Class Name(s):

• 10:00 Antineoplastic Agents

Pronunciation:

• (mel' fa lan floo fen' a mide)

Brand Name(s):

• Pepaxto^®

Other Name(s):

• Phenylalanine mustard
• Melflufen

IMPORTANT NOTICE:

Melphalan flufenamide is no longer commercially available in the U. S. See the FDA website (http://www.accessdata.fda.gov/scripts/cder/daf/) for information on drugs that have been discontinued.

Because this drug is no longer available in the U. S. market, the material in this monograph is no longer updated. If this drug is used in countries other than the U. S., it is essential that the manufacturers' labeling be consulted for more recently available information.

WHY is this medicine prescribed?

Melphalan flufenamide injection is used along with dexamethasone to treat multiple myeloma (a type of cancer of the bone marrow) in adults whose disease has returned or has not improved after receiving at least four other chemotherapy medications. Melphalan flufenamide is in a class of medications called alkylating agents. It works by stopping or slowing the growth of cancer cells in your body.

HOW should this medicine be used?

Melphalan flufenamide injection comes as a powder to be mixed with liquid to be slowly injected intravenously (into a vein) over 30 minutes by a doctor or nurse in a medical facility. It is usually given once every 4 weeks. The length of treatment depends on how well your body responds to treatment.

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 flufenamide.

Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient.

Are there OTHER USES for this medication?

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

What SPECIAL PRECAUTIONS should I follow?

Before receiving melphalan flufenamide injection,

• tell your doctor and pharmacist if you are allergic to melphalan flufenamide, melphalan, any other medications, or any of the ingredients in melphalan flufenamide injection. Ask your pharmacist for a list of the ingredients.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take.
• tell your doctor if you have a infection.
• you should know that melphalan flufenamide may interfere with the normal menstrual cycle (period) in women and may temporarily or permanently stop sperm production in men. Melphalan flufenamide may cause infertility (difficulty becoming pregnant); however, you should not assume that you cannot get pregnant or that you cannot get someone else pregnant. Tell your doctor if you are pregnant or plan to become pregnant. You will need to have a pregnancy test before you start treatment with melphalan flufenamide. If you are female, you should use birth control to prevent pregnancy during your treatment and for 6 months after you stop receiving melphalan flufenamide injection. If you are male, you and your female partner should use birth control during your treatment and for 3 months after you stop receiving melphalan flufenamide injection. If you become pregnant while using receiving melphalan flufenamide injection, call your doctor. Melphalan flufenamide may harm the fetus.
• Tell your doctor if you are breastfeeding. You should not breastfeed during your treatment with melphalan flufenamide and for 7 days after your final dose.

What SIDE EFFECTS can this medicine cause?

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

• nausea
• diarrhea
• constipation
• vomiting
• decreased appetite
• headache
• joint, muscle or back pain
• difficulty falling asleep or staying asleep
• swelling of the face, arms, hands, feet, ankles or lower legs

Some side effects can be serious. If you experience any of these symptoms call your doctor immediately or get emergency medical treatment:

• fever, sore throat, ongoing cough and congestion, or other signs of infection
• frequent, painful, or burning feeling during urination
• unusual bleeding or bruising
• bloody or black, tarry stools
• bloody vomit or vomiting blood or brown material that resembles coffee grounds
• pale skin
• unusual tiredness or weakness
• shortness of breath
• dizziness, lightheadedness, or fainting
• fast, irregular, or pounding heartbeat
• rash
• hives
• itching

Melphalan flufenamide may increase the risk that you will develop other cancers. Talk to your doctor about the risks of taking this medication.

Melphalan flufenamide 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).

What should I do in case of OVERDOSE?

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at http://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.

What OTHER INFORMATION should I know?

Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your body's response to melphalan flufenamide.

Keep a written list of all of the prescription and nonprescription (over-the-counter) medicines, vitamins, minerals, and dietary supplements you are taking. Bring this list with you each time you visit a doctor or if you are admitted to the hospital. You should carry the list with you in case of emergencies.

This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.

The American Society of Health-System Pharmacists, Inc. represents that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. makes no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. does not endorse or recommend the use of any drug. The information is not a substitute for medical care.

AHFS^® Patient Medication Information™ Copyright, 2025. The American Society of Health-System Pharmacists^®, 4500 East-West Highway, Suite 900, Bethesda, Maryland. All Rights Reserved. Duplication for commercial use must be authorized by ASHP.

Selected Revisions: July 20, 2024.