Handling of Hazardous Medicines by Healthcare Workers
- October 9, 2025
Medicines are considered hazardous if they can cause cancer, genetic mutations, reproductive harm, or serious organ toxicity at low doses. Risk from occupational exposure is dependent on several factors unique to each work setting such as:
- medicine formulation (route, frequency, duration, and magnitude of exposure).
- work practice (administration versus compounding or dispensing).
- presence or absence of personal protective equipment (PPE).
- personal risk factors such as pregnancy.
While systemic exposure from handling hazardous medicines is theoretically possible, specific quantitative data are very limited, and it is therefore recommended that PPE is used unless specific local institutional guidelines exist for individual medicines. This bulletin classifies the hazardous medicines available in Aotearoa, and provides information on safety measures to protect healthcare workers by minimising occupational exposure. International guidelines and classifications of hazardous medicines can vary quite widely; the tables below have been curated for Aotearoa healthcare settings based on the Australian eviQ guidelines and the USA’s National Institute for Occupation Safety and Health (NIOSH). They are intended as a guide, rather than a complete representation of all hazardous medicines. All healthcare workers should use PPE for medicines in Table 1, and those who are pregnant or trying to conceive should use PPE for medicines in Tables 1 and 2.
Table 1: Cytotoxic Medicines
| amsacrine | chlorambucil | epirubicin | ixazomib | procarbazine |
| arsenic trioxide | cidofovir | eribulin | lomustine | ralitrexed |
| azacitidine | cisplatin | etoposide | melphalan | temozolomide |
| azathioprine | cladribine | fludarabine | mercaptopurine | thiotepa |
| bendamustine | clofarabine | fluorouracil | methotrexate | tioguanine |
| bleomycin | cyclophosphamide | ganciclovir | mitomycin | topotecan |
| bortezomib | cytarabine | gemcitabine | mitotane | trastuzumab |
| brentuximab | dacarbazine | gemtuzumab | mitoxantrone | trifluridine + tipiracil |
| busulfan | dactinomycin | hydroxycarbamide | oxaliplatin | valganciclovir |
| cabazitaxel | daunorubicin | idarubicin | paclitaxel | vinblastine |
| capecitabine | dexrazoxane | ifosfamide | pegaspargase | vincristine |
| carboplatin | docetaxel | inotuzumab | pemetrexed | vindesine |
| carmustine | doxorubicin | irinotecan | pentostatin |
Table 2: Reproductive Hazardous Medicines (potential hazard to those who are pregnant or trying to conceive)
| abemaciclib | cyproterone | ivabradine | osimertinib | testosterone |
| abiraterone | dabrafenib | leflunomide | oxcarbazepine | thalidomide |
| acitretin | dasatinib | lenalidomide | palbociclib | trametinib |
| afatinib | deferiprone | lenvatinib | pazopanib | topiramate |
| alectinib | dutasteride | letrozole | pembrolizumab | tretinoin |
| alitretinoin | encorafenib | leuprorelin | phenytoin | ulipristal |
| ambrisentan | enzalutamide | macitentan | plerifaxor | vemurafenib |
| atezolizumab | finasteride | medroxyprogesterone | pomalidomide | vigabatrin |
| axitinib | fingolimod | megestrol | ponatinib | vismodegib |
| bicalutamide | finasteride | midostaurin | propylthiouracil | warfarin |
| binimetinib | fluconazole | mifepristone | raloxifene | zonisamide |
| bosentan | flutamide | misoprostol | regorafenib | |
| carbamazepine | fulvestrant | mycophenolate | ribavirin | |
| carfilzomib | ganirelix | neratinib | ripretinib | |
| cetrorelix | goserelin | nilotinib | sodium valproate | |
| cobimetinib | ibrutinib | niraparib | sorafenib | |
| colchicine | imatinib | nivolumab | sunitinib | |
| crizotinib | isotretinoin | olaparib | teriflunomide |
Table 3: Recommended Safety Measures
The varying recommendations reflect the range of exposure potential for different activities and formulations, and are based on best practice advice from NIOSH. Intact tablets and capsules are unlikely to pose the same risk as manipulated oral dosage forms, liquids, or mixed injectables. Where possible, use formulations compounded by a pharmacy with specialised facilities, and closed systems for manipulations, such as oral dispensers and enteral syringes.
| Recommended Safety Measures | |||||
| Activity | Formulation | Gloves | Gown | Mask | Safety glasses |
| Receiving and unpacking | All | Yes | No | No | No |
| Dispensing or compounding | Intact tablets or capsules | Yes | No | No | No |
| Crushing or manipulating tablets or capsules | Yes | Yes | Yes | Yes | |
| Oral liquid | Yes | Yes | Yes | Yes | |
| Topical | Yes | Yes | Yes | Yes | |
| Withdrawing or mixing injections from a vial | Yes | Yes | Yes | Yes | |
| Irrigation solution | Yes | Yes | Yes | Yes | |
| Aerosol powder or solution | Yes | Yes | Yes | Yes | |
| Administration | Intact tablets or capsules | Yes | No | Yes if vomit potential | Yes if vomit potential |
| Cut, crushed or uncoated tablets or capsules | Yes | Yes | Yes if vomit potential | Yes if vomit potential | |
| Prefilled syringes or infusions | Yes | Yes | Yes if splash potential | Yes if splash potential | |
| Oral liquid | Yes | Yes | Yes if vomit, splash or inhalation potential | Yes if vomit, splash or inhalation potential | |
| Topical | Yes | Yes | Yes if splash or inhalation potential | Yes if splash or inhalation potential | |
| Irrigation solution | Yes | Yes | Yes | Yes | |
| Aerosol powder or solution | Yes | Yes | Yes if splash or inhalation potential | Yes if splash or inhalation potential | |
| Disposal | Body fluids | Yes | Yes | Yes if splash or inhalation potential | Yes if splash or inhalation potential |
| Other contaminated waste | Yes | Yes | Yes if splash or inhalation potential | Yes if splash or inhalation potential | |
| Routine Cleaning | All | Yes | Yes | No | No |
| Spill Cleaning | All | Yes | Yes | Yes | Yes |
References
- eviQ Cancer Institute New South Wales, Australia. eviQ Hazardous drugs table (909 v.9) [Internet]. [cited 2025 Oct 9]. Available
from: https://www.eviq.org.au/clinical-resources/administration-of-anti-cancer-drugs/909-hazardous-drugs-table#hazardousdrugs-tables - U.S. Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health. NIOSH [2024] List of
Hazardous Drugs in Healthcare Settings [Internet]. [cited 2025 Oct 9]. Available from: https://www.cdc.gov/niosh/docs/2025-103/pdfs/2025-103.pdf?id=10.26616/NIOSHPUB2025103 - U.S. Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health. NIOSH [2023]. Managing
Exposures to Hazardous Drugs: Information for Healthcare Settings. [cited 2025 Oct 9]; Available from:
https://www.cdc.gov/niosh/docs/2023-130/default.html - eviQ Safe handling and waste management of hazardous drugs 188 v.9 [Internet]. [cited 2025 Oct 9]. Available from:
https://www.eviq.org.au/clinical-resources/administration-of-anti-cancer-drugs/188-safe-handling-and-waste-management-ofhazardou - European Commission. Guidance for the safe management of hazardous medicinal products at work [Internet]. 2023 [cited 2025
Oct 9]. Available from: https://op.europa.eu/en/publication-detail/-/publication/8e504373-8a77-11ee-99ba01aa75ed71a1/language-en
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