Safe Handling of Oral Cytotoxic and Caution Medications

Uses

Precaution

Handling

Uses

What is Safe Handling of Oral Cytotoxic and Caution Medications for?

Medications under the “Cytotoxic” category interfere with division of body cells. Prolonged exposure or exposure to large amount of cytotoxic drugs can lead to serious 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 in embryo/fetus

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. Hence, special precaution should be taken while handling cytotoxic/caution medications.

How should I take or use Safe Handling of Oral Cytotoxic and Caution Medications?

The tablets/capsules should be swallowed with some water and not chewed.

The dose prescribed may not always be one tablet or one capsule:

For tablets, sometimes it may be necessary to halve or quarter the tablet in order to obtain the correct dose for the child. In such cases, use a tablet-cutter. Always wear gloves and cut the tablets in a still-air room. Use separate tablet cutters for cytotoxic and non-cytotoxic medications. (Please refer to the information below for more specific instructions)

For capsules, it may be necessary to open the capsules in a still-air room and dissolve the contents in water before administration. Always wear gloves and mask. (Please refer to the information below for more specific instructions)

Do not crush the tablet or the capsule, as this may cause small particles to be released into the air. Breathing in or coming into contact with these particles can cause harmful effects to the body cells.
If the child is unable to swallow the required tablet/capsule OR specific doses are required, please refer to the table below for guides on administration.

For tablets:

You will need:

An oral syringe
A plastic measuring cup
A pair of disposable gloves
Mask
Tablet cutter if necessary

Put on your gloves
Put 10 ml of water into the measuring cup
Place required tablet(s) into the measuring cup and allow it to soften and disperse. This may take a few minutes.
Syringe out the required volume to give your child

For capsules:

If you need to open a capsule, you need to take extra care not to inhale the powder.

You will need:

An oral syringe
A plastic measuring cup
A pair of disposable gloves
Mask

Put on your gloves and mask
Put 10 ml water into the measuring cup
Gently twist and pull the capsule open, emptying the contents of required capsule(s) into the water
Syringe out required volume to give your child
Wrap the empty plastic capsule case in paper and throw it away with the mask and gloves.

It is best to dispose the plastic medicine cup and syringe after each use. However, if you wish to re-use these items, always wash them separately from other household dishes. You may reuse the syringe and plastic cup to handle the same oral cytotoxic/caution medication, but do not use them for any other purposes.

Precaution

What precautions should I take when taking or using Safe Handling of Oral Cytotoxic and Caution Medications?

Do not handle these medications with your bare hands. Always wear a pair of disposable gloves when handling the tablets/capsules/syrups.

Wash your hands thoroughly before and after handling these medications.

Avoid handling these medications if you are pregnant or think you may be pregnant or are breastfeeding

Handling

How should I store Safe Handling of Oral Cytotoxic and Caution Medications?

Keep away from children
Keep in a cool, dry place, away from direct sunlight
Store the medication in the orignal container it came in.

How do I throw away Safe Handling of Oral Cytotoxic and Caution Medications safely?

Any excess tablets/capsules/syrups should be returned to the hospital for disposal.

Double-bag the empty pill containers / oral syringes / syrup bottles before disposal with household waste.

How should I handle Safe Handling of Oral Cytotoxic and Caution Medications safely?

In case of accidental exposure, this is what you should do:

Route of exposure	What to do
Direct contact via skin, eye or mucous membrane.	Wash the area of contact thoroughly, with plenty of water. Seek medical attention if there is any irritation over the area.
Inhalation of aerosols and powders.	Seek medical attention immediately.
Accidental spillage.	Wear a pair of gloves and cover the area with paper towels. Wipe the area with water then clean with household cleaner and water. Remove all contaminated clothing immediately and blot dry with paper towels. Wash separately from other laundry. Double-bag all used paper towels before disposing it with the household waste. Wash your hands thoroughly after cleaning up the spillage.
Contamination of surfaces with child’s vomitus, faeces and urine.	Wear a pair of gloves and cover the area with paper towels. Wipe the area with water then clean with household cleaner and water. Remove all contaminated clothing immediately and blot dry with paper towels. Wash separately from other laundry. Double-bag all used paper towels before disposing it with the household waste. Empty the contents of urinal commodes and vomit bowls in the toilet bowl and flush twice. Used diapers should be double-bagged before disposal as well. Wash your hands thoroughly after cleaning up the contaminated surfaces.

Disclaimers

Please take note that the above is not a complete list of all possible side effects. If you have any concerns about your medication or if you have other side effects that you think are caused by this medication, please consult your doctor or pharmacist.

If you take more than the recommended dose, please seek medical advice immediately. The information provided on this page does not replace information from your healthcare professional. Please consult your healthcare professional for more information.

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 the 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.