Evaluation of genotoxic risk of handling cytostatic drugs in clinical pharmacy practice

Abstract

The genotoxic risk of handling antineoplastic drugs was evaluated in fifteen women preparing chemotherapeutics in the Pharmacy Department of the University Hospital Maastricht. Twenty nurses of the same hospital, who were not exposed to cytostatics, acted as controls. Endogenous exposure to antineoplastic drugs was assessed by determination of urine mutagenicity, as well as by analysis of urinary methotrexate levels. As genotoxicological end-points, sister chromatid exchanges and hypoxanthine guanine phosphoribosyl transferase locus point mutations were studied in peripheral lymphocytes obtained via venous puncture. No differences in urine mutagenic activity, in sister chromatid exchange frequencies and in hypoxanthine guanine phosphoribosyl transferase point mutation frequencies between exposed and non-exposed groups were detected. Higher sister chromatid exchange frequency was observed in smokers as compared to non-smokers.

Chemical degradation of wastes of antineoplastic agents: cyclophosphamide, ifosfamide and melphalan

“…Numerous publications report the risks of exposure of pharmacy, nursing and other hospital personnel to these mutagenic drugs. This is illustrated by an increase in the mutagenic potency of the urine of exposed workers (Bos et al 1982;Kolmodin-Hedman et al 1983;Benhamou et al 1986;Guinee et al 1991;De Me´o et al 1995) and an increased risk of abortion ). Possible adverse health effects caused by the handling of these drugs have been reviewed by Rousselin and Stu¨cker (1990).…”

“…Possible adverse health effects caused by the handling of these drugs have been reviewed by Rousselin and Stu¨cker (1990). Hospital staff or family members handling the excreta from patients treated with antineoplastic drugs or equipment contaminated by these excreta, such as urinals and chamber pots, may be more heavily exposed to the drugs or their metabolites than trained hospital nurses or pharmacists (Guinee et al 1991;Cass et al 1992;Sessink et al 1992).…”

SHPA Standards of Practice for the Safe Handling of Cytotoxic Drugs in Pharmacy Departments: The Society of Hospital Pharmacists of Australia Committee of Specialty Practice in Oncology

“…The adoption of improved handling techniques and in particular the use of cytotoxic drug safety cabinets (CDSCs) has reduced exposure of cytotoxic drugs in health workers to levels that cannot be detected. 21,28,[38][39][40][41][42] These standards should be read in conjunction with current SHPA guidelines for aseptic dispensing and standards of practice for the provision of clinical oncology pharmacy services. 43,44 The Director of Pharmacy is responsible for ensuring the implementation of these standards within each institution.…”