DRUGS & SUPPLEMENTS
1 INDICATIONS AND USAGE
Melphalan is an alkylating drug indicated for:
1.1 Multiple Myeloma-Conditioning Treatment
Melphalan is indicated for use as a high-dose conditioning treatment prior to hematopoietic progenitor (stem) cell transplantation in patients with multiple myeloma.
1.2 Multiple Myeloma-Palliative Treatment
Melphalan is indicated for the palliative treatment of patients with multiple myeloma for whom oral therapy is not appropriate.
2 DOSAGE AND ADMINISTRATION
2.1 Recommended Dosage for Conditioning Treatment
The recommended dose of Melphalan for conditioning treatment is 100 mg/m2/day administered over 30 minutes by intravenous infusion for 2 consecutive days (Day -3 and Day -2) prior to autologous stem cell transplantation (ASCT, Day 0). For patients who weigh more than 130% of their ideal body weight, body surface area should be calculated based on adjusted ideal body weight.
Administer prophylactic antiemetics .
2.2 Recommended Dosage for Palliative Treatment
The recommended dose of Melphalan for palliative treatment is 16 mg/m2 administered as a single intravenous infusion over 15-20 minutes at 2-week intervals for 4 doses, then, after adequate recovery from toxicity, at 4‑week intervals.
Administer prophylactic anti-emetics [see Warnings and Precautions .
2.3 Dose Modification for Renal Impairment
For Conditioning Treatment: No dose adjustment is necessary.
For Palliative Treatment: Dosage reduction of up to 50% should be considered in patients with renal impairment (BUN ≥30 mg/dL) .
2.4 Preparation and Administration
Melphalan is a cytotoxic drug. Follow applicable special handling and disposal procedures1.
Melphalan is light sensitive. Retain in original carton until use.
Do not mix Melphalan with other Melphalan hydrochloride for injection drug products.
Reconstitution and Infusion Instructions:
3 DOSAGE FORMS AND STRENGTHS
For injection: 50 mg, white to off-white lyophilized powder in single-dose vial for reconstitution (after reconstitution the solution is clear and colorless to light yellow). Each vial contains 50 mg Melphalan free base equivalent to 56 mg Melphalan hydrochloride.
For Injection: 50 mg per vial, lyophilized powder in a single-dose vial for reconstitution. (3)
History of serious allergic reaction to Melphalan.
5 WARNINGS AND PRECAUTIONS
5.1 Bone Marrow Suppression
For patients receiving Melphalan as part of a conditioning regimen, myeloablation occurs in all patients. Do not begin the conditioning regimen if a stem cell product is not available for rescue. Monitor complete blood counts, provide supportive care for infections, anemia and thrombocytopenia until there is adequate hematopoietic recovery.
For patients receiving Melphalan as palliative treatment, if the bone marrow has been compromised by prior irradiation, prior chemotherapy or is recovering from chemotherapy, the risk of severe myelosuppression with Melphalan is increased. Perform periodic complete blood counts during the course of treatment with Melphalan. Provide supportive care for infections, bleeding, and symptomatic anemia .
5.2 Gastrointestinal Toxicity
For patients receiving Melphalan as part of a conditioning regimen, nausea, vomiting, mucositis, and diarrhea may occur in over 50% of patients. Use prophylactic antiemetic medication. Provide supportive care for nausea, vomiting, diarrhea, and mucositis. The frequency of grade 3/4 mucositis in clinical studies was 13%. Provide nutritional support and analgesics for patients with severe mucositis. .
For patients receiving Melphalan as palliative treatment, nausea and vomiting, diarrhea, and oral ulceration may occur. Use prophylactic antiemetics. Provide supportive care for nausea, vomiting, diarrhea and mucositis.
Hepatic disorders ranging from abnormal liver function tests to clinical manifestations such as hepatitis and jaundice have been reported after treatment with Melphalan. Hepatic veno-occlusive disease has also been reported. Monitor liver chemistries.
Acute hypersensitivity reactions, including anaphylaxis, have occurred in approximately 2% of patients who received an intravenous formulation of Melphalan. Symptoms may include urticaria, pruritus, edema, and skin rashes and, in some patients, tachycardia, bronchospasm, dyspnea, and hypotension. Discontinue treatment with Melphalan for serious hypersensitivity reactions.
