When This Medicine Should Not Be Used:
You should not use this medicine if you have had an allergic reaction to melphalan or if you have used this medicine before and it did not help you. Do not use this medicine if you are pregnant.

How to Use This Medicine:
Tablet

• Medicines used to treat cancer are very strong and can have many side effects. Before receiving this medicine, make sure you understand all the risks and benefits. It is important for you to work closely with your doctor during your treatment.
• Your doctor will tell you how much medicine to use. Do not use more than directed.
• The medicine often causes changes in your blood. Your doctor may tell you to stop taking this medicine occasionally so he or she can take blood samples.
• This medicine sometimes works slowly, and it may keep working for several months. Follow your personal medicine schedule carefully.

Drugs and Foods to Avoid:
Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

• Tell your doctor if you have ever been treated with radiation or other cancer medicines.

Warnings While Using This Medicine:

• Make sure your doctor knows if you are breastfeeding, or if you have kidney disease.
• It is not safe to take this medicine during pregnancy. It could harm an unborn baby. Tell your doctor right away if you become pregnant.
• This medicine could cause infertility. Talk with your doctor before using this medicine if you plan to have children.
• This medicine may make you bleed, bruise, or get infections more easily. Take precautions to prevent illness and injury. Wash your hands often.
• Your doctor will do lab tests at regular visits to check on the effects of this medicine. Keep all appointments.
• Some people who have used this medicine have developed a second form of cancer. It is not known if this medicine caused the second cancer to develop. Talk to your doctor about this risk.
• Cancer medicine can cause nausea or vomiting, sometimes even after you receive medicine to prevent these effects. Ask your doctor or nurse about other ways to control any nausea or vomiting that might happen.

Possible Side Effects While Using This Medicine:
Call your doctor right away if you notice any of these side effects:

• Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
• Blood in your urine or stools
• New lumps or growths under your skin
• Painful or difficult breathing
• Severe nausea, vomiting, diarrhea
• Skin or eyes turn yellow
• Skin rash or redness
• Unexplained fever, chills, cough
• Unusual bleeding, bruising, or weakness

If you notice these less serious side effects, talk with your doctor:

• Hair loss
• Missed menstrual periods
• Sores or white patches on your lips, mouth, or throat
• Weight loss

If you notice other side effects that you think are caused by this medicine, tell your doctor.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088