Melphalan Flufenamide
A dipeptide-carried form of melphalan for late-stage multiple myeloma, approved and then withdrawn in the US, still authorised in the EU
Melphalan flufenamide, usually shortened to melflufen, joins the old alkylating drug melphalan to a fluorinated phenylalanine, making a fat-soluble dipeptide ester that slips into cells and is cut apart there by peptidases. It is given by infusion once every four weeks with dexamethasone to people whose myeloma has stopped responding to several drug classes. FDA granted it accelerated approval as Pepaxto in February 2021; the company pulled it from the US market that October after the phase 3 OCEAN trial, and FDA later withdrew the approval. In the EU it is authorised as Pepaxti.
Manufacturer's recommended dosing (EU label, EMA): 40 mg (dexamethasone 40 mg on days 1, 8, 15 and 22; 20 mg from age 75), Day 1 of each 28-day cycle, Intravenous Details ↓
Recommended Dosing
Manufacturer's recommended dosing (EU label, EMA)
From the prescribing information. Other doses studied, if any, are in the full dosing data below.
Last FDA label of a product discontinued in the US (not a current US recommendation)
From the last US prescribing information of a product discontinued in the US (see the regulatory status on this page). It records what that label said while the product was sold there; it is not a current US recommendation. Other doses studied, if any, are in the full dosing data below.
Used in human trials
No manufacturer dose exists for this use: these are amounts given in published trials, not recommendations.
What is it?
Melphalan has been used against multiple myeloma for decades. Melflufen is an attempt to get more of it into the cancer cell. The drug is melphalan bonded to para-fluoro-L-phenylalanine and closed as an ethyl ester, which makes a small, fat-soluble peptide. That lets it cross cell membranes quickly; once inside, aminopeptidases and esterases split it, and the freed melphalan, which crosses membranes far less easily, is left trapped in the cell. In myeloma cell lines and mice, it reached higher melphalan levels inside cells than melphalan itself did, killed cells that had become resistant to melphalan and bortezomib, and lost much of its effect when the enzyme aminopeptidase N was knocked down.
In people it is a 30-minute infusion given once every 28 days with weekly dexamethasone. The early phase 1-2 trial in relapsed myeloma set 40 mg as the highest tolerable dose, because 55 mg caused severe falls in white cells and platelets. The pivotal single-arm HORIZON trial then gave 40 mg to 157 heavily pretreated patients, most of whom had stopped responding to the three main drug classes. About 29% responded, the median response lasted 5.5 months and median survival was 11.6 months. FDA granted accelerated approval on that basis in February 2021, for patients with at least four earlier lines of therapy whose disease no longer responded to a proteasome inhibitor, an immunomodulatory drug and an anti-CD38 antibody.
Accelerated approval rests on a promise that a confirmatory trial will show real benefit. OCEAN was that trial, comparing melflufen with pomalidomide, each with dexamethasone, in 495 patients. Melflufen delayed progression longer (median 6.8 against 4.9 months), but median overall survival was numerically shorter (19.8 against 25.0 months). The company withdrew Pepaxto from the US market in October 2021, and after an appeal and an advisory committee review FDA's final decision withdrawing the approval was announced in April 2024. Commentators used the case to question how accelerated approval works.
Europe read the same data differently. Later analyses of OCEAN found the survival deficit came from patients whose myeloma had returned within three years of a stem cell transplant; patients without a transplant, or who relapsed later, lived longer on melflufen (median 23.6 against 19.8 months). The EU authorised Pepaxti in August 2022 for adults with at least three earlier lines of therapy who are triple-class refractory and who either had no transplant or relapsed more than three years after one, and the EMA medicines list now shows it as authorised without conditional status. Small real-world series from the United States, Italy and Spain have since reported response rates of about 28% to 55%.
Its side effects are those of a strong alkylating drug. In every trial most patients had severe drops in platelets and neutrophils, and infections such as pneumonia were the most common serious non-blood events. This is a hospital chemotherapy drug, dosed by body weight and kidney function and given only by haematology teams. Nothing about its peptide structure makes it a research peptide or something to obtain outside that setting.
Mechanism of Action
Melflufen is a delivery vehicle for melphalan: its peptide form gets it into cells fast, and enzymes inside the cell release the alkylating drug.