5.5 Secondary Malignancies
Melphalan has been shown to cause chromatid or chromosome damage in humans. Secondary malignancies such as myeloproliferative syndrome or acute leukemia have been reported in multiple myeloma patients treated with melphalan-containing chemotherapy regimens. The potential benefit of Melphalan therapy must be considered against the possible risk of the induction of a secondary malignancy.
5.6 Embryo-Fetal Toxicity
Based on its mechanism of action, Melphalan can cause fetal harm when administered to a pregnant woman. Melphalan is genotoxic, targets actively dividing cells, and was embryolethal and teratogenic in rats. Advise females of reproductive potential to avoid pregnancy during and after treatment with Melphalan. If this drug is used during pregnancy or if the patient becomes pregnant while taking this drug, advise the patient of potential risk to the fetus .
Melphalan-based chemotherapy regimens have been reported to cause suppression of ovarian function in premenopausal women, resulting in persistent amenorrhea in approximately 9% of patients. Reversible or irreversible testicular suppression has also been reported.
6 ADVERSE REACTIONS
Most common adverse reactions observed in at least 50% of patients treated with Melphalan are neutrophil count decreased, white blood cell count decreased, lymphocyte count decreased, platelet count decreased, diarrhea, nausea, fatigue, hypokalemia, anemia, and vomiting.
To report SUSPECTED ADVERSE REACTIONS, contact Spectrum Pharmaceuticals, Inc. at 1-888-292-9617 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch
The following serious adverse reactions are described in more detail in other sections of the prescribing information.
6.1 Clinical Trials Experience
Because clinical studies are conducted under widely varying conditions, adverse reaction rates observed in the clinical studies of Melphalan may not reflect the rates observed in practice.
The most common adverse reactions observed in at least 50% of patients with multiple myeloma treated with Melphalan were neutrophil count decreased, white blood cell count decreased, lymphocyte count decreased, platelet count decreased, diarrhea, nausea, fatigue, hypokalemia, anemia, and vomiting.
Myeloablative Conditioning in Multiple Myeloma Patients Undergoing ASCT
The safety of Melphalan was evaluated in 61 patients with multiple myeloma in a single arm clinical trial in which patients were administered Melphalan at a dosage of 100 mg/m2/day administered over ~30 minutes (range: 24-48 minutes) by intravenous (IV) infusion for 2 consecutive days (Day -3 and Day -2) prior to autologous stem cell transplant (ASCT, Day 0).
Table 1 summarizes the adverse reactions from the single-arm trial in patients with multiple myeloma. Severe myelosuppression is expected and these adverse reactions are not listed below.
Serious Adverse Reactions
Twelve (20%) patients experienced a treatment emergent serious adverse reaction while on study. The most common serious adverse reactions (>1 patient, 1.6%) were pyrexia, hematochezia, febrile neutropenia, and renal failure. Treatment-related serious adverse reactions reported in >1 patient were pyrexia (n=2, 3%), febrile neutropenia (n=2, 3%), and hematochezia (n=2, 3%).
Palliative Treatment of Patients with Multiple Myeloma
The safety of Melphalan was evaluated in 295 patients with multiple myeloma in the randomized clinical trial. One hundred and ninety-five patients were administered IV Melphalan at a dosage of 16 mg/m2 q 2 weeks x 4 (over 6 weeks) followed by the same dose every 4 weeks. One hundred patients were administered oral Melphalan at a dosage of 0.15 mg/kg/day x 7 followed by 0.05 mg/kg/day when WBC counts began to rise.
Severe myelotoxicity (WBC ≤1,000 and/or platelets ≤25,000) was more common in the IV Melphalan arm (28%) than in the oral Melphalan arm (11%).
An association was noted between poor renal function and myelosuppression; consequently, an amendment to the protocol required a 50% reduction in IV Melphalan dose if the BUN was ≥30 mg/dL. The rate of severe leukopenia in the IV arm in the patients with BUN over 30 mg/dL decreased from 50% (8/16) before protocol amendment to 11% (3/28) after the amendment.
Before the dosing amendment, there was a 10% (8/77) incidence of drug-related death in the IV arm. After the dosing amendment, this incidence was 3% (3/108). This compares to an overall 1% (1/100) incidence of drug-related death in the oral Melphalan arm.
7 DRUG INTERACTIONS
No formal drug interaction studies have been conducted. The development of severe renal impairment has been reported in patients treated with a single dose of intravenous Melphalan 140-250 mg/m2 followed by standard oral doses of cyclosporine. Intravenous Melphalan may also reduce the threshold for BCNU lung toxicity. When nalidixic acid and IV Melphalan are given simultaneously, the incidence of severe hemorrhagic necrotic enterocolitis has been reported to increase in pediatric patients.
