Alkeran Dosage/Direction for Use

Alkeran is a cytotoxic drug which falls into the general class of alkylating agents. It should only be prescribed by physicians experienced in the management of malignant disease with such agents.
Since Alkeran is myelosuppressive, frequent blood counts are essential during therapy and the dosage should be delayed or adjusted if necessary (see Precautions).
The absorption of Alkeran after oral administration is variable. Dosage may need to be cautiously increased until myelosuppression is seen, in order to ensure that potentially therapeutic levels have been reached.
Adults: Multiple Myeloma: 0.15 mg/kg body weight/day in divided doses for 4 days repeated at 6-week intervals. Numerous regimens have, however, been used and the scientific literature should be consulted for details.
The administration of oral Alkeran and prednisone may be more effective than Alkeran alone. The combination is usually given on an intermittent basis.
Prolonging treatment beyond 1 year in responders does not appear to improve results.
Advanced Ovarian Adenocarcinoma: 0.2 mg/kg body weight/day for 5 days, repeated every 4-8 weeks, or as soon as the peripheral blood count has recovered.
Breast Carcinoma: 0.15 mg/kg body weight or 6 mg/m² body surface area/day for 5 days, repeated every 6 weeks. The dose should be decreased if bone marrow toxicity was observed.
Polycythaemia Rubra Vera: For remission induction, 6-10 mg daily for 5-7 days; after which, 2-4 mg given daily until satisfactory disease control was achieved.
Maintenance Therapy: 2-6 mg once weekly. In view of the possibility of severe myelosuppression if Alkeran is given on a continuous basis, it is essential that frequent blood counts are taken throughout therapy, with dosage adjustment or breaks in treatment, as appropriate, to maintain careful haematological control.
Children: Alkeran, within the conventional dosage range, is only rarely indicated in children and absolute dosage guidelines cannot be provided.
Elderly: Although Alkeran is frequently used at a conventional dosage in the elderly, there is no specific information available relating to its administration to this patient subgroup.
Renal Impairment: Alkeran clearance, though variable, is decreased in renal impairment. Currently available pharmacokinetic data do not justify an absolute recommendation on dosage reduction when administering Alkeran to patients with renal impairment, but it may be prudent to use a reduced dosage initially until tolerance is established (see Precautions).