Which drugs are part of the NIOSH hazardous drug list?
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These tables are based on the NIOSHr, IARCr and product informationr recommendations and only include drugs used in the treatment of cancer. It is intended as a guide and should not be construed as complete representation of all hazardous drugs used in health care settings. Show Some drugs defined as hazardous may not pose a significant risk of direct occupational exposure because of their dosage formulation (e.g. intact medications such as coated tablets or capsules that are administered to patients without modifying the formulation). However, they may pose a risk if solid drug formulations are altered outside a ventilated cabinet (e.g. If tablets are crushed or dissolved, or if capsules are pierced or opened). The dust from uncoated tablets may present a risk of exposure by skin contact and/or inhalation when the tablets are counted.r Reproductive hazardous drugs have a potential to be an occupational hazard to those healthcare workers (both male and female) who are actively trying to conceive and females who are pregnant, breastfeeding or may become pregnant. These healthcare workers should use precautions when handling these drugs.r Occupational Health and Safety and Worker Compensation authoritiesrr, as well as various Professional Practice Standardsrr, uniformly mandate the use of personal protective equipment (PPE) by healthcare workers who handle hazardous drugs. While the tables below separate anti-cancer drugs into the categories ‘cytotoxic’ and ‘non-cytotoxic’ there is no intention to imply that hazardous drug handling recommendations should not be applied, including the use of PPE, in either case. Due to the existence of minimal data regarding occupational risk involved in administering many agents, eviQ recommends PPE be employed unless local institutional guidelines exist that specifically address occupational risk minimisation for individual agents. The following tables list common anti-cancer agents classified as hazardous or reproductive hazardous. Hazardous cytotoxic anti-cancer drugsNIOSH recommends full PPE when handling and administering these drugsr.
Hazardous non-cytotoxic anti-cancer drugsFor parenteral and oral liquid formulations NIOSH recommends full PPE when handling and administering. Intact drugs (such as coated tablets or capsules) may not pose the same degree of occupational exposure risk as compounded injectable drugs due to their dosage formulation. For these intact formulations NIOSH recommends single gloving for handling and administration. However, if these formulations are manipulated (crushed, dissolved etc.) they may pose a higher risk and full PPE is recommended. Healthcare workers (both male and female) who are actively trying to conceive and females who are pregnant, breastfeeding or may become pregnant should use PPE when handling all formulations of these drugs.r
* For parenteral and oral liquid formulations of these drugs NIOSH recommends PPE when handling and administering. ** Olaparib is not classified as cytotoxic however has cytotoxic inducing effects so is considered hazardous.r ^ NIOSH groups these agents in Group 1 i.e. recommending double gloving and a protective gown during administration. The risk of occupational exposure from prefilled syringes is difficult to quantify and no guidance provided in the literature. Whilst we have chosen to predominantly adopt the NIOSH 2016 definitions of hazardous medicines, we propose that for the administration of prefilled syringes, a more pragmatic approach may be taken permitting these agents to be administered, similarly to intact formulations. Reproductive hazardous drugsHealthcare workers (both male and female) who are actively trying to conceive and females who are pregnant, breastfeeding or may become pregnant should use full PPE when handling these drugs. Intact drugs (such as coated tablets or capsules or prefilled syringes) may not pose the same degree of occupational exposure risk as compounded injectable drugs due to their dosage formulation. For these intact formulations NIOSH recommends single gloving for handling and administration. However, if these formulations are manipulated (crushed, dissolved etc.) they may pose a higher risk and full PPE is recommended.r All other healthcare workers handling these medications should use universal precautions.
* For aerolised pentamidine a sensible approach would be to wear PPE and appropriate respiratory protection during administration. What are NIOSH hazardous drugs?The definition was modified from the American Society of Health-System Pharmacists definition of a hazardous drug. The NIOSH criteria include : carcinogenicity, teratogenicity, reproductive toxicity, genotoxicity, organ toxicity at low doses, and drugs that mimic existing drugs in structure or toxicity.
Which medications are hazardous drugs?Hazardous drugs include those used for can- cer chemotherapy, antiviral drugs, hormones, some bioengineered drugs, and other miscella- neous drugs.
What are the three types of hazardous drugs?DHHS (NIOSH) Publication No.
The format for the 2014 list was revised to include three groups of hazardous drugs: (1) Antineoplastic drugs; (2) Non-antineoplastic hazardous drugs; and (3) Drugs with reproductive effects.
What are Group 1 hazardous drugs?Group 1 is antineoplastic drugs (roughly, chemotherapy medications). Group 2 is other drugs (not antineoplastic) that are hazardous, while Group 3 are drugs that may interrupt fertility in women or men or that may get into breast milk.
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