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Alkeran (Melphalan)  

Melphalan is an anti-tumor drug used in cancer treatment. It interferes with the development of cancer cells and retards their growth and proliferation in the body. Alkeran (Melphalan) is also known as L-phenylalanine mustard, phenylalanine mustard, L-PAM, or L-sarcolysin; and is a phenylalanine imitative of nitrogen mustard.  

Indications: The drug comes in injection and tablet form. In addition to advanced stage prostate cancer, the tablets are indicated for the treatment of breast cancer and epithelial carcinoma (cancer of the ovary). Intermittently, this drug is indicated in the treatment of testicular cancer, osteogenic sarcoma (common form of bone cancer in children).  

Alkeran (Melphalan) is also recommended to treat multiple myeloma, a type of blood cancer. Multiple myeloma is regarded as an excessive production of abnormal plasma cells. The patients of multiple myeloma experience weight loss, frequent urination, bone pain, frequent infections, constipation etc. 

Dosage: Alkeran can be taken by intravenous injection (administered in vein) and also as oral tablets on an empty stomach. A typical oral dosage of Alkeran is 16 mg/m2. This dosage should be reduced up to 50% in patients with kidney problems or renal insufficiency. Patients with multiple myeloma attain better results while using the drug orally.  

Dosage of Alkeran for the treatment of ovarian cancer is to administer single course of 0.2mg/kg daily for 5 days. Based upon the hematologic tolerance, the course of treatment may be repeated for 4 to 5 weeks.  

Contraindications: Alkeran faces contraindications under certain conditions.  Allergy may occur due to the usage of this drug or one of its components. Breast feeding is not recommended with the use of Alkeran. It is advisable not to take this drug during first quarter of pregnancy lest there may be destructive effects on the fetus.  Infants, children and elderly people who are treated with Alkeran (Melphalan) are to be supervised under strict medical conditions.  

Before beginning an Alkeran treatment, conditions of lactase deficiency, kidney problems, galatosemia, fructose intolerance, glucose-galactose malabsorption must be considered. If patient has undergone radiotherapy or antineoplastic agents in previous 3 weeks, the doctor must be consulted before taking this medicine.   

Mechanism of Action (MOA):  Alkeran, a phenylalanine derivative of nitrogen mustard, helps in destruction of cancer cells by forming cross- linkages between DNA strands, which thereby reduce the reproduction of tumor cells. 

Pharmacology – This drug is an alkylating agent that preventing cell replication. 

Pharmacokinetics - The absorption of this drug is variable with its bio-availability in the range of 56±27%. Its elimination half-life is 90±57 min where 11% of Alkeran gets recovered in the urine above 24 hrs.  

Interactions: Alkeran when coupled with nalidixic acid (Neggram), cyclosporine or other immunosuppressant may result in serious and toxic infections. The over dosage of Alkeran may also result in kidney problems.  

Side Effects: taking Alkeran can result in minor to major side effects like gastrointestinal effects in the form of vomiting, nausea, and diarrhea. Over dosing can also lead to few toxic effects in the form of leucopenia, anemia and thrombocytopenia.  

On experiencing any of the over dosing side effects of Alkeran, doctor must consulted at earliest who would institute relevant supportive measures.