Alkeran

Alkeran has antitumor and cytostatic activity, which is provided by its alkylating effect, which allows slowing the replication of atypical neoplasm cells (malignant in nature), which are subject to active division.

The drug blocks the processes of cellular mitosis of rapidly multiplying tissues and shows noticeable selectivity in relation to neoplasms in the lymphatic area. The drug inhibits tumor growth by stopping the formation of new cells and the proliferation of existing atypical cells. [ 1 ]

The positive effect on malignant tumors is combined with a negative effect on hematopoiesis. Restoration of bone marrow activity usually occurs after the end of therapy.

Indications Alkeran

It is used in cases of neuroblastoma in children, as well as in true polycythemia, adenocarcinoma affecting the ovaries, myeloma (multiple form), melanoma (localized type), breast carcinoma, and sarcoma that affects the soft tissues in the extremities.

Release form

The therapeutic substance is released in tablets with a volume of 2 mg - 25 pieces inside glass bottles. There is 1 such bottle inside the pack.

In addition, it can be produced in powder form - in vials containing 50 mg of the medicinal substance. The box contains 1 vial with powder (10 ml) and 1 vial containing solvent.

Dosing and administration

Therapy using Alkeran should be carried out under the supervision of an oncologist, with his prescription.

The tablets should be swallowed whole, without chewing. The medicinal effect develops individually in each patient, taking into account the degree of absorption of melphalan. Therefore, the dosage should be selected individually; during therapy, the portion is increased until the therapeutic effect occurs.

The parenteral liquid is prepared before the procedure. The solvent (10 ml), which comes with the medicine, is poured into the vial with the powder. The vial must be shaken to completely dissolve the substance. 1 ml of liquid contains 5 mg of melphalan. The prepared liquid cannot be stored in the refrigerator.

The medication is administered intra-arterially (regional perfusion into the artery area) and intravenously (through a drip together with saline as an infusion). The injection procedure can last a maximum of 90 minutes. If crystals appear in the liquid or it becomes cloudy, the substance must be disposed of.

It can be used as monotherapy with the drug, or in combination with cytostatics (including prednisolone).

In case of multiple myeloma, it is necessary to take tablets in a dose of 0.15 mg/kg per day for 4 days. In this case, the drug intake should be divided into several doses. At the end of the 4-day cycle, it is necessary to take a break for 1.5 months.

Intravenous use for the above disease (along with cytostatics) is performed at a dosage of 8-30 mg/m2 of the patient's epidermal area. The interval between injections should be 0.5-1.5 months. In case of monotherapy, the dose is 0.4 mg/kg, with 1-time use per month. The drug should be administered again after stabilization of blood test results. The treatment is considered high-dose if doses of 0.1-0.2 g/m2 are used. When using doses over 0.14 g/m2, the patient needs to undergo an autologous bone marrow transplant.

In case of problems with kidney function, it is necessary to reduce the dose of the drug by half.

For adenocarcinoma affecting the ovaries, 0.2 mg/kg per day is taken orally for 5 days. The tablets should be used in cycles, with 1-2 month intervals between them. For parenteral use, 1 mg/kg per day (monotherapy) or 0.3-0.4 mg/kg per day (combination with cytostatics) is required. Alkeran should be used with a 1-1.5 month interval.

In case of true polycythemia, oral administration of 6-10 mg of the substance per day (in the period of 5-7 days) is required to stimulate remission of the disease. At the end of the initial phase of treatment, tablets are taken in a portion of 2-4 mg per day, once a week.

In case of neuroblastoma (of a progressive nature), a child is given 0.1-0.24 g/m2 of the drug intravenously for a period of 1-3 days.

In case of melanoma (having a malignant form), the drug is used at the initial stage - intra-arterially, through regional hyperthermic perfusion. The selection of the dose is performed by the attending physician individually.

Treatment of sarcoma requires intra-arterial administration of the drug in combination with actinomycin D, as well as surgery.

Use Alkeran during pregnancy

The medication should not be prescribed to pregnant women (especially in the first trimester).

When using Alkeran during lactation, breastfeeding should be discontinued.

Contraindications

It is contraindicated to prescribe the medicine to people with allergies to its components. Large doses of the medicine are not used in people with kidney failure.

Side effects Alkeran

When the drug is administered, leukopenia or thrombocytopenia, stomatitis, nausea, diarrhea, suppression of bone marrow activity, alopecia and a transient increase in blood urea levels are often observed.

After an intravenous injection, you may experience tingling and a feeling of heat.

Rarely, when using the drug, pulmonary fibrosis, anemia (of a hemolytic nature) or interstitial pneumonia appear, as well as hepatitis, allergy (itching, rash, anaphylaxis and urticaria), maculopapular rashes, liver dysfunction and veno-occlusive pathology.

The drug inhibits ovarian function, so it can provoke the development of amenorrhea in women. Occasionally, the drug affects spermatogenesis processes and can provoke permanent or transient sterility in men.

Overdose

In case of poisoning with the drug, digestive dysfunction is observed - the appearance of pain in the epigastric region, nausea and stool disorders. Rarely, in case of overdose, hemorrhagic diarrhea develops.

Long-term administration of large doses of drugs causes suppression of bone marrow activity, which leads to thrombocytopenia or leukopenia and anemia.

Interactions with other drugs

After intravenous and intra-arterial use of the drug together with nalidixic acid, the risk of death increases (especially in children). Among the negative consequences of combined treatment is the occurrence of enterocolitis, which has a hemorrhagic nature.

The use of large doses of Alkeran prior to hematopoietic stem cell transplantation, followed by administration of cyclosporine, may cause renal dysfunction.

The drug should not be administered with infusion fluids that include glucose. A saline solution (0.9% NaCl) can be used as a base for the drug.

Storage conditions

Alkeran tablets must be stored in the refrigerator - at temperatures within the range of +2/+8oC. Powder can be stored at standard temperatures of up to 25oC.

Shelf life

Alkeran is allowed to be used within a 36-month period from the date of manufacture of the medicinal product.

Analogues

Analogues of the therapeutic substance are the drugs Alfalan, Klokeran, Endoxan with Ifomide, Leukeran with Holoxan, and also Bentero, Cyclophosphamide, Ifosfamide with Ifolem, Cel and Ifos.