8 USE IN SPECIFIC POPULATIONS
Based on its mechanism of action, Melphalan can cause fetal harm when administered to a pregnant woman, including teratogenicity and/or embryo-fetal lethality. Melphalan is a genotoxic drug and can cause chromatid or chromosome damage in humans . In animal studies, Melphalan was embryolethal and teratogenic in rats at doses below the recommended clinical doses . Advise a pregnant woman of the potential risk to a fetus..
The background risk of major birth defects and miscarriage for the indicated populations are unknown. However, the background risk in the U.S. general population of major birth defects is 2-4% and of miscarriage is 15-20% of clinically recognized pregnancies.
Adequate animal studies have not been conducted with intravenous Melphalan. Melphalan was embryolethal and teratogenic in rats following oral administration of 6 to 18 mg/m2/day for 10 days (0.06 to 0.18 times the highest recommended clinical dose of 100 mg/m2/day) and intraperitoneal administration of 18 mg/m2 (0.18 times the highest recommended clinical dose). Malformations resulting from Melphalan administration included alterations of the brain (underdevelopment, deformation, meningocele, and encephalocele) and eye (anophthalmia and microphthalmos), reduction of the mandible and tail, and hepatocele (exomphaly).
It is not known whether Melphalan is present in human milk. Because many drugs are excreted in human milk and because of the potential for serious adverse reactions in nursing infants from Melphalan, breastfeeding is not recommended during treatment with Melphalan.
8.3 Females and Males of Reproductive Potential
Melphalan administration can cause fetal harm when administered to a pregnant woman. Advise females of reproductive potential to avoid pregnancy, which may include the use of effective contraception methods, during and after treatment with Melphalan.
Melphalan administration may damage spermatozoa and testicular tissue, resulting in possible genetic fetal abnormalities. Advise males with female sexual partners of reproductive potential to use effective contraception during and after treatment with Melphalan [see Nonclinical Toxicology ].
Melphalan causes suppression of ovarian function in premenopausal women, resulting in amenorrhea in a significant number of patients.
Reversible and irreversible testicular suppression has been reported in male patients after administration of Melphalan.
8.4 Pediatric Use
Pediatric patients were not included in clinical trials. Safety and effectiveness have not been established in pediatric patients.
8.5 Geriatric Use
Of the total number of subjects in the single-arm pivotal study of Melphalan, 30% were 65 and over, but no patients were 75 and over. No overall differences in safety or effectiveness were observed between these subjects and younger subjects. A greater incidence of engraftment syndrome was observed in older patients; 7% of patients younger than 65 years old versus 28% (5 of 18) of patients 65 years old and over.
8.6 Patients with Renal Impairment
For Conditioning Treatment, renal impairment is not a criterion for dose reduction or exclusion from Melphalan therapy.
For Palliative Treatment, consider dose reduction for patients with renal impairment receiving Melphalan. Bone marrow suppression has been observed in patients with BUN levels ≥30 mg/dL. A 50% reduction in the IV Melphalan dose decreased the incidence of severe bone marrow suppression in the latter portion of this study .
Overdoses resulting in death have been reported with Melphalan. Overdoses, including doses up to 290 mg/m2, have produced the following symptoms: severe nausea and vomiting, decreased consciousness, convulsions, muscular paralysis, and cholinomimetic effects. Severe mucositis, stomatitis, colitis, diarrhea, and hemorrhage of the gastrointestinal tract occur at high doses (>100 mg/m2). Elevations in liver enzymes and veno-occlusive disease occur infrequently. Significant hyponatremia, caused by an associated inappropriate secretion of ADH syndrome, has been observed. Nephrotoxicity and adult respiratory distress syndrome have been reported rarely.
The principal toxic effect is bone marrow suppression leading to leucopenia, thrombocytopenia and anemia. Hematologic parameters should be closely followed for 3 to 6 weeks. An uncontrolled study suggests that administration of autologous bone marrow or hematopoietic growth factors (i.e., sargramostim, filgrastim) may shorten the period of pancytopenia. General supportive measures together with appropriate blood transfusions and antibiotics should be instituted as deemed necessary by the physician. This drug is not removed from plasma to any significant degree by hemodialysis or hemoperfusion. A pediatric patient survived a 254 mg/m2 overdose treated with standard supportive care.
