Contamination of lenalidomide on blister packages after administration and its exposure countermeasures

Risk of exposure of patients’ family members to lenalidomide at home

“…Considering the risk of accumulated toxicity of lenalidomide, the case should be disposable or be washed periodically. The importance of wearing gloves when taking medication and washing hands after taking medication is widely known and cleaning objects that have touched the capsules is strongly recommended 9 18 19. We confirmed that the capsule surface immediately after removal from the blister package was contaminated with a large amount of lenalidomide.…”

“…The case is the patient’s property, and thus no wipe samples were obtained during blister package collection. Komuro et al found lenalidomide on the dedicated case and highlighted the risk of exposure via dedicated cases 19. Komuro et al compared the contamination of blister packages when they were placed in the medicine envelope versus in the case, finding twice as much lenalidomide on the case compared with the envelope.…”

“…The maximum amount of drugs per square metre was around 1000 ng, which is near the amount of drug dispersal from the blister packages in this study, suggesting that contamination of the environment by lenalidomide blister packages requires attention as well as contamination in toilets and bathrooms. Komuro et al reported that the amount of lenalidomide that pharmacists might be exposed to when handling returned blister packages is up to several hundred nanograms per package, and the risk of adverse health effects from lenalidomide exposure when handling returned blister packages is low because the area under the curve of lenalidomide for an accidental inoculation of about 500 ng was estimated to be about 0.04 ng·h/mL 19. However, we found used blister packages containing up to approximately 4000 ng/pack of lenalidomide, suggesting that approximately 40 µg/pack of lenalidomide may have been dispersed throughout the patient’s living environment.…”

“…The amount of lenalidomide contamination per package was found to be at least 100 ng less after collection by the pharmacist than immediately after removal of the capsules. A previous study reported some lenalidomide might be dispersed into the case and medicine envelope 19. However, because significant amounts of contamination were found in some samples and the risk of lenalidomide dispersal during capsule removal in the home remains unknown, it is recommended to clean the surrounding area and wash one’s hands after taking the capsules.…”

“…The case containing used blister packages is returned to the pharmacist at the next visit, and the pharmacist counts the number of capsules remaining in the blister package to check adherence. In a study of the amount of lenalidomide on the surface of blister packages returned from patients, Komuro et al found that lenalidomide adhered to the blister packages, although in tiny amounts compared with the dose administered, and pharmacists risked exposure when handling drugs or related items, including blister packages 19. However, the possibility of lenalidomide dispersal when patients handle lenalidomide at home and the risk of exposure of patients' family members to lenalidomide in their homes have not been assessed.…”