Quick entry
As a fat-soluble dipeptide ester it crosses cell membranes in about a minute (PMID 37752623).
Cut apart inside
Aminopeptidases such as aminopeptidase N and esterases release melphalan and desethyl-melflufen, which are less able to leave the cell (PMIDs 23584492, 33961277).
DNA cross-links
The released alkylators cross-link DNA; a short exposure caused irreversible damage in myeloma cells (PMID 27098276).
Published Research
Studies of melflufen read from their PubMed abstracts: the dose-finding and pivotal myeloma trials, the phase 3 OCEAN and LIGHTHOUSE trials and their later analyses, pharmacokinetic studies, real-world series after approval, two reviews of its approval and withdrawal, and laboratory work on how it kills cells.
HORIZON: the pivotal single-arm trial
157 patients with relapsed myeloma, a median of five earlier treatment lines and 76% triple-class refractory, received 40 mg on day 1 of each 28-day cycle with weekly dexamethasone. 29% responded (26% of the triple-class refractory group); median response lasted 5.5 months, progression-free survival 4.2 months and overall survival 11.6 months. Nearly all patients had a grade 3 or worse event, mostly low neutrophils (79%) and platelets (76%).
OCEAN: better on progression, not on survival
In this phase 3 trial, 495 patients refractory to lenalidomide were randomised to melflufen 40 mg or pomalidomide 4 mg daily, both with dexamethasone. Median progression-free survival was 6.8 months against 4.9 (hazard ratio 0.79), but median overall survival was 19.8 against 25.0 months (hazard ratio 1.10, not significant). Severe low platelets affected 63% on melflufen against 11% on pomalidomide.
O-12-M1: finding the dose
In this phase 1-2 study, doses of 15, 25, 40 and 55 mg were tried every 21 days with dexamethasone. At 55 mg four of six patients had grade 4 neutropenia, so 40 mg became the maximum tolerated dose. In phase 2, 31% of 45 patients on the combination responded, against 8% of 13 given melflufen alone, and that single-agent arm was closed early.
O-12-M1: long-term survival
After a median of 46 months of survival follow-up, patients from the phase 2 part of O-12-M1 given melflufen and dexamethasone had a median overall survival of 20.7 months, and a median of 7.9 months passed before they needed their next treatment.
Who did worse in OCEAN
Longer follow-up of OCEAN and HORIZON found that relapse within 36 months of a stem cell transplant marked the patients who did poorly on melflufen. Leaving those patients out, median survival in OCEAN was 23.6 months on melflufen against 19.8 on pomalidomide (hazard ratio 0.83, not significant). This subgroup became the basis of the EU indication.
OCEAN: disease already resistant to alkylators
In a post hoc look at 153 OCEAN patients whose myeloma no longer responded to earlier alkylators such as cyclophosphamide or melphalan, progression-free survival (5.6 against 4.7 months) and overall survival (23.4 against 20.0 months) were similar for melflufen and pomalidomide; the authors read this as activity beyond that of ordinary alkylators.
LIGHTHOUSE: stopped early by an FDA hold
This phase 3 trial added melflufen to daratumumab and dexamethasone and compared it with daratumumab alone. An FDA partial clinical hold on all melflufen studies forced it to close in February 2022 with 54 of 240 planned patients. Responses were 59% against 30% and progression-free survival favoured the triplet (hazard ratio 0.18), with more severe neutropenia and thrombocytopenia.
ANCHOR: triplets and a lower dose
In this phase 1/2a study, melflufen at 30 or 40 mg was combined with dexamethasone and either daratumumab (33 patients) or bortezomib (23). Response rates were 73% and 78%, and median progression-free survival 12.9 and 14.7 months. Patients given 30 mg stayed on treatment longer, so 30 mg was chosen as the dose for triplets.
Quality of life in HORIZON
In 64 HORIZON patients who completed questionnaires, global quality of life, physical and emotional functioning, pain and fatigue held steady or improved, including after eight cycles, and worsening came later in patients who responded than in those who did not.
How melflufen is handled by the body
In whole blood the drug entered blood cells within a minute and became melphalan within minutes. After a 40 mg infusion in 27 patients, melflufen's half-lives were 1.2 and 27 minutes for its two phases; a population model of 298 patients showed melphalan exposure falling as body weight and kidney function rose.
