Some medications have a “cytotoxic” or “caution” label. When you handle these medications, you have to take special precautions as they may be harmful to certain groups of people if not handled correctly. Learn more about how to handle these medications safely.
What does “Cytotoxic” or “Caution” medications mean?
You may be given a medication that has a “cytotoxic” or “caution” label. When you handle these medications, you have to take special precautions as they may be harmful to certain groups of people if not handled correctly.
- Medications under the “Cytotoxic” category affect division of our body cells.
- Prolonged exposure or exposure to large amounts of cytotoxic drugs can lead to harmful effects to the normal body cells e.g. blood cells and cells lining the stomach and intestines.
- Medications under the “Caution” category are those which can cause health problems such as airway irritation, irregular heartbeat and in some cases, increase the possibility of abnormal development of the baby in the womb. These medications can be used to treat a variety of diseases. Exposure to these agents may cause irritation to the skin, eyes or mucous membrane.
How should I handle the oral medications that are labelled “Cytotoxic” or “Caution”?
- Do not handle these medications with your bare hands. Always wear a pair of disposable gloves when having direct contact with the tablets/capsules/syrups.
- You may also use disposable medicine cups to handle the tablets or capsules to avoid direct contact with the medication.
- Wash your hands thoroughly before and after handling these medications.
- Avoid handling these medications if you are pregnant or breastfeeding.
How should oral “Cytotoxic” or “Caution” medication be administered?
- The tablets/capsules should be swallowed whole with water. The medication should not be crushed or chewed unless advised by your doctor or pharmacist.
- If you are unable to swallow the required tablet/capsule OR if less than a whole tablet/capsule is prescribed, please refer to the table below for guides on administration.
- Tablets with special coating may not be suitable for cutting or dissolving. Please check with your doctor or pharmacist on how to handle them.
- Oral “Cytotoxic” or “Caution” medications should be handled in a manner that avoids skin contact and the release of powdered medicine into the air. Direct contact with or breathing in these particles can cause harmful effects.
- For tablets, sometimes it may be necessary to cut the tablet into half or quarters to obtain the correct dose, especially if prescribed for children.
- In such cases, use a tablet-cutter. Tablet-crushers are not preferred.
- Always wear gloves and cut the tablets in a still-air room (i.e. not directly under a fan).
- Use separate tablet cutters for “Caution” and “Cytotoxic” medications to avoid an unwanted or harmful mixing with normal medications.
- For capsules, it may be necessary to open the capsules in a still-air room and dissolve the contents in water before consuming. Always wear gloves and a mask. (Please refer to the table below for more information)
Table 1: Administration Guide for Patients who cannot Swallow or Partial Doses | ||
For Tablets | For Capsules | |
Dose CAN be rounded to the nearest quarter tablet | Dose CANNOT be rounded to the nearest quarter tablet | |
1. You will need:
2. Put on your gloves and mask. 3. Using a tablet-cutter, cut the tablet according to the required dose. Store any remaining tablet in a suitable container for the subsequent dose. Only cut one tablet at a time. 4. Put 5 to 10 ml of water into the measuring cup. 5. Place the required fraction of a tablet into the measuring cup and allow it to soften and disperse. This may take a few minutes. 6. Administer the entire solution to the patient. | 1. You will need:
2. Put on your gloves. 3. Put 5 to 10 ml water into the measuring cup. 4. Place the required tablet(s) into the measuring cup and allow it to soften and disperse. This may take a few minutes.
| 1. You will need:
2. Put on your gloves and mask. 3. Put 5 to 10 ml water into the measuring cup. 4. Gently twist and pull the capsule open, emptying the contents of required capsule(s) into the water.
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5. Syringe out required volume to administer to the patient. 6. Throw away any remaining solution in a suitable container to be brought back to the hospital for proper disposal. | ||
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What should I do in case of accidental exposure?
| Route of exposure | What to do ? |
| Direct contact with your skin, eye or mucous membrane | Wash the area of contact thoroughly, with plenty of water. Seek medical attention if there is any irritation (e.g. redness) over the area. |
| Breathing in aerosols and powders | Seek medical attention. |
Accidental spillage
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| Contamination of surfaces with patient’s vomit, faeces and urine |
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How should the oral “Cytotoxic” or “Caution” medication be stored and disposed of?
- Store the medication in its dispensed container, in a cool, dry place.
- Keep out of reach from children.
- Any excess tablets/capsules/syrups should be returned to the hospital for disposal. Pack the medication into a bag and bring it back to the pharmacy where you received the medication from.
- Double-bag the empty pill containers/oral syringes/syrup bottles before disposal with household waste.
Disclaimers
This leaflet provides information on safe handling of oral cytotoxic or “caution” medications. It does not contain all the available information. It also does not take the place of talking to your doctor or pharmacist.
This article is jointly developed by members of the National Medication Information workgroup. The workgroup consists of cluster partners (National Healthcare Group, National University Health System and SingHealth), community pharmacies (Guardian, Unity and Watsons) and Pharmaceutical Society of Singapore. The content does not reflect drug availability and supply information in pharmacies and healthcare institutions. You are advised to check with the respective institutions for such information.
Last updated in April 2024
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