Be Ready for Possible Changes to Your Hazardous Med Policy

The National Institute for Occupational Safety and Health (NIOSH) is proposing big changes to its hazardous med list.

We're used to the NIOSH list being divided into three tables of hazardous meds...Table 1 for antineoplastics, Table 2 for NON-antineoplastics, and Table 3 for meds primarily with reproductive risks.

But these tables have caused confusion about true risk. For example, some antineoplastics aren't cytotoxic.

Expect to see just two tables in the proposed NIOSH list.

Table 1 will include known or probable carcinogens...plus hazardous meds with special handling info in the package insert.

Table 2 meds are NOT thought to be carcinogenic, but do meet other hazardous criteria...organ toxicity, reproductive risks, etc.

This means you'll now see letrozole, megestrol, and some other antineoplastics in Table 2...instead of Table 1.

Be ready for this to change your hazardous med policy. USP <800> is clarifying that standards for handling antineoplastics only refer to those that remain in Table 1.

For example, you won't automatically need to wear double chemo gloves when prepping a subcutaneous leuprolide dose.

Instead, your hospital will be able to perform an "assessment of risk" for Table 2 antineoplastics...to decide handling procedures.

On the flip side, some NON-antineoplastics will be reclassified to Table 1. But be aware, this isn't based on new information.

For instance, azathioprine, cyclosporine, and estrogens are moving to Table 1...and they are already known carcinogens.

Anticipate continuing your current process for NON-antineoplastics...even if the med is moving to Table 1.

Get our Handling Hazardous Meds chart for more on assessment of risk...and managing meds NOT on NIOSH's list, such as new or investigational drugs.

• FAQ: Handling Hazardous Meds