Alkeran (Melphalan) Guide: Uses, Dosage, Side Effects, Safety [2025]

You typed 'Alkeran' because you need clarity fast. Maybe a doctor mentioned it, or you saw it on a treatment plan. Here’s the simple version: what it does, how it’s given (tablets or IV), the big safety flags, and the quickest way to reach the official prescribing info and patient leaflets in Australia, the US, and Europe/UK. I’ll flag the practical stuff you’ll actually use-dose basics, lab checks, what to do if you miss a dose, and when to call for help.

Set expectations: this is a clear, people-first guide, not a replacement for your oncology team. Drug availability and brand names vary by country, and hospital protocols trump any generic advice here.

What Alkeran (Melphalan) Is and Who It’s For

Alkeran is the brand name for melphalan, an alkylating chemotherapy. It damages cancer cell DNA so those cells can’t divide. Some regions now use mostly generic melphalan; in others, the Alkeran brand still appears on labels or hospital shelves. Your hospital pharmacy will tell you what’s stocked locally.

Where it’s used most:

• Multiple myeloma: often as part of induction or maintenance in some settings; classically used in high-dose conditioning before autologous stem cell transplant.
• AL amyloidosis: as part of tailored regimens.
• Ovarian carcinoma: less common today but still referenced in some protocols.

Forms and routes:

• Oral tablets (varies by market): used in chronic regimens for some patients.
• IV melphalan: used in conditioning (high-dose) and in some non-transplant regimens. Stability and preparation are handled by oncology pharmacy; some centres use melphalan for injection with propylene glycol and others newer formulations-expect local differences.

Why doctors pick it: it’s a backbone in transplant conditioning for myeloma and stays useful in select regimens where its risk-benefit profile makes sense. Evidence is rooted in decades of oncology practice and current guideline sets like NCCN (Multiple Myeloma 2024-2025), ESMO guidelines, and national protocols (eviQ in Australia).

Fast Access: Official Prescribing Info and Patient Leaflets (AU, US, EU/UK)

If you just want the official label or the lay-language leaflet, here’s the shortest route. Follow the steps for your region.

Australia (TGA + PBS context)

1. Open your search engine and type: TGA melphalan product information PDF.
2. Look for a result that mentions the Therapeutic Goods Administration (TGA) and 'Product Information'. You want the PDF that oncology pharmacies use.
3. On that page, locate the brand or active ingredient 'melphalan' and download the PI (Product Information) for healthcare professionals and the CMI (Consumer Medicine Information) for patients, if available.
4. For practical protocols, search: eviQ melphalan myeloma. Pick the protocol that matches your scenario (e.g., autologous transplant conditioning). eviQ is the standard in Australian cancer centres.

Visual cues: the PI PDF usually has a large 'Product Information' title at the top, with sections like Indications, Dosage and Administration, Contraindications, Warnings, Adverse Effects.

United States (FDA/DailyMed)

1. Search: DailyMed melphalan label.
2. Select the DailyMed entry that shows 'melphalan' (Alkeran may appear in historical labels; many products are now listed by the generic name).
3. Open the Full Prescribing Information. Scroll to Highlights, then Sections 1-17 for indications, dosing, warnings, adverse reactions, and handling.

Visual cues: look for 'FULL PRESCRIBING INFORMATION' and boxed warnings (if present). DailyMed entries include revision dates and manufacturer details.

Europe/UK (EMA/MHRA)

1. Search: EMA melphalan SmPC PDF (for the Summary of Product Characteristics).
2. Choose the EMA product page or your country’s medicines agency page. Download the SmPC and the PIL (Patient Information Leaflet).
3. In the UK, search: MHRA melphalan PIL. The leaflet is written for patients and carers.

Why these sources: they are the primary, regulator-approved references. Doctors and pharmacists use them to counsel, dose, and monitor safely.

Credible sources to reference during consults: TGA Product Information (Australia), eviQ protocols (Australia), FDA labeling via DailyMed (US), EMA SmPC (EU), MHRA PIL (UK), NCCN and ESMO guidelines for disease-specific context, MASCC/ISOO supportive care guidelines for mucositis and nausea prevention. If your hospital gives you a local chemo plan, that plan outranks anything generic you read online.

How It’s Given: Dosing Basics, Schedules, and Practical Tips

Every protocol is customised. That said, here are the patterns you’ll actually hear in clinic, so the conversation makes sense.

