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Indication of Melphalan-50:
For medicinal forms taken orally, – multiple myeloma, the true polycythemia. For injections – lymphoepithelial Schmincke’s tumor, melanoma of the limbs, soft tissue sarcoma of the extremities (including hemangiendothelioma) – regional perfusion, progressive neuroblastoma in children. Intraarterially and intraperitoneal administration of relatively high doses: neuroblastoma, melanoma (late stages), cancer of the colon and rectum. Refractory malignant blood diseases followed by autologous bone marrow transplantation.
Contraindications of Melphalan-50:
Hypersensitivity, pregnancy (especially the first trimester) – a high probability of embryotoxic and teratogenic action, requiring the termination of pregnancy. With caution. The condition after radiation therapy, preceded by cytotoxic therapy, anemia, leukopenia (the number of white blood cells is below 2 thousand / μL), thrombocytopenia (below 50 thousand / μL), suppression of bone marrow function, chicken pox, herpes zoster and other infections, terminal stage of the disease; severe concomitant diseases: parenchymal hepatitis, gouty arthritis, urological nephropathy, nephritis and diseases of the cardiovascular system in decompensation stage, lactation period.
Side effects of Melphalan-50:
From the hemopoiesis: oppression of bone marrow hematopoiesis (suppression of stem cells): leukopenia, thrombocytopenia (most often completely reversible after timely withdrawal), anemia, incl. very rarely – hemolytic anemia. From the endocrine system: ovarian hypofunction (especially in the period before menopause, which accelerates the development of amenorrhea), azoospermia. On the part of the digestive system: gastrointestinal disorders: nausea, vomiting (in 30%), diarrhea, stomatitis, stomach ulcers and duodenal ulcer (the risk of these side effects is greatly increased when combined cytotoxic therapy is performed), extremely rarely – dysfunction liver. Allergic reactions: skin rash, hives, rarely – maculopapular rash, itching, anaphylactic shock. From the respiratory system: very rarely – pulmonary fibrosis, interstitial pneumonitis. Other: alopecia, hyperuricemia, vasculitis. Melphalan (like other alkylating antitumor remedies) with prolonged use can cause the development of acute leukemia. Against the background of leukopenia / neutropenia, the development of secondary infections is possible.
Interaction of Melphalan-50:
Unsteadies in fluids for infusions, it cannot be used in dextrose solutions. It is possible to dissolve in 0.9% NaCl solution, the shelf life of the resulting solution is not more than 8 hours. If possible, simultaneous administration of nalidixic acid (may cause death in children due to the development of hemorrhagic enterocolitis) should be avoided. Cyclosporine and large doses of Melphalan are a potentially dangerous combination because of the possible development of renal dysfunction (the remedy itself does not possess nephrotoxicity). Chlorpromazine, chloramphenicol, metamizole sodium increase the severity of myelodepressive action. Cisplatin induces renal dysfunction and changes the clearance.