BRIDGE: patients with weak kidneys
35 patients with moderate or severe kidney impairment received 20 to 40 mg. Melphalan exposure was lower at the reduced doses, and its half-life lengthened only slightly as kidney function fell (about 89 to 110 minutes). The authors judged the results to support 30 mg in moderate impairment; six patients died of treatment-emergent events.
PORT: a peripheral line works too
Earlier trials gave melflufen through a central venous catheter. In this crossover study, infusion through an arm vein gave melphalan levels within the bioequivalence range of the central route, and no phlebitis or local infusion reactions were seen.
First in humans, in solid tumours
45 patients with advanced solid tumours, mostly ovarian and lung cancer, received 25 to 130 mg every three weeks. Reversible falls in neutrophils and platelets limited the dose, and 50 mg was set as the phase 2 dose. One ovarian cancer patient had a partial response and 18 had stable disease.
Real-world use in Boston
Of 12 heavily pretreated patients treated at one US centre, 55% responded, including three complete responses. Side effects were mainly in the blood counts. Among the reasons treatment stopped, a third of patients stopped because the drug left the US market.
Real-world use in Bologna
17 patients treated outside trials in Italy between 2021 and 2025 had a 41% response rate and a median progression-free survival of 3.7 months (9.0 months in responders). About half had severe neutropenia or thrombocytopenia; most went on to further treatment.
Real-world use after immunotherapy in Spain
19 patients at eight Spanish hospitals, most of them already treated with newer BCMA or GPRC5D immunotherapies, had a 28% response rate and a median progression-free survival of 4.8 months. Severe thrombocytopenia and neutropenia each affected 68%.
The first approval
This review traces melflufen's development to its February 2021 US approval with dexamethasone for patients after at least four lines of therapy. It describes the drug as a lipophilic dipeptide ester that cells take up rapidly and cut into melphalan and desethyl-melflufen, which then cross-link DNA.
Approval and withdrawal
This commentary records the October 2021 US market withdrawal after OCEAN showed numerically worse survival, and argues that OCEAN's control arm was weak, that a drug derived from melphalan should have been tested against melphalan, and that accelerated approval let patients take a drug when confirmatory data were close.
Myeloma cells and mice
In myeloma cell lines, patient cells and mouse xenografts, melflufen built higher melphalan levels inside cells than melphalan itself, killed cells resistant to melphalan and bortezomib, and slowed tumours more than equal molar doses of melphalan. Silencing aminopeptidase N weakened it.
Fast, lasting DNA damage
In myeloma cells, a two-hour exposure to melflufen was enough to cause irreversible DNA damage, with damage markers appearing within two hours even in melphalan-resistant cells. Melphalan, unlike melflufen, switched on the repair protein Ku80.
Breast cancer cell lines
Tumour-forming breast cell lines were more sensitive to melflufen than a normal-derived line, and in mice it curbed spread of triple-negative breast cancer cells more than doxorubicin. Blocking aminopeptidases with bestatin reduced its effect.
Dosing Data
The first rows are the current EU label for Pepaxti. The US rows are from the last Pepaxto label before FDA withdrew the approval; they are printed to explain the US trials and the 2021 approval, not as a current US dose. The last row is a dose chosen in a combination trial.
Educational information, not medical advice. Each dose above is tagged with its source: an approved label, a published human study, animal data, or amounts reported by users. None is a recommendation for you. An unapproved compound has no established safe or effective human dose, and products sold for “research use only” are not made or tested for people. Talk to a doctor before acting on anything on this site, including before you start, stop or change any medicine or dose. Full medical disclaimer.
What a Buyer Needs to Know
What is sold, how it is mixed, stored and taken, and what is known about its safety, quality and legal status. Each part names its source. Where we have none, it says unknown.
What is sold
Unknown: we hold no regulator's label that says in what form Melphalan Flufenamide is supplied. It is prepared and given by clinical staff, not bought and mixed at home: the next part says where.
Mixing a vial: a worked example
Nothing to mix at home, and no syringe units to work out: Melphalan Flufenamide is prepared and given by clinical staff, by a cancer team in hospital.
In the carded HORIZON trial it was infused on day 1 of each 28-day cycle in people with relapsed myeloma.
Source: PMID 33296242 (a study carded under Research below).