Typical dosing patterns (examples, not prescriptions)

• High-dose conditioning (autologous stem cell transplant in myeloma): IV melphalan around 200 mg/m² once (sometimes split over 1-2 days), with cryotherapy and aggressive supportive care. Kidney function can influence dose.
• Oral regimens (legacy use in myeloma or amyloidosis): low-dose melphalan tablets in cycles, often combined with steroids (e.g., prednisolone). This is centre- and patient-specific and less common with newer agents.

How dosing is calculated: usually by body surface area (mg per m²). If kidneys are impaired or the bone marrow is fragile, oncologists often reduce or adjust dosing. Your lab numbers drive these calls.

Food, timing, and handling

• Oral tablets: food can affect absorption. Follow the specific instructions on your label; some centres prefer consistent timing relative to meals. Swallow whole with water. Don’t crush unless your pharmacist says it’s okay and provides a safe handling plan.
• IV: given in a chemo day unit or inpatient setting. Infusion times vary; the nurse will premedicate for nausea and monitor during and after.
• Handling at home: melphalan is cytotoxic. If tablets are supplied for home use, wash hands before and after handling, avoid touching the drug dust, and use a clean surface. Caregivers who are pregnant should not handle chemo tablets.

Supportive care that makes a difference

• Nausea prevention: standard antiemetics are given up front. If you still feel sick, tell your team early; there are backup options.
• Mouth care: oral cryotherapy (sucking on ice chips around infusion) can reduce mouth sores with high-dose melphalan. This is backed by supportive care guidelines used in transplant units.
• Hydration: especially important with high-dose treatment. Your team will set targets.

Missed dose (tablets): if you miss a dose, don’t double up unless your oncologist tells you to. Call the clinic and get instructions. For IV, the hospital manages timing.

Quick reference

Note: examples reflect common practice but not a one-size plan. Always use your centre’s protocol sheet.

Safety First: Side Effects, Interactions, and Red Flags

You’ll hear a lot of side-effect talk; here’s what tends to matter most and how to manage it day to day.

Common effects

• Bone marrow suppression: low white cells (infection risk), low platelets (bleeding/bruising), low red cells (fatigue). Timing depends on dose-expect nadirs about 7-14 days after lower-dose regimens; with high-dose, the team tracks you daily.
• Nausea and vomiting: usually preventable with good antiemetics. Speak up early if control is poor.
• Mouth sores (mucositis): especially after high-dose. Ice chips around infusion can help; strict mouth care reduces infections.
• Diarrhoea or constipation: both can happen. Your team can pre-plan bowel care.
• Hair thinning: less dramatic than some drugs but possible.

Less common but serious

• Severe infections: fever can be the only sign. Treat any temperature spike as urgent.
• Allergic/infusion reactions: rare but possible with IV; nurses are trained to manage fast.
• Secondary malignancies: a known long-term risk with alkylators. Your team weighs this when building your plan.
• Kidney impact: dosing may be reduced if kidneys are already struggling.

Interactions to flag

• Live vaccines: avoid during and after chemo until your oncologist clears it.
• Other myelosuppressive meds: antibiotics like linezolid, some antivirals, and many chemo agents add to low blood counts-your team already accounts for this.
• Warfarin and some anticoagulants: bleeding risk rises when platelets drop; you’ll get a tailored plan.
• Complementary/herbal products: St John’s wort and others can muddle metabolism or bleeding risk. Tell your pharmacist everything you take, including supplements and over-the-counter meds.

Who should not take it (or needs extra caution)

• Pregnancy: do not use. Melphalan can harm a developing baby. Use reliable contraception during treatment and for the period your team recommends afterward.
• Breastfeeding: generally not advised during treatment.
• Severe marrow suppression or serious infections: treatment may be delayed or adjusted.

Red flags: call urgently

• Fever 38.0°C or higher, or chills/shakes.
• Uncontrolled vomiting or diarrhoea, unable to keep fluids down.
• Bleeding that won’t stop, black/tarry stools, blood in urine.
• New chest pain, shortness of breath, confusion, severe headache.

Monitoring you can expect: full blood counts, kidney and liver tests, infection checks, and symptom reviews. Transplant settings use daily rounds and strict protocols until counts recover.

Real-World Help: Questions to Ask, Alternatives, and Next Steps

A good consult saves time and stress. Bring this list to your next visit.

Questions to ask your oncologist or pharmacist

• What exact regimen am I getting (drug names, doses, days), and what is the goal-curative transplant, disease control, symptom relief?
• How will we prevent nausea and mouth sores? Can I use ice chips during infusion?
• Which lab numbers do we watch, and what thresholds lead to delays or dose changes?
• What’s my plan if I miss a tablet dose, or if I vomit soon after taking it?
• Which vaccines are allowed, and when can I get boosters again?
• Which warning signs mean I should call right away?

