Special handling requirements for oral cytotoxics and cytotoxic immunosuppressant medicines

Cytotoxic medicines are used to kill or damage abnormal cells and there are many different kinds with many different uses. This describes how oral cytotoxic and cytotoxic immunosuppressant medicines should be given and provides advice on how to handle these medicines safely.

This section does not give specific information relating to individual medicines or describe their uses. For this information you must read the individual leaflets produced for the medicine that your child is taking. If you are concerned about anything in this section, please ring one of the contact numbers below. Ask your doctor, nurse or pharmacist if you have more general queries or concerns.

• Keep all medicines in a safe place where children cannot reach them.

• It is important to give medicines as directed by the doctor, nurse or pharmacist and at the right time.

• If your child vomits (is sick) after taking the medicine, tell their doctor or nurse, as another dose may be required, but do NOT give another dose without advice.

• If you forget to give your child their medicine, do not give them a double dose. Do tell their doctor or nurse, but keep to their regular dose schedule.

• If the doctor decides to stop treatment, return any remaining medicine to your pharmacist. Do not flush them down the toilet or throw them away.

How are oral cytotoxics and cytotoxic immunosuppressant medicines given?

• Ideally the tablets or capsules should be swallowed, and then washed down with some liquid.
• Cyclophosphamide tablets must be taken with plenty of liquid, at least a large glassful.
• Sometimes, it may be necessary to halve tablets to obtain the correct dose for your child. A tablet cutter must be used. These are available from the pharmacy department or your community pharmacy. Keep the tablet cutter for cytotoxic medicines only.
• It is very important that if you are cutting or crushing tablets, you do not touch them directly with your hands. You must wear gloves and/or use tweezers. Ideally, you should work in the kitchen with just your child present. If you are pregnant or think you may be pregnant or are breast feeding it is better to avoid handling oral chemotherapy if at all possible.
• Always wash your hands after handling any oral cytotoxic or cytotoxic immunosuppressant medicines.
• Waste products, that is, used paper towels, vomit and dirty disposable nappies, should be placed in a double lined plastic rubbish bin. The double bag should be disposed of as for normal household waste.
• If your child cannot swallow tablets or capsules and a liquid preparation is not available, you can make the tablet or capsule into a mixture.

Making a tablet dose into a mixture

• You will need:

  • an oral syringe

  • a plastic measuring cup or glass
• If you prefer, you can wear a pair of household rubber gloves to protect yourself. Do not use for any other purpose.
• Place the required number of tablets or part of a tablet into the measuring cup.

• Pour a little water on the tablets and allow to disperse. This may take a few minutes. Do not try to make the tablet disperse faster by stirring or shaking the container.

 Alternative method

• Place the required number of tablets or part of tablet into a tablet crusher.

• Gently add some water making sure the powder is washed off the crusher.

• Draw up the dose into an oral syringe and give the dose to your child.

• Wash the gloves, oral syringe and measuring cup in warm, soapy water. These can be used again for further doses but do not use them for any other purpose.

Making a capsule dose into a mixture

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

• You will need:
  • a pair of rubber gloves and mask
  • a glass or plastic measuring cup
• An oral syringe.

• Put on your gloves and mask.

• Put a little water into a glass.

• Empty the contents of the capsule onto the water.

• Draw up the dose into an oral syringe and give the dose to your child.

• Wash the gloves, oral syringe and measuring cup in warm, soapy water. These can be used again for further doses but do not use them for any other purpose.

• Wrap the empty plastic capsule case in paper and throw it away with the mask as described above. A new mask should be used for each dose.

Accidental spillages

• If contact occurs with your skin, you must wash the area immediately, using plenty of water. If the skin is sore you should contact your GP (family doctor) for advice.
• If contact occurs with your eyes, wash immediately with plenty of water for at least ten minutes. If after this your eyes are sore you should go to your nearest Accident and Emergency (A&E) department.
• If you spill any cytotoxic medicines on the worksurface or floor, wearing gloves, cover the spillage with kitchen paper. Wipe the area with water then clean with household cleaner and water. Used kitchen paper and other items used to clean up the spillage should be double bagged and disposed of with the household waste.
• If any cytotoxic medicine is spilt on clothing, the spill should be blotted dry with kitchen paper. Clothing should be removed immediately and washed separately from other items. Used kitchen paper should be disposed of as above.

Last reviewed by Great Ormond Street Hospital: May 2010

Ref: 2010F0756 © GOSH Trust May 2010
Compiled by the Pharmacy Department in collaboration with the Child and Family Information Group

Please read this information in conjunction with any patient information leaflet provided by the manufacturer. However, please note that this information explains about the use of medicines in children and young people so may differ from the manufacturer’s information.

Each person reacts differently to medicines so your child will not necessarily suffer every side effect mentioned. This information does not constitute health or medical advice and will not necessarily reflect treatment at other hospitals. If you have any questions, please ask your doctor. No liability can be taken as a result of using this information.