A significant number of medicines have the potential to pose a health and safety risk as a result of unintended exposure when people other than the patient - such as carers, family members or healthcare professionals - handle the medicine.
To help protect people from such exposure, the latest edition of the Australian Pharmaceutical Formulary and Handbook (APF23) contains a list of hazardous medicines that are:
- designated as pregnancy category X or D
- reported to pose a risk to patients or carers through inappropriate handling.
APF23 recommends such medicines be identified as hazardous though the use of a Cautionary Advisory Label (CAL) which reads Special handling and disposal required - ask your pharmacist.
Chair of the APF23 Editorial Board, Emeritus Professor Lloyd Sansom, said the unintended exposure to a hazardous medicine during preparation and administration could occur through skin contact, ingestion or inhalation and some people, such as pregnant women, may be at greater risk from unintended exposure than others.
"Some hazardous medicines may not pose a significant risk if they are administered to patients intact, (that is via coated tablets, capsules), but the risk can be increased if these formulations are modified (e.g. cutting, crushing, or opening capsules), or with long-term, low-level exposure." he said.
Oral products of hazardous medicines should be swallowed whole where possible, and should not be removed from their original packaging for transfer into a dose-administration aid. Standard operating procedures should be developed by institutions to minimise risk.
"APF23 recommends patients and their carers are made aware of the risks of hazardous medicines and the precautions that can be used to minimise risk of exposure, including the use of gloves, face masks and non-permeable gowns," Professor Sansom said.
"There is limited data available on exposure limits for individual medicines identified as being hazardous. The APF provides general guidance, but this may not be applicable to all possible scenarios encountered in practice. Pharmacists are advised to conduct their own risk assessment to determine the appropriateness of labelling and handling requirements in specific circumstances.
"Cautionary advisory labels are an important counselling tool for pharmacists."