Melphalan contains Melphalan hydrochloride, an alkylating drug, as the active ingredient. The chemical name of Melphalan hydrochloride is 4-[bis(2-chloroethyl)amino]-L-phenylalanine hydrochloride. Its molecular formula is C13H18Cl2N2O2 - HCl and the molecular weight is 341.67. The structural formula is:
Melphalan hydrochloride is a white to off-white powder, with a melting range of 199°C − 201°C. It is practically insoluble in water, but freely soluble in 1 N HCl and methanol.
Melphalan (melphalan) for injection is supplied as a sterile white to off-white lyophilized powder in a single-dose vial for intravenous use. Each vial contains 50 mg Melphalan free base equivalent to 56 mg Melphalan hydrochloride and 2700 mg Betadex Sulfobutyl Ether Sodium, NF.
12 CLINICAL PHARMACOLOGY
12.1 Mechanism of Action
Melphalan is an alkylating agent of the bischloroethylamine type. As a result, its cytotoxicity appears to be related to the extent of its interstrand cross-linking with DNA, probably by binding at the N7 position of guanine. Like other bifunctional alkylating agents, it is active against both resting and rapidly dividing tumor cells.
Pharmacokinetic-pharmacodynamic analysis showed that Melphalan administration increased heart rate-corrected QT interval. The mean change from baseline for QTcF at the mean Cmax of 4701 ng/mL was 8.0 msec. Patients treated with 200 mg/m2 Melphalan showed an increase of heart rate.
Following injection, drug plasma concentrations declined rapidly in a biexponential manner with distribution phase and terminal elimination phase half-lives of approximately 10 and 75 minutes, respectively. Estimates of average total body clearance (CL) varied among studies, but typical values of approximately 7 to 9 mL/min/kg (250 to 325 mL/min/m2) were observed. One study reported that on repeat dosing of 0.5 mg/kg every 6 weeks, the clearance of Melphalan decreased from 8.1 mL/min/kg after the first course, to 5.5 mL/min/kg after the third course, but did not decrease appreciably after the third course. Mean (±SD) peak Melphalan plasma concentrations in myeloma patients given IV Melphalan at doses of 10 or 20 mg/m2 were 1.2 ± 0.4 and 2.8 ± 1.9 mcg/mL, respectively.
The steady-state volume of distribution of Melphalan is 0.5 L/kg. Melphalan penetrates into cerebrospinal fluid (CSF). Average Melphalan binding to plasma proteins ranges from approximately 50% to 90%. Serum albumin is the major binding protein, accounting for approximately 40% to 60% of the plasma protein binding, while α1-acid glycoprotein accounts for about 20% of the plasma protein binding. Approximately 30% of Melphalan is (covalently) irreversibly bound to plasma proteins.
Melphalan is eliminated from plasma primarily by chemical hydrolysis to inactive monohydroxymelphalan and dihydroxymelphalan.
The contribution of renal excretion to Melphalan clearance appears to be low (mean values of amount of Melphalan excreted in urine range from 5.8-21.3%).
Patient Body Weight
A typical patient with an ideal body weight (IBW) of 45 kg has a 28% decrease in clearance relative to a patient with IBW of 70 kg, while a patient with an IBW of 100 kg has a 31% increase in clearance as compared to a patient with an IBW of 70 kg.
A decrease in estimated creatinine CL from 100 mL/min to 30 mL/min results in 28.2% reduction in CL for a typical person with an IBW of 70 kg.
13 NONCLINICAL TOXICOLOGY
13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility
Adequate and well-controlled carcinogenicity studies have not been conducted in animals. However, intraperitoneal (IP) administration of Melphalan in rats (5.4 to 10.8 mg/m2) and in mice (2.25 to 4.5 mg/m2) 3 times per week for 6 months followed by 12 months post-dose observation produced peritoneal sarcomas and lung tumors, respectively.
Intramuscular administration of Melphalan at 6 and 60 mg/m2 produced structural aberrations of the chromatid and chromosomes in bone marrow cells of Wistar rats.
