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Melphalan Side Effects

For the Consumer

Applies to melphalan: intravenous powder for solution

Other dosage forms:


Intravenous route (Powder for Solution)

Alkeran®: Melphalan should be administered under the supervision of a qualified physician experienced in the use of cancer chemotherapeutic agents. Severe bone marrow suppression with resulting infection or bleeding may occur. Controlled trials comparing intravenous (IV) to oral melphalan have shown more myelosuppression with the IV formulation. Hypersensitivity reactions, including anaphylaxis, have occurred in approximately 2% of patients who received the IV formulation. Melphalan is leukemogenic in humans. Melphalan produces chromosomal aberrations in vitro and in vivo and, therefore, should be considered potentially mutagenic in humans

Intravenous route (Powder for Solution)

Evomela(TM): Severe bone marrow suppression with resulting infection or bleeding may occur. Controlled trials have shown more myelosuppression with the IV formulation than the oral formulation. Monitor hematologic laboratory parameters. Hypersensitivity reactions, including anaphylaxis, have occurred in patients who received the IV formulation of melphalan hydrochloride. Discontinue treatment with melphalan hydrochloride for serious hypersensitivity reactions. Melphalan produces chromosomal aberrations in vitro and in vivo. Melphalan hydrochloride should be considered potentially leukemogenic in humans.

Side effects requiring immediate medical attention

Along with its needed effects, melphalan may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur while taking melphalan:

More common

  • Chest pain
  • chills
  • cough or hoarseness
  • fever
  • lower back or side pain
  • painful or difficult urination
  • shortness of breath
  • sores, ulcers, or white spots on the lips or in the mouth
  • swollen glands
  • unusual bleeding or bruising
  • unusual tiredness or weakness

Incidence not known

  • Abdominal or stomach pain
  • absent, missed, or irregular menstrual periods
  • back or leg pains
  • bleeding gums
  • bloated abdomen or stomach
  • blurred vision
  • clay-colored stools
  • confusion
  • dark urine
  • difficult or labored breathing
  • difficulty with swallowing
  • dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
  • fast, pounding, or irregular heartbeat or pulse
  • general body swelling
  • headache
  • hives, itching, or rash
  • indigestion
  • light-colored stools
  • loss of appetite
  • nausea and vomiting
  • noisy breathing
  • nosebleeds
  • pain and fullness in right upper abdomen or stomach
  • pale skin
  • puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  • reddening of the skin, especially around the ears
  • sore throat
  • sweating
  • swelling of eyes, face, hands, ankles, feet, or lower legs
  • tightness in the chest
  • unpleasant breath odor
  • unusual lumps or masses
  • vomiting of blood
  • weight gain or loss
  • yellow eyes or skin

Side effects not requiring immediate medical attention

Some side effects of melphalan may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.

Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Less common

  • Indigestion
  • passing of gas
  • stomach fullness

Incidence not known

  • Blue-green to black skin discoloration
  • hair loss or thinning of the hair
  • pain, redness, soreness, or sloughing of the skin at the injection site
  • sores, welting, or blisters

For Healthcare Professionals

Applies to melphalan: intravenous powder for injection, oral tablet


thrombocytopenia, anemia)

Rare (less than 0.1%): Hemolytic anemia[Ref]


Frequency not reported: Secondary malignancies (e.g., acute nonlymphocytic leukemia, myeloproliferative syndrome, carcinoma[Ref]


Rare (less than 0.1%): Interstitial pneumonitis, pulmonary fibrosis

Frequency not reported: Bronchospasm, dyspnea[Ref]


Very common (10% or more): Alopecia (at high dose)

Common (1% to 10%): Alopecia (at conventional dose)

Rare (less than 0.1%): Maculopapular rash, pruritus

Frequency not reported: Skin hypersensitivity, skin necrosis (rarely requiring skin grafting)[Ref]


Frequency not reported: Tachycardia, hypotension, vasculitis[Ref]


Very common (10% or more): Nausea, vomiting, diarrhea, stomatitis (at high dose)

Rare (less than 0.1%): Stomatitis (at conventional dose)[Ref]


Rare (less than 0.1%): Abnormal liver function tests to clinical manifestations such as hepatitis and jaundice; veno-occlusive disease following high dose treatment[Ref]


Uncommon (0.1% to 1%): Allergic reactions (e.g., urticaria, edema, skin rashes, anaphylactic shock)[Ref]


Very common (10% or more): Warmth, tingling

Frequency not reported: Chromosome damage[Ref]


Common (1% to 10%): Temporary significant elevation of the blood urea has been seen in the early stages of therapy with this drug in myeloma patients with renal damage[Ref]


Frequency not reported: Skin ulceration at injection site[Ref]


Very common (10% or more): Muscle atrophy, muscle fibrosis, myalgia, blood creatine phosphokinase increased

Common (1% to 10%): Compartment syndrome

Frequency not reported: Muscle necrosis, rhabdomyolysis[Ref]


1. "Product Information. Alkeran (melphalan)." ApoPharma USA Inc, Rockville, MD.

2. "Product Information. Melphalan (melphalan)." Actavis U.S. (Alpharma USPD), Owings Mills, MD.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Some side effects may not be reported. You may report them to the FDA.