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International Journal of Clinical Pharmacy

, Volume 37, Issue 6, pp 984–987 | Cite as

A case of melphalan sustained accumulation in an 80-year old patient

  • Pierre-Alain JolivotEmail author
  • Vianney Poinsignon
  • Angelo Paci
  • Bertrand Guidet
  • Claire Pichereau
  • Christine Fernandez
  • Patrick Hindlet
Case Report

Abstract

Case We report the case of melphalan accumulation in an 80-year old female with multiple myeloma. Her initial health status was good except for a moderate chronic renal failure (estimated glomerular filtration rate: 31 ml/min) and anemia. Among other drugs, her usual treatment included trimethoprim/sulfamethoxazole and the patient received melphalan from day 1 to day 4 for multiple myeloma. On day 13, she was admitted in intensive care unit for acute renal failure and severe sepsis with pancytopenia. Usual treatments were stopped. Melphalan blood concentrations were 123.6 ng/ml on day 16 and 87.5 ng/ml on day 17 while cerebrospinal fluid concentration was 173.8 ng/ml on day 25. Patient recovered on day 30. Melphalan accumulation may be explained by substrate competition between sulfamethoxazole and melphalan in metabolism pathway and chronic renal failure. Conclusion close clinical and renal monitoring should be performed in patient receiving melphalan and sulfamethoxazole.

Keywords

Acute kidney injury Drug interactions Melphalan Multiple myeloma Pancytopenia Trimethoprim–sulfamethoxazole combination 

Notes

Acknowledgments

The authors thank Mrs. Stella Ghouti-Baxter for her linguistic support.

Funding

None.

Conflicts of interest

The authors declare that they have no conflicts of interest.

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Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2015

Authors and Affiliations

  • Pierre-Alain Jolivot
    • 1
    • 2
    Email author
  • Vianney Poinsignon
    • 3
  • Angelo Paci
    • 3
  • Bertrand Guidet
    • 2
    • 4
  • Claire Pichereau
    • 4
  • Christine Fernandez
    • 1
    • 2
    • 5
  • Patrick Hindlet
    • 1
    • 2
    • 5
  1. 1.Service de Pharmacie, Hôpital Saint-AntoineAssistance Publique - Hôpitaux de ParisParisFrance
  2. 2.Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d’épidémiologie et de Santé Publique (IPLESP UMRS 1136)ParisFrance
  3. 3.Gustave Roussy Cancer Campus - Service interdépartemental de Pharmacologie et d’Analyse du Médicament (SIPAM)VillejuifFrance
  4. 4.Service de Réanimation médicale, Hôpital Saint-AntoineAssistance Publique - Hôpitaux de ParisParisFrance
  5. 5.Faculté de PharmacieUniversité Paris-SudChatenay-MalabryFrance

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