Storage before and after mixing
Unknown: no label on file says how Melphalan Flufenamide is stored. It is kept and prepared by the hospital or clinic that gives it (see the part above); the home rules for a mixed vial in the mixing guide do not apply to it.
How it is taken
As the approved label gives it: Intravenous (Day 1 of each 28-day cycle; EU label: relapsed or refractory myeloma, body weight over 60 kg).
Source: Manufacturer's recommended dosing (EU label, EMA): the route and frequency of each row in Dosing Data below.
What to expect, and when
How long it stays in the body: a half-life of about 2 minutes for melflufen; about 70 minutes for the melphalan it releases. After about five half-lives almost none is left.
How long the doses were given: EU label: relapsed or refractory myeloma, body weight over 60 kg: Until progression or unacceptable toxicity; EU label: body weight 60 kg or less: Reduce stepwise to 20 mg, then 15 mg, for side effects; EU label: kidney impairment (eGFR 30-45 mL/min/1.73 m²): Too little data below eGFR 30.
When effects appear: unknown; no source on this page gives a time to effect for Melphalan Flufenamide. Results reported in the studies are under Published Research.
Source: half-life: Pepaxti (melphalan flufenamide) summary of product characteristics, EPAR product information, European Medicines Agency (downloaded October 29, 2026), section 5.2; Manufacturer's recommended dosing (EU label, EMA), the duration of each row in Dosing Data below.
Side effects, and when to stop or get help
From the Side Effects section: Severe thrombocytopenia and neutropenia in most patients (76% and 79% in HORIZON; PMID 33296242); Anaemia, often severe (43% grade 3 or 4 in OCEAN; PMID 35032434); Pneumonia and other infections, the most common serious non-blood events (PMIDs 33296242, 32213344); Nausea, diarrhoea and other gut effects, mostly mild (PMID 33296242); Bleeding when platelets were very low (PMIDs 33296242, 42270486). Full list and cautions ↓
When to stop or get help: unknown; no label or trial on file sets rules for stopping Melphalan Flufenamide. Treat a severe or unexpected reaction as a reason to stop and see a doctor.
Source: the Side Effects section below (“From the trials and series above”).
Interactions
Unknown: a PubMed search for human interaction studies of Melphalan Flufenamide (reviewed 2026-10-28) found none. Unknown is not the same as safe to combine.
Every peptide's record, with its source: the interaction matrix.
Checking what you bought
Unknown: no published independent test of Melphalan Flufenamide products is in our lab-results database yet, so how products sold under this name measure up is not known.
To read a certificate of analysis, paste it into the COA decoder; it checks the measured mass against Melphalan Flufenamide's expected mass, 498.4 Da, from this entry's molecular data. Trust & Verification explains what independent testing can and cannot show.
Legal status
US: Not FDA Approved (US: accelerated approval as Pepaxto (NDA 214383) in February 2021 (PMID 33961277)). Elsewhere: approved in EU (EMA: Pepaxti, authorised August 17, 2022). Sport: Not on the 2026 List.
Country by country ↓ · Regulatory tracker
Source: this entry's approval status and the WADA Prohibited List, as in Legal Status below.
Side Effects & Contraindications
Reported Side Effects
From the trials and series above.
Contraindications & Cautions
From the EU summary of product characteristics and the last US label (revised February 2021).
Legal Status
Melflufen's status differs sharply between the US and the EU.
Frequently Asked Questions
?Is melflufen a peptide?
Partly. It is melphalan, an alkylating chemotherapy drug, joined to the amino acid para-fluoro-L-phenylalanine as an ethyl ester, so it is a small dipeptide conjugate. The peptide part is a carrier that gets melphalan into cells.
?Why was it withdrawn in the US?
Its accelerated approval depended on a confirmatory trial. In OCEAN it delayed progression more than pomalidomide, but median survival was numerically shorter (19.8 against 25.0 months), so the company withdrew it in October 2021 and FDA later withdrew the approval.
?Why is it still sold in Europe?
European regulators limited it to patients without a recent stem cell transplant. In OCEAN, the survival shortfall came from patients who had relapsed within three years of a transplant; in the others survival favoured melflufen.
?How is it given?
As a 30-minute intravenous infusion once every 28 days, with dexamethasone tablets or infusions on days 1, 8, 15 and 22. Lighter patients and those with reduced kidney function get 30 mg instead of 40 mg in the EU.
