irregular heartbeat
• Shortness of breath or troubled breathing
• Interstitial lung disease or pulmonary fibrosis (scarring of the lungs)
• Liver problems including hepatitis or jaundice (yellowing of skin or eyes)
• Kidney problems, including acute kidney injury
• Secondary cancers, including leukemia, occurring months or years later
• Blood clots, including deep vein thrombosis and pulmonary embolism, especially when combined with certain other medicines

Warnings and precautions

• This medicine can severely lower your bone marrow's ability to make blood cells, which can lead to serious infection or bleeding.
• This medicine has been linked to the development of blood cancers like leukemia.
• This medicine can cause changes to chromosomes and should be considered capable of causing genetic mutations in humans.
• Do not have any vaccinations, especially live vaccines, without your doctor's approval while taking this medicine and after you stop, because your weakened immune system may not be able to handle them safely, and you could also catch infections from people recently vaccinated with certain live vaccines.
• This medicine must only be given under the care of a doctor experienced in treating cancer with these types of medicines, because of its serious risks.
• This medicine may affect your ability to have children in the future, in both men and women, and may cause permanent infertility.
• This medicine should not be given to anyone who has had an allergic reaction to melphalan before.
• This medicine should be avoided during pregnancy, especially in the first three months, because it may harm an unborn baby. Effective contraception is needed during and after treatment.
• Mothers taking this medicine should not breastfeed.
• This medicine is cleared more slowly by the body in people with kidney problems, so your doctor may need to lower your dose and monitor you closely. High doses can also cause sudden kidney injury.
• Liver problems, including hepatitis and jaundice, have been reported rarely with this medicine.
• Alcohol should be discussed with the oncology team because treatment can cause gastrointestinal and liver-related adverse effects.
• There is no information available on whether this medicine affects your ability to drive or use machines.

Storage

• Store at 2°C to 8°C (in the refrigerator)
• Keep the tablets in the original bottle or amber bottle to protect them from light
• ALKERAN tablets should be destroyed in accordance with relevant local regulatory requirements concerning the disposal of cytotoxic medicines
• Provided the outer coating of the tablet is intact, there is no risk in handling ALKERAN Tablets

When to see a doctor

• Get medical help right away if you notice signs of infection such as fever, chills, cough or hoarseness, lower back or side pain, or pain when urinating.
• Get medical help right away if you notice unusual bleeding or bruising, black tarry stools, blood in your urine or stools, or small red spots on your skin.
• Get emergency help if you have signs of a serious allergic reaction, such as throat tightness, trouble breathing, hives or itching, swelling, chest pain, fast heartbeat, or dizziness.
• Tell your provider right away if you or your partner becomes pregnant during treatment, since this medicine can harm an unborn baby.
• Get medical help if you develop sudden skin rash or itching, shortness of breath, or troubled breathing.

Alternatives

• Cyclophosphamide
• Bendamustine
• Bortezomib
• Daratumumab