Background and importance After the National Institute for Occupational Safety and Health (NIOSH) classified hazardous drugs (HD), it was deemed necessary to make healthcare workers aware of the risks associated with handling HD in their daily work to mitigate these risks.

Aim and objectives To analyse oral HD handling activities to make handling recommendations based on the lowest dust inhalation risk and to ensure the safety of healthcare workers in hospital units.

Material and methods Oral HD were classified into two categories: groups 1 and 2 and group 3 according to NIOSH grouping system. Secondly, oral HD handling activities in hospital units based on their dust inhalation risk to the workers were ranked and decisions were taken accordingly: opening capsules and sachets must be avoided; marketed liquid formulations is strongly preferred; and in their absence, crushing tablets using closed systems is preferred over compounding medications due to shorter administering periods in hospital units. Finally, the above mentioned ranking was followed for every oral HD. If no marketed liquid alternatives were found, research on techniques for crushing and dissolving tablets was conducted. In the absence of crushing techniques, academic research on compounding oral HD was carried out. For the remaining oral HD, information was requested from the manufacturers.

Results A total of 59 active pharmaceutical ingredients (API) from groups 1 and 2 were analysed. Marketed liquid formulations were found for 13 API (abacavir, ciclosporin, crizotinib, phenytoin, megestrol, mycophenolate mofetil, mycophenolic acid, nevirapine, oxcarbazepine, trametinib, tofacitinib, valganciclovir, and zidovudine). Techniques on crushing and dissolving tablets were available for 21 API (abiraterone, axitinib, busulfan, dasatinib, entecavir, enzalutamide, everolimus, exemestane, flutamide, imatinib, letrozole, medroxyprogesterone, melphalan, mercaptopurine, methimazole, methotrexate, mitotane, ponatinib, rasagiline, sorafenib and tamoxifen).

For 13 API (azathioprine, capecitabine, carbamazepine, cyclophosphamide, chlorambucil, etoposide, hydroxyurea, procarbazine, spironolactone, sunitinib, tacrolimus, thalidomide and topotecan) compounding oral information was found. No information was obtained for 12 API (20.3%) (bexarotene, bosutinib, cabozantinib, fingolimod, fludarabine, ixazomib, lenalidomide, nilotinib, pazopanib, pomalidomide, regorafenib and vinorelbine) for which avoiding their handling and seeking other therapeutic alternative was advised. For the remaining 79.7% of API, priority was given to the recommendation of the lowest dust inhalation risk handling alternative.

Conclusion and relevance Safe handling alternatives were found for most of the analysed oral HD in the sample, with potential to minimise workers’ handling risk and ensure safety measures in hospital units.

References and/or acknowledgements No conflict of interest.