?What are the main risks?
Very low platelets and white cells, which raise the risk of bleeding and infection, plus anaemia. Second blood cancers have occurred, as with other alkylators.
?Can it be bought as a research peptide?
It should not be. It is a cytotoxic cancer drug prepared by hospital pharmacies and given with blood-count monitoring; outside that setting its risks have no counterweight.
References
- [other] PubChem CID 9935639, Melphalan Flufenamide: formula C24H30Cl2FN3O3, molecular weight 498.4. Read October 28, 2026. https://pubchem.ncbi.nlm.nih.gov/compound/9935639
- [other] European Medicines Agency, medicines list (JSON report, downloaded October 28, 2026): Pepaxti (melphalan flufenamide hydrochloride): authorised, marketing authorisation date August 17, 2022; indicated with dexamethasone for adults with multiple myeloma after at least three prior lines of therapy.
- [other] Pepaxti (melphalan flufenamide hydrochloride), EPAR product information (summary of product characteristics), European Medicines Agency, EU/1/22/1669/001. Downloaded October 29, 2026. https://www.ema.europa.eu/en/documents/product-information/pepaxti-epar-product-information_en.pdf
- [other] Pepaxto (melphalan flufenamide) for injection, US prescribing information, revised February 2021 (NDA 214383, Oncopeptides). Drugs@FDA label archive, read October 29, 2026. https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/214383s000lbl.pdf
- [other] US Food and Drug Administration. Final Decision on Withdrawal of PEPAXTO (melphalan flufenamide) Following Appeal of the Proposal To Withdraw Approval; Availability of Final Decision. Federal Register, April 18, 2024, document 2024-08274. https://www.federalregister.gov/documents/2024/04/18/2024-08274/final-decision-on-withdrawal-of-pepaxto-melphalan-flufenamide-following-appeal-of-the-proposal-to
- [registry] ClinicalTrials.gov API v2, read October 29, 2026: NCT02963493 (HORIZON, completed), NCT03151811 (OCEAN, terminated), NCT04649060 (LIGHTHOUSE, terminated), NCT03481556 (ANCHOR, terminated), NCT03639610 (BRIDGE, terminated), NCT04412707 (PORT, terminated), NCT07559799 (MARINA, non-interventional, recruiting).
- [clinical-trial] Richardson PG, et al. "Melflufen and Dexamethasone in Heavily Pretreated Relapsed and Refractory Multiple Myeloma." J Clin Oncol, 2021;39(7):757-767. PMID: 33296242.
- [clinical-trial] Schjesvold FH, et al. "Melflufen or pomalidomide plus dexamethasone for patients with multiple myeloma refractory to lenalidomide (OCEAN): a randomised, head-to-head, open-label, phase 3 study." Lancet Haematol, 2022;9(2):e98-e110. PMID: 35032434.
- [clinical-trial] Richardson PG, et al. "Melflufen plus dexamethasone in relapsed and refractory multiple myeloma (O-12-M1): a multicentre, international, open-label, phase 1-2 study." Lancet Haematol, 2020;7(5):e395-e407. PMID: 32213344.
- [clinical-trial] Bringhen S, et al. "Melflufen plus dexamethasone in relapsed/refractory multiple myeloma: long-term survival follow-up from the Phase II study O-12-M1." Br J Haematol, 2021;193(6):1105-1109. PMID: 33403663.
- [clinical-trial] Sonneveld P, et al. "Benefit Versus Risk Assessment of Melflufen and Dexamethasone in Relapsed/Refractory Multiple Myeloma: Analyses From Longer Follow-up of the OCEAN and HORIZON Studies." Clin Lymphoma Myeloma Leuk, 2023;23(9):687-696. PMID: 37355418.
- [clinical-trial] Schjesvold FH, et al. "Melflufen in relapsed/refractory multiple myeloma refractory to prior alkylators: A subgroup analysis from the OCEAN study." Eur J Haematol, 2024;112(3):402-411. PMID: 37968873.
- [clinical-trial] Pour L, et al. "Efficacy and safety of melflufen plus daratumumab and dexamethasone in relapsed/refractory multiple myeloma: results from the randomized, open-label, phase III LIGHTHOUSE study." Haematologica, 2024;109(3):895-905. PMID: 37646660.
