Cytotoxics

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The risk of occupational exposure to these mutagenic and potentially carcinogenic drugs has restricted the preparation of all cytotoxic doses to specialist facilities in the hospital pharmacy.


Cytotoxics

 

The risk of occupational exposure to these mutagenic and potentially carcinogenic drugs has restricted the preparation of all cytotoxic doses to specialist facilities in the hospital pharmacy. The narrow therapeutic index, extreme toxicity and complexity of cytotoxic treatment regimens provide strong clinical justification for dose calculation and preparation by experienced staff using well-controlled systems. A close working rela-tionship between clinical pharmacy and technical services staff is desirable for all aseptic work, but is essential in the case of cytotoxics.

 

Even with the use of oral agents, pressures on pharmacy cytotoxic services include increased demand, as more cancer patients receive chemotherapy and also an increasing trend towards outpatient-based administration of chemotherapy. This places immediate demands on the service to avoid lengthy patient waiting times and the risk of errors caused by untrained staff administering chemotherapy outside normal working hours. Strategies designed to offset these pressures include dose banding, which enables doses to be prepared as standard prefilled syringes, which are used in combination to provide the ‘banded’ dose. This approach is, of course, dependent upon the stability of the reconstituted infusions. A recent survey reported that dose banding of chemotherapy is now widely accepted by UK oncologists and haematologists.

 

The introduction of monoclonal antibodies or targeted therapies such as trastuzumab into chemotherapy regimens has also created additional workload. These are not conventional cytotoxic drugs and the occupational exposure risks are the subject of much debate. However, given that tar-geted therapies are used to treat high-risk patients who are immuno-compromised, many pharmacists feel these infusions should be treated in the same way as conventional cytotoxic infusions.

 

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