Melphalan injection is used to treat multiple myeloma (a type of cancer of the bone marrow) in people who are unable to take melphalan by mouth. Melphalan injection is also used to destroy bone marrow and cancer cells in preparation for a bone marrow transplant in people with multiple myeloma. Melphalan is in a class of medications called alkylating agents. It works by stopping or slowing the growth of cancer cells in your body.

Melphalan injection should be given only under the supervision of a doctor with experience in the use of chemotherapy medications.

Melphalan can cause a severe decrease in the number of blood cells in your bone marrow. This may cause certain symptoms and may increase the risk that you will develop a serious infection or bleeding. If you experience any of the following symptoms, call your doctor immediately: fever, sore throat, ongoing cough and congestion, or other signs of infection; unusual bleeding or bruising; bloody or black, tarry stools; bloody vomit; or vomiting blood or brown material that resembles coffee grounds.

Keep all appointments with your doctor and the laboratory. Your doctor will order laboratory tests regularly before and during your treatment to see if your blood cells are affected by this drug.

Melphalan may increase the risk that you will develop other cancers. Talk with your doctor about the risks of taking melphalan.

Melphalan injection comes as a powder to be mixed with liquid to be slowly injected intravenously (into a vein) over 15 to 30 minutes by a doctor or nurse in a medical facility. When melphalan injection is given to treat multiple myleoma in people who are unable to take melphalan by mouth, it is usually given once every 2 weeks for 4 doses and afterwards, once every 4 weeks for as long as your doctor recommends that you receive treatment. When melphalan is given to people with multiple myeloma to destroy bone marrow and cancer cells in preparation for a bone marrow transplant, it is usually injected once a day for 2 days before bone marrow transplant.

Your doctor may need to delay your treatment or adjust your dose if you experience certain side effects. It is important for you to tell your doctor how you are feeling during your treatment with melphalan

Melphalan injection may cause nausea and vomiting during treatment with the medication. Your doctor may give you another medication to help prevent nausea and vomiting.

Before receiving melphalan injection,

• tell your doctor and pharmacist if you are allergic to melphalan, any other medications, or any of the ingredients in melphalan injection. Ask your pharmacist for a list of the ingredients.
• tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: carmustine (BICNU), cisplatin, or cyclosporine (Sandimmune, Gengraf, Neoral).
• tell your doctor if you have taken melphalan before, but your cancer did not respond to the medication. Your doctor may not want you to receive melphalan injection.
• tell your doctor if you have received radiation therapy or other chemotherapy recently or if you have or have ever had liver or kidney disease.
• you should know that melphalan may interfere with the normal menstrual cycle (period) in women and may temporarily or permanently stop sperm production in men. Melphalan may cause infertility (difficulty becoming pregnant); however, you should not assume that you cannot get pregnant or that you cannot get someone else pregnant. Women who are pregnant or breast-feeding should tell their doctors before they begin taking this drug. You should not plan to have children or breast-feed while receiving chemotherapy or for a while after treatments. (Talk to your doctor for further details.) Use a reliable method of birth control to prevent pregnancy. Melphalan may harm the fetus.
• do not have any vaccinations without talking to your doctor.

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Symptoms of overdose may include the following:

• severe nausea
• severe vomiting
• severe diarrhea
• sores in the mouth and throat
• black, tarry, or bloody stools
• bloody vomit or vomited material that looks like coffee grounds
• unusual bruising or bleeding
• seizures
• decreased consciousness
• loss of the ability to move muscles and to feel a part of the body

Melphalan injection may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• nausea
• vomiting
• loss of appetite or weight
• diarrhea
• constipation
• stomach pain
• heartburn
• changes in your sense of taste
• sores in the mouth and throat
• missed menstrual periods (in girls and women)
• hair loss
• swelling of the feet, ankles, or lower legs

Some side effects can be serious. If you experience any of these symptoms or those listed in the IMPORTANT WARNING section, call your doctor immediately or get emergency medical treatment:

• pain, itching, redness, swelling, blisters, or sores in the place where the medication was injected
• rash
• hives
• itching
• difficulty breathing or swallowing
• swelling of your face, tongue, or throat
• pale skin
• unusual tiredness or weakness
• shortness of breath
• dizziness, lightheadedness, or fainting
• fast, irregular, or pounding heartbeat
• blurry vision
• yellowing of the skin or eyes
• pain in the upper right part of the stomach
• dark colored urine
• unusual lumps or masses

Melphalan injection may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

• Alkeran® Injection
• Evomela® Injection