- [clinical-trial] Ocio EM, et al. "ANCHOR: melflufen plus dexamethasone and daratumumab or bortezomib in relapsed/refractory multiple myeloma: final results of a phase I/IIa study." Haematologica, 2024;109(3):867-876. PMID: 37646657.
- [clinical-trial] Larocca A, et al. "Patient-reported outcomes in relapsed/refractory multiple myeloma treated with melflufen plus dexamethasone: analyses from the Phase II HORIZON study." Br J Haematol, 2022;196(3):639-648. PMID: 34671975.
- [clinical-trial] Huledal G, et al. "Pharmacokinetics and Metabolism of Melflufen, an Alkylating Peptide-Drug Conjugate, in Patients with Relapsed Refractory Multiple Myeloma." J Clin Pharmacol, 2024;64(2):240-252. PMID: 37752623.
- [clinical-trial] Pour L, et al. "BRIDGE (OP-107): A Phase 2 Pharmacokinetic Study of Melflufen Plus Dexamethasone in Patients with Relapsed/Refractory Multiple Myeloma and Impaired Renal Function." Clin Lymphoma Myeloma Leuk, 2026;26(7):e942-e952. PMID: 42215355.
- [clinical-trial] Pour L, et al. "PORT: A Randomized, Cross-Over, Phase 2 Study of Melflufen Peripheral Versus Central Intravenous Administration in Patients With Relapsed/Refractory Multiple Myeloma." Clin Lymphoma Myeloma Leuk, 2024;24(6):e267-e275.e2. PMID: 38490927.
- [clinical-trial] Berglund Å, et al. "First-in-human, phase I/IIa clinical study of the peptidase potentiated alkylator melflufen administered every three weeks to patients with advanced solid tumor malignancies." Invest New Drugs, 2015;33(6):1232-41. PMID: 26553306.
- [pubmed] Hossain S, et al. "Outcomes of Melflufen Treatment in Patients With Relapsed/Refractory Multiple Myeloma." Eur J Haematol, 2025;114(6):982-989. PMID: 39988462.
- [pubmed] Mancuso K, et al. "Positioning of Melflufen in Heavily Pretreated RRMM Patients: Real-World Evidence in a Rapidly Evolving Therapeutic Landscape." Eur J Haematol, 2026;116(6):928-936. PMID: 41813608.
- [pubmed] Martínez-Campuzano D, et al. "Real-World Outcomes of Melflufen Plus Dexamethasone in Heavily Pretreated Relapsed/Refractory Multiple Myeloma After Exposure to Immunotherapies." Clin Lymphoma Myeloma Leuk, 2026;26(8):e1061-e1068.e1. PMID: 42270486.
- [review] Dhillon S, et al. "Melphalan Flufenamide (Melflufen): First Approval." Drugs, 2021;81(8):963-969. PMID: 33961277.
- [review] Olivier T, et al. "The approval and withdrawal of melphalan flufenamide (melflufen): Implications for the state of the FDA." Transl Oncol, 2022;18:101374. PMID: 35196605.
- [pubmed] Chauhan D, et al. "In vitro and in vivo antitumor activity of a novel alkylating agent, melphalan-flufenamide, against multiple myeloma cells." Clin Cancer Res, 2013;19(11):3019-31. PMID: 23584492.
- [pubmed] Ray A, et al. "A novel alkylating agent Melflufen induces irreversible DNA damage and cytotoxicity in multiple myeloma cells." Br J Haematol, 2016;174(3):397-409. PMID: 27098276.
- [pubmed] Schepsky A, et al. "Melflufen, a peptide-conjugated alkylator, is an efficient anti-neo-plastic drug in breast cancer cell lines." Cancer Med, 2020;9(18):6726-6738. PMID: 32717133.
Sources & Citations
Every study on this page was read from its PubMed record on October 29, 2026. Doses come from the EU Pepaxti product information (EMA, downloaded October 29, 2026) and the February 2021 Pepaxto label on Drugs@FDA; status from Drugs@FDA (openFDA), the Federal Register, the EMA medicines list and ClinicalTrials.gov, read the same day. The formula is PubChem's. Grey Peptides sells nothing and links to no vendor.
Medical Disclaimer: This content is for educational and informational purposes only. It is not medical advice, and nothing here is an instruction to obtain or use any compound. Talk to a licensed clinician about your own situation.