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Pepaxto Side Effects

Generic name: melphalan flufenamide

Medically reviewed by Last updated on Jun 10, 2022.

Note: This document contains side effect information about melphalan flufenamide. Some dosage forms listed on this page may not apply to the brand name Pepaxto.

Applies to melphalan flufenamide: intravenous powder for injection.


Melphalan flufenamide can increase your risk of bleeding or infection. Call your doctor if you have unusual bruising or bleeding, or new signs of infection (fever, chills, cough, burning when you urinate).

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • a new or worsening cough;

  • pain or burning when you urinate; or

  • low blood cell counts--fever, chills, tiredness, mouth sores, skin sores, easy bruising, unusual bleeding, pale skin, cold hands and feet, feeling light-headed or short of breath.

Common side effects may include:

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

For Healthcare Professionals

Applies to melphalan flufenamide: intravenous powder for injection.


Very common (10% or more): Decreased platelets (99%), decreased leukocytes (99%), decreased lymphocytes (97%), decreased neutrophils (95%), decreased hemoglobin (84%)

Common (1% to 10%): Febrile neutropenia, hemorrhages[Ref]


Very common (10% or more): Nausea (32%), diarrhea (27%), constipation (15%), vomiting (13%)[Ref]


Very common (10% or more): Pneumonia (13%), respiratory tract infection (24%), cough (17%), dyspnea (11%), dyspnea exertional (10%)

Common (1% to 10%): Respiratory failure[Ref]


Very common (10% or more): Fatigue (55%), pyrexia (24%)

Common (1% to 10%): Sepsis, general physical health deterioration[Ref]


Very common (10% or more): Decreased appetite (14%), hypokalemia (14%), hypocalcemia (10%)[Ref]


Very common (10% or more): Increased creatinine (68%)[Ref]


Common (1% to 10%): Hypersensitivity reaction[Ref]


Very common (10% or more): Bone pain (13%), pain in extremity (13%), back pain (12%), arthralgia (10%)[Ref]


Very common (10% or more): Insomnia (11%)[Ref]

Nervous system

Very common (10% or more): Headache (13%), dizziness (11%)[Ref]


Very common (10% or more): Peripheral edema (14%)[Ref]

More about Pepaxto (melphalan flufenamide)

Patient resources

Professional resources

Related treatment guides


1. "Product Information. Pepaxto (melphalan flufenamide)." Oncopeptides Inc. (2021):

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.