Clinical evidence,mechanism, importance and management
A study in 10 patients with multiple myeloma showed that half-life of oral melphalan 5 mg/m(See reference number 2) was unaffected when it was taken with a standardised breakfast, but AUC was reduced by 39%. In one patient, no melphalan was detectable in plasma when it was given with food. In 8 of patients who had also been given intravenous melphalan at same dose, bioavailability of oral melphalan was calculated to be 85 % (range 26 % to 96%) when fasting and 58 % (7% to 99%) when given with food. The authors recommend that melphalan should not be taken with food (See reference number 1). The manufacturer notes that absorption after oral administration is highly variable, and that dosage should be adjusted based on frequent monitoring of blood counts. They make no specific recommendations about intake in relation to food (See reference number 2,3).
1. Reece PA,Kotasek D, Morris RG, Dale BM, Sage RE. The effect of food on oral melphalanabsorption. Cancer Chemother Pharmacol (1986) 16, 194–7.
Alkeran Tablets (Melphalan). GlaxoSmithKline UK. UK Summary of product characteristics,July 2007.
Alkeran (Melphalan). GlaxoSmithKline. US Prescribing information,November 2004.