14. CLINICAL STUDIES
14.1 Myeloablative Conditioning in Patients with Multiple Myeloma Undergoing ASCT
An open-label, single-arm, non-randomized trial of Melphalan was conducted at 5 US centers. The 61 patients enrolled had symptomatic multiple myeloma, and had at least 2 × 106 CD34+ cells/kg cryopreserved stem cells available. The median age was 62 years ; 57% male, 80% white, 18% black, 2% Asian. Melphalan was administered at 100 mg/m2/day over 30 minutes by IV infusion for two consecutive days (Day -3 and Day -2) prior to ASCT (Day 0).
The objective of the trial was to determine the overall safety and toxicity profile of 200 mg/m2 of Melphalan in patients with multiple myeloma undergoing ASCT. The efficacy was evaluated by the International Myeloma Working Group response criteria comparing the disease response immediately prior to the ASCT procedure to the disease response assessed 90 to 100 days post-transplant. In addition, successful myeloablation, and time to engraftment were evaluated.
The overall response rate (partial response or better) improved from 79% (48 of 61) prior to the ASCT procedure to 95% (58 of 61) at 90 to 100 days post-transplant. There was also an increase in the number of patients with a stringent complete response from 0 patients prior to the ASCT procedure to 16% (10 of 61) at 90 to 100 days post-transplant.
Myeloablation and engraftment were evaluated by complete blood cell count tests daily until neutrophil and platelet engraftment, and then weekly until Day 30, and at Day 60 and Day 90-100. Myeloablation was defined as any of the following: absolute neutrophil count (ANC) < 500/mm3, absolute lymphocyte count < 100/mm3, or platelet count < 20,000/mm3). Neutrophil engraftment was defined as ANC > 500/mm3 ×3 consecutive daily assessments. Platelet engraftment was defined as untransfused platelet counts > 20,000/mm3 ×3 consecutive daily assessments. Nonengraftment was defined as failure to reach an ANC > 500/mm3 ×3 consecutive daily assessments by Day 90-100.
Myeloablation, neutrophil engraftment and platelet engraftment were achieved by all 61 patients. Myeloablation occurred on ASCT Day 5 (range ASCT days -1 to 6) with the median time to myeloablation from dosing of 8 days. The median time to neutrophil engraftment was 12 days (range ASCT days 10 to 16). The median time to platelet engraftment was 13 days (range ASCT days 10 to 28).
14.2 Palliative Treatment of Patients with Multiple Myeloma
A randomized trial compared prednisone plus IV Melphalan to prednisone plus oral Melphalan in the treatment of multiple myeloma. As discussed below, Overall Response Rates at Week 22 were comparable; however, because of changes in trial design, conclusions as to the relative activity of the 2 formulations after Week 22 are impossible to make.
Both arms received oral prednisone starting at 0.8 mg/kg/day with doses tapered over 6 weeks. Melphalan doses in each arm were:
One hundred seven patients were randomized to the oral Melphalan arm and 203 patients to the IV Melphalan arm. More patients had a poor-risk classification (58% versus 44%) and high tumor load (51% versus 34%) on the oral arm compared to the IV arm (P<0.04). Response rates at Week 22 are shown in the following table:
Because of changes in protocol design after Week 22, other efficacy parameters such as Response Duration and Survival could not be compared.
16 HOW SUPPLIED/STORAGE AND HANDLING
16.1 How Supplied
Melphalan is supplied in a single carton containing one vial. Each 50 mg vial contains a white to off-white lyophilized powder in single-dose vial for reconstitution (after reconstitution the solution is clear and coloress to light yellow). Each vial contains 50 mg Melphalan free base equivalent to 56 mg Melphalan hydrochloride.
NDC 68152-109-00: Individual carton of Melphalan 20 mL single-dose vial containing 50 mg Melphalan free base.
16.2 Storage and Handling
Store Melphalan at room temperature 25°C (77°F). Temperature excursions are permitted between 15-30°C (59-86°F).
Melphalan is light sensitive. Retain in original carton until use.
Melphalan is a cytotoxic drug. Follow special handling and disposal procedure .
17 PATIENT COUNSELING INFORMATION
Advise the patient to read the FDA-approved patient labeling (Patient Information).
Advise patients or their caregivers of the following:
Low Blood Cell Counts
Nausea, Vomiting and Diarrhea
Patient Package Insert
Spectrum Pharmaceuticals, Inc.
Irvine, CA 92618
Melphalan Carton Label
Melphalan® (melphalan) for Injection
50 mg per vial*
For Intravenous Infusion Only
Discard Unused Portion
*Each vial contains 50 mg Melphalan free base equivalent to 56 mg Melphalan hydrochloride.
