Medication: Melphalan

Your cat 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.
• Cats 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 cat’s mouth and should be given on an empty stomach (at least 6 hours after eating). 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 cat’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). Due to their size they need to be given directly into the mouth. 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 administering the medication to your cat, 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 cat, please contact your veterinarian for advice.

The following adverse reactions have been noted:

• Gastrointestinal symptoms (rare): not eating, nausea, vomiting, diarrhea.
• Low white blood cell count (leukopenia or neutropenia) – regular blood tests will monitor the white blood cell counts.
• Low platelet counts (thrombocytopenia) (uncommon).
• Low red blood 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 cat 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 cat

The risk of you absorbing any of the toxic products from your cat is small. However, as the risk cannot be quantified, there are some sensible precautions you should take to reduce your exposure during this time.

• Wear gloves when handling any urine, feces, vomit or saliva from your cat.
• Aways wash your hands after handling your cat and before eating or drinking.
• The following people should minimize direct contact with your cat:
  • Pregnant or breastfeeding women
  • Young children who do not understand the need for hand washing after contact
  • Immunosuppressed or receiving chemotherapy or immunosuppressive drugs.
• Outdoor cats should be kept indoors for 72 hours after treatment, particularly if they have access into parks or areas where children play.
• Cat litter trays should be lined with plastic litter tray liners and filled with clumping cat litter. This is to prevent contaminated dust.
• Wear gloves when handling the litter tray contents.
• Empty the tray by lifting all the litter out with the liner as soon as possible after soiling to prevent your cat from scratching around in their dirty tray. It may be sensible to use a smaller amount of litter when you refill it during this time. Covered litter trays will restrict the amount of dust that can be spread into the air.
• If your cat has an accident in the house or has soiled itself, you should 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 cat’s bedding should be washed regularly as some toxic products may end up on your cat’s coat when they lick themselves.
• There is no risk to other pets in the home from sharing water bowls or toileting in the same litter tray.

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 cat’s medication.