Medication: Melphalan

Your dog has been prescribed melphalan for the treatment of a form of cancer, most often myeloma or lymphoma. This drug may be given in association with other medications.

Key points: 
• Antineoplastic chemotherapy drug.
• Alkylating agent which kills certain types of cancer cells.
• Do not handle melphalan if you are pregnant, breastfeeding, under 18, immunosuppressed or receiving chemotherapy or immunosuppressive drugs.
• Aways wear gloves to handle the tablets and wash your hands afterwards.
• Never crush or split tablets.
• Dogs will excrete chemotherapy products for up to 7 days after administration so precautions must be followed to reduce exposure to other people and pets.
• Dosage: the frequency of dosing varies and should be clearly stated on the packaging provided by your veterinarian. 

This information sheet is designed to help answer commonly asked questions and help you give the medication safely and effectively to your pet. It does not contain all available information for this medication. If you have other questions or need more information, contact your veterinarian or pharmacist.Always follow the dosing instructions provided by your veterinarian.

Name

• Melphalan (mel-fah-lan).

Brand name

• There are no licensed veterinary products containing melphalan.

Class of medication

• Chemotherapy/anti-cancer.

Storage

• Store in a refrigerator and protect from light.
• Wear gloves when handling and wash hands thoroughly afterwards.

Melphalan is used in the treatment of certain cancers such as myeloma and lymphoma and some solid tumors. It is sometimes used when there have been side-effects to other chemotherapy drugs such as cyclophosphamide.

Melphalan is given orally (as tablets). The frequency may alter during treatment so follow your veterinarian’s directions carefully and ask for help if you are struggling to medicate your pet.

Tablets should be administered directly into your dog’s mouth and should be given on an empty stomach (at least 6 hours after eating). If your pet does not like taking the tablet then you can hide it in a very small amount of strong smelling food. Tablets must not be divided or crushed, and you should wear disposable gloves when handling this medication.

Handling melphalan

• Do not handle melphalan if you are pregnant, breastfeeding, under 18, immunosuppressed or receiving chemotherapy or immunosuppressive drugs. 
• Aways wear gloves to handle the tablets and wash your hands afterwards.
• Never crush or split tablets as it can result in dust which could be dangerous to those around.
• Keep your dog’s drugs in the container supplied. This should be a child proof container.
• Store them in a safe place and always out of the reach of children and pets.
• Melphalan tablets should be given on an empty stomach (at least 6 hours after eating). They can be disguised in a small amount of food if required. Make sure you wash them down with some food or water by syringe afterwards to prevent them getting stuck.
• If you find a tablet on the floor after giving the medication, wear gloves to pick it up and bag it. Do not give another dose until you have spoken to your veterinarian.
• If you are unable to give oral medication to your dog, please contact your veterinarian for advice.

The following adverse reactions have been noted:

• Gastrointestinal symptoms (rare): not eating, nausea, vomiting, diarrhea.
• Low white cell count (leukopenia or neutropenia) – regular blood tests will monitor the white blood cell counts.
• Low platelet counts (thrombocytopenia) (uncommon).
• Low red cell counts (anemia) (rare).
• Lung problems resulting in breathlessness or breathing faster or deeper.

Your pet may be able to continue with the drug, if side-effects are mild, but it’s best to let your veterinarian know as soon as possible if you have any concerns, so that they can decide whether additional medications or different medications are required.

The following drugs may interact with melphalan: cimetidine, digoxin, cyclosporin and phenytoin.

Melphalan should be administered according to your veterinarian’s instructions. The length of treatment will vary between patients.

All unused drugs should be returned to your veterinary practice for disposal and must not be placed in household waste.

If you miss a dose, give the dose as soon as possible but do not give a double dose.

Contact your veterinarian immediately if you think you may accidentally have overdosed your pet with melphalan.

If your pet is unwell, contact your veterinarian for advice.

You must also contact your veterinarian straight away if:

• Your pet has a high temperature (above 38.8ºC/102ºF – with a fever they will usually be quiet and unwilling to eat).
• Your pet is unwell (even without a high temperature).
• Your pet is having difficulty breathing.

Melphalan should only be given to the dog that it has been prescribed for. If accidentally given to other pets, contact your veterinarian for advice.

If accidentally consumed by a human, speak to your primary care physician or poison control center.

Handling your dog

Your dog will excrete products from the chemotherapy drug for up to 7 days after melphalan has been given. This period is referred to as the “chemo barrier” period. As there is a small risk of you absorbing these toxic products, there are some sensible precautions that you should take to reduce your exposure during this time.

• Wear gloves when handling any urine, feces, vomit or saliva from your dog.
• Aways wash your hands after handling your dog and before eating or drinking.
• The following people should minimize direct contact with your dog:
  • Pregnant or breastfeeding women
  • Young children who do not understand the need for hand washing after contact
  • Immunosuppressed or receiving chemotherapy or immunosuppressive drugs.
• Dogs should be exercised away from areas where children play or where there are lots of other dogs. However, they are fine to remain in contact with other pets in the home.
• Double bag all feces and dispose of them as normal. We do not recommend flushing them down the toilet due to risk of aerosols forming.
• Urine passed on a surface where it can drain away (such as grass or soil) is not a problem. If your dog passes urine on a solid surface (pavements, paths etc) use a bottle of water to rinse away the urine.
• There is no risk to other pets in the home from sharing water bowls or toileting in the garden unless the other pet is likely to ingest any contaminated urine or feces. In any case feces passed in the garden should be double bagged as soon as they have been passed.
• If your dog should have an accident in the house or soil itself, wear gloves to clean the area as quickly as possible using copious amounts of soapy water. Use disposable paper towels to dry the area and dispose of these in a plastic bag in an outside bin.
• Your dog’s bedding should be washed regularly as some toxic products may end up on your dog’s coat when they lick themselves.
• We discourage people from allowing their dog to sleep in the family beds because their coat may be contaminated.

Your pet will require blood tests to be checked regularly throughout treatment. The frequency will vary depending on the treatment protocol your pet is receiving. Your veterinarian will need to check your pet regularly and may need to run regular blood tests or perform other diagnostics to monitor your pet’s response to the treatment.

Further information

If you have any concerns, further information on melphalan can be found on the package insert or via your veterinarian.

Europe & UK

• There are no licensed veterinary products containing this drug in the UK or Europe. Your veterinarian may prescribe a human medication containing this drug and will explain off-license use of medications to you.

US

• There are no licensed veterinary products containing this drug in the US. Your veterinarian may prescribe a human medication containing this drug and will explain off-license use of medications to you.

Always follow the recommended dosage and contact your veterinary team or pharmacist if you have any questions regarding your dog’s medication.