Melphalan Vial Label
Melphalan® (melphalan) for Injection
50 mg per vial*
For Intravenous Infusion Only
Single-Use Vial Discard Unused Portion
*Each vial contains 50 mg Melphalan free base equivalent to 56 mg Melphalan hydrochloride.
Melphalan pharmaceutical active ingredients containing related brand and generic drugs:
Active ingredient is the part of the drug or medicine which is biologically active. This portion of the drug is responsible for the main action of the drug which is intended to cure or reduce the symptom or disease. The other portions of the drug which are inactive are called excipients; there role is to act as vehicle or binder. In contrast to active ingredient, the inactive ingredient's role is not significant in the cure or treatment of the disease. There can be one or more active ingredients in a drug.
Melphalan available forms, composition, doses:
Form of the medicine is the form in which the medicine is marketed in the market, for example, a medicine X can be in the form of capsule or the form of chewable tablet or the form of tablet. Sometimes same medicine can be available as injection form. Each medicine cannot be in all forms but can be marketed in 1, 2, or 3 forms which the pharmaceutical company decided based on various background research results.
Composition is the list of ingredients which combinedly form a medicine. Both active ingredients and inactive ingredients form the composition. The active ingredient gives the desired therapeutic effect whereas the inactive ingredient helps in making the medicine stable.
Doses are various strengths of the medicine like 10mg, 20mg, 30mg and so on. Each medicine comes in various doses which is decided by the manufacturer, that is, pharmaceutical company. The dose is decided on the severity of the symptom or disease.
Melphalan destination | category:
Destination is defined as the organism to which the drug or medicine is targeted. For most of the drugs what we discuss, human is the drug destination.
Drug category can be defined as major classification of the drug. For example, an antihistaminic or an antipyretic or anti anginal or pain killer, anti-inflammatory or so.
Melphalan Anatomical Therapeutic Chemical codes:
A medicine is classified depending on the organ or system it acts [Anatomical], based on what result it gives on what disease, symptom [Therapeutical], based on chemical composition [Chemical]. It is called as ATC code. The code is based on Active ingredients of the medicine. A medicine can have different codes as sometimes it acts on different organs for different indications. Same way, different brands with same active ingredients and same indications can have same ATC code.
Melphalan pharmaceutical companies:
Pharmaceutical companies are drug manufacturing companies that help in complete development of the drug from the background research to formation, clinical trials, release of the drug into the market and marketing of the drug.
Researchers are the persons who are responsible for the scientific research and is responsible for all the background clinical trials that resulted in the development of the drug.
Frequently asked QuestionsCan i drive or operate heavy machine after consuming Melphalan?
Depending on the reaction of the Melphalan after taken, if you are feeling dizziness, drowsiness or any weakness as a reaction on your body, Then consider Melphalan not safe to drive or operate heavy machine after consumption. Meaning that, do not drive or operate heavy duty machines after taking the capsule if the capsule has a strange reaction on your body like dizziness, drowsiness. As prescribed by a pharmacist, it is dangerous to take alcohol while taking medicines as it exposed patients to drowsiness and health risk. Please take note of such effect most especially when taking Primosa capsule. It's advisable to consult your doctor on time for a proper recommendation and medical consultations.Is Melphalan addictive or habit forming?
Medicines are not designed with the mind of creating an addiction or abuse on the health of the users. Addictive Medicine is categorically called Controlled substances by the government. For instance, Schedule H or X in India and schedule II-V in the US are controlled substances.
Please consult the medicine instruction manual on how to use and ensure it is not a controlled substance.In conclusion, self medication is a killer to your health. Consult your doctor for a proper prescription, recommendation, and guidiance.
Reviewsdrugs.com conducted a study on Melphalan, and the result of the survey is set out below. It is noteworthy that the product of the survey is based on the perception and impressions of the visitors of the website as well as the views of Melphalan consumers. We, as a result of this, advice that you do not base your therapeutic or medical decisions on this result, but rather consult your certified medical experts for their recommendations.
Visitor reported usefulNo survey data has been collected yet
Visitor reported side effectsNo survey data has been collected yet
Visitor reported price estimatesNo survey data has been collected yet
Visitor reported frequency of useNo survey data has been collected yet
Visitor reported dosesNo survey data has been collected yet
Visitor reported time for resultsNo survey data has been collected yet
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One visitor reported age
The information was verified by Dr. Arunabha Ray, MD Pharmacology