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NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings, 2014

Preamble: The National Institute for Occupational Safety and Health (NIOSH) Alert: Preventing Occupational Exposures to Antineoplastic and Other Hazardous Drugs in Health Care Settings was published in September 2004, In Appendix A of the Alert, NIOSH identified a sample list of major hazardous drugs. The list was compiled from information provided by four institutions that had generated lists of hazardous drugs for their respective institutions, as well as a list from the Pharmaceutical Research and Manufacturers of America (PhRMA). The 2004 list was updated in 2010 and 2012. The current update (2014) adds 27 drugs and includes a review of the 2004 list and the consequent removal of 12 drugs that did not meet the NIOSH criteria for hazardous drugs. In addition, a new format has been developed for the list of hazardous drugs, as described below. The review process for the addition of the new listings is described in the Federal Register:

Appendix A ยท Drugs Considered Hazardous

General Approach to Handling Hazardous Drugs

In the Alert (NIOSH 2004) and updates to the hazardous drug list (NIOSH 2012), NIOSH has recommended standard precautions or universal precautions be taken in handling hazardous drugs. Given the addition of many non-antineoplastic drugs and drugs in tablet and/or capsule form to the list, no single approach can cover the diverse potential occupational exposures to the drugs. The current NIOSH approach involves three groups of drugs:

  • Group 1: Antineoplastic drugs (AHFS Classification 10:00) [ASHP/AHFS DI 2013]. Note that many of these drugs may also pose a reproductive risk for susceptible populations (Table 1).
  • Group 2: Non-antineoplastic drugs that meet one or more of the NIOSH criteria for a hazardous drug. Note that some of these drugs may also pose a reproductive risk for susceptible populations (Table 2).
  • Group 3: Drugs that primarily pose a reproductive risk to men and women who are actively trying to conceive and women who are pregnant or breast feeding, because some of these drugs may be present in breast milk (Table 3).