Special handling requirements for oral cytotoxics and immunosuppressant medicines

Cytotoxic medicines are used to kill or damage abnormal cells. There are many different kinds with many different uses. This information from Great Ormond Street Hospital (GOSH) describes how oral cytotoxic and immunosuppressant medicines should be given. It also 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.
  • Most 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.
  • If you are cutting tablets, you should not touch them directly with your hands. You should wear a pair of household rubber gloves or use tweezers. Do not use these for any other purpose. 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 these medicines if at all possible.
  • Always wash your hands after handling any oral cytotoxic or 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, a liquid preparation is usually available. If a liquid preparation is not available, instructions on how to give the tablets or capsules will be given in the leaflet for the individual medicine.

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 10 minutes. If after this your eyes are sore you should go to your nearest accident and emergency (A&E) department.
  • If you spill any these medicines on the worksurface or floor, 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 of the 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.
Compiled by: 
the Pharmacy Department in collaboration with the Child and Family Information Group
Last review date: 
October 2016


Please read this information sheet from GOSH alongside the patient information leaflet (PIL) provided by the manufacturer. If you do not have a copy of the manufacturer’s patient information leaflet please talk to your pharmacist. A few products do not have a marketing authorisation (licence) as a medicine and therefore there is no PIL.

For children in particular, there may be conflicts of information between the manufacturer’s patient information leaflet (PIL) and guidance provided by GOSH and other healthcare providers. For example, some manufacturers may recommend, in the patient information leaflet, that a medicine is not given to children aged under 12 years. In most cases, this is because the manufacturer will recruit adults to clinical trials in the first instance and therefore the initial marketing authorisation (licence) only covers adults and older children.  

For new medicines, the manufacturer then has to recruit children and newborns into trials (unless the medicine is not going to be used in children and newborns) and subsequently amend the PIL with the approved information. Older medicines may have been used effectively for many years in children without problems but the manufacturer has not been required to collect data and amend the licence. This does not mean that it is unsafe for children and young people to be prescribed such a medicine ‘off-licence/off-label’. However, if you are concerned about any conflicts of information, please discuss with your doctor, nurse or pharmacist.