Alternatives and combinations

In myeloma, melphalan competes with or complements a big toolkit: proteasome inhibitors (like bortezomib), immunomodulators (lenalidomide, pomalidomide), monoclonal antibodies (daratumumab), and newer cellular therapies in select settings. In transplant conditioning, high-dose melphalan remains a standard. Your team matches the plan to your disease stage, fitness, kidney function, and personal goals.

If melphalan isn’t a fit-because of marrow reserve, kidney function, prior toxicities, or logistics-your oncologist will map a different route. That might mean a non-alkylator doublet/triplet, or timing CAR-T/bi-specifics in 2025 care paths. These are nuanced decisions; lean on your centre’s protocol board.

Day-of-treatment checklist

• Eat light, hydrate, and take premeds exactly as instructed.
• Bring your questions, a list of meds/supplements, and a contact number for your support person.
• Have mouth-care supplies ready at home: soft toothbrush, bland rinses (salt/bicarbonate), lip balm.
• Set up a thermometer and a plan for after-hours calls.

Home with tablets? Store them as directed, away from kids and pets, and return unused tablets to a pharmacy for safe disposal.

Navigation Cheatsheet (By Region): Get the Right Page in 60 Seconds

Use these exact searches and click patterns. Saves you from wading through ads or outdated PDFs.

Australia

1. Type: 'TGA melphalan Product Information PDF'.
2. Click the TGA page that lists melphalan; download the PI and CMI (if posted).
3. For protocols: search 'eviQ melphalan autologous transplant' or 'eviQ melphalan multiple myeloma'. Pick the protocol that matches your plan.

United States

1. Type: 'DailyMed melphalan'.
2. Open the melphalan entry with the most recent 'Revised' date and 'Full Prescribing Information'.
3. Skim Highlights for warnings; print Sections 2 (Dosage) and 5/6 (Warnings/Adverse Reactions) if you like hard copies.

Europe/UK

1. Type: 'EMA melphalan SmPC' or for UK 'melphalan MHRA PIL'.
2. Open the official agency page, not forum or third-party sites.
3. Download the SmPC (for clinicians) and PIL (for patients).

Credible names to recognise on-page: Therapeutic Goods Administration (TGA), eviQ, DailyMed (NLM/FDA), European Medicines Agency (EMA), Medicines and Healthcare products Regulatory Agency (MHRA). These are your 'no-drama' sources.

Mini‑FAQ

Is Alkeran still sold under that brand? Depends on the country. Many places use generic melphalan; some still show Alkeran on packs or labels. Your hospital pharmacy will tell you what’s stocked.

Can I take Alkeran at home? Oral tablets may be taken at home if prescribed that way. High-dose IV melphalan is always given in hospital or a specialised day unit.

What if I’m planning pregnancy? Press pause and talk to your oncologist. You’ll need effective contraception during therapy and for a period afterward. Don’t breastfeed during treatment.

Will I lose my hair? Hair thinning can happen, but it’s usually less dramatic than with some other chemos. Your team can discuss scalp cooling if appropriate.

Can I have vaccines? Avoid live vaccines during treatment. Inactivated vaccines may be timed around your counts. Your oncologist will give a personalised plan.

Next Steps and Troubleshooting

If you’re starting soon: get the exact regimen name from your clinic (e.g., 'High-dose melphalan conditioning'), download the official label (PI/SmPC/Full Prescribing Information) using the steps above, and read the sections on dosing, warnings, and handling. Print your centre’s protocol if they allow it-it’s the most accurate snapshot of what you’ll receive.

If you’re halfway through and struggling with side effects: call the clinic and ask for a toxicity review. Ask specifically about antiemetic escalation, mouth sore prevention, and whether dose holds or growth factors are appropriate.

If something feels off after hours: err on the safe side. Fever and uncontrolled vomiting are never 'wait and see' on chemo. Your care team would rather hear from you early.

For carers: set up a simple log-temperature, symptoms, meds taken, and fluid intake. It helps the nurse triage fast on the phone.

Professional references your team may cite: TGA PI/CMI for melphalan (Australia), eviQ protocols, FDA DailyMed label, EMA SmPC, NCCN/ESMO disease guidelines, and MASCC/ISOO mucositis guidance. These aren’t bedtime reading, but they’re the backbone of safe care.

Last thing: every centre does this a little differently for good reasons-drug stability, infusion setups, and transplant workflows vary. If your handout conflicts with what you read online, go with your handout and ask your team to explain the differences. That quick conversation is worth its weight in calm.