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μμ© κΈ°μ : Melphalan acts as a bifunctional alkylating agent. It forms **inter- and intrastrand cross-links** with DNA β alters DNA structure β **inhibits DNA synthesis and function**, ultimately leading to cell death (apoptosis), particularly in rapidly dividing neoplastic cells.
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κΈκΈ°
- Bone marrow suppression
- Concurrent infection
- Impaired renal function
μ΄μλ°μ
- Myelosuppression (leucopenia, thrombocytopenia)
- Anorexia
- Nausea
- Vomiting
- Pulmonary infiltrates
- Pulmonary fibrosis
- Oral ulceration (reported in humans)
μ½λ¬Ό μνΈμμ©
- Cimetidine Β· Decreases the oral bioavailability of melphalan Β· moderate
- Steroids Β· Enhance the antitumour effects of melphalan Β· moderate
- Ciclosporin Β· Enhances the risk of renal toxicity (reported in humans) Β· major
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- Complete Blood Count (CBC) - monitor for leucopenia and thrombocytopenia
- Renal function panel
- Gastrointestinal signs (anorexia, vomiting)
- Respiratory rate and effort (for pulmonary infiltrates/fibrosis)
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Overdosage primarily manifests as severe **myelosuppression** (profound neutropenia and thrombocytopenia) and severe **gastrointestinal toxicity** (vomiting, diarrhea, ulceration). Treatment is supportive, including broad-spectrum antibiotics for neutropenia, antiemetics, and potentially blood transfusions or colony-stimulating factors.
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