San Diego State University
Environmental Health and Safety Department
Cytotoxic/Antineoplastic and Other Hazardous Drugs
National Institute of Occupational Safety & Health - List of Antineoplastic and Other Hazardous Drugs
in Healthcare Settings 2012
Table 1. Sample List of Drugs that Should be Handled as Hazardous
Drug
Source
Acitretin
Aldesleukin
Ambrisentan
7
4,5
7
Alefacept
6
Alitretinoin
3,4,5
Altretamine
Amsacrine
Anastrozole
Arsenic trioxide
Asparaginase
Azacitidine
Azathioprine
Bacillus Calmette-Guerin
(BCG)†
Bendamustine HCl
Bexarotene
Bicalutamide
Bleomycin
Bortezomib
Bosentan
1,2,3,4,5
3,5
1,5
1,2,3,4,5
1,2,3,4,5
3,5
2,3,5
1,2,4
Busulfan
Cabergoline
1,2,3,4,5
7
Capecitabine
Carbamazepine
1,2,3,4,5
7
Carboplatin
Carmustine
Cetrorelix acetate
1,2,3,4,5
1,2,3,4,5
5
Chlorambucil
Chloramphenicol
Choriogonadotropin alfa
1,2,3,4,5
1,5
5
7
2,3,4,5
1,5
1,2,3,4,5
6
6
AHFS Pharmacologic-therapeutic
classification
88:04 Vitamin A
10:00 Antineoplastic agents
24:12.92 Vasodilating agents,
miscellaneous
84:92 Skin and mucous membrane
agents, miscellaneous
84:92 Skin and mucous membrane
agents, miscellaneous
10:00 Antineoplastic agents
Not in AHFS (antineoplastic agent)
10:00 Antineoplastic agents
10:00 Antineoplastic agents
10:00 Antineoplastic agents
10:00 Antineoplastic agents
92:44 Immunosuppressant agents
80:12 Vaccines
10:00 Antineoplastic agents
10:00 Antineoplastic agents
10:00 Antineoplastic agents
10:00 Antineoplastic agents
10:00 Antineoplastic agents
24:12.92 Vasodilating agents,
miscellaneous
10:00 Antineoplastic agents
28:36.20.04 Ergot-derivative dopamine
receptor agonists
10:00 Antineoplastic agents
28:12.92 Anticonvulsants,
miscellaneous
10:00 Antineoplastic agents
10:00 Antineoplastic agents
92:40 Gonadotropin-releasing hormone
antagonists
10:00 Antineoplastic agents
8:12.08 Chloramphenicols
68:18 Gonadotropins
Drug
Source
Cidofovir
,5
Cisplatin
Cladribine
Clofarabine
Clonazepam
Colchicine
Cyclophosphamide
Cyclosporin
Cytarabine
Dacarbazine
Dactinomycin
Dasatinib
Daunorubicin HCl
Decitibine
Degarelix
Denileukin
Diethylstilbestrol
,2,3,4,5
,2,3,4,5
Dinoprostone
Docetaxel
Doxorubicin
Dronedarone HCl
Dutasteride
Entecavir
Epirubicin
Ergonovine/methylergonovi
ne
Estradiol
Estramustine phosphate
Estrogen-progestin
combinations
Estrogens, conjugated
Estrogens, esterified
8 Drug
Estrone
Estropipate
Etoposide
Everolimus
,2,3,4,5
,2,3,4,5
,2,3,4,5
,2,3,4,5
,2,3,4,5
,4,5
,2,3,4,5
,2,3,4,5
,2,3,4,5
,5
,2,3,4,5
ource
5
5
1,2,3,4,5
7
AHFS Pharmacologictherapeutic classification
:18.32 Nucleosides and
nucleotides
0:00 Antineoplastic agents
0:00 Antineoplastic agents
0:00 Antineoplastic agents
8:12.08 Benzodiazepines
2:16 Antigout agents
0:00 Antineoplastic agents
2:44 Immunosuppressive agents
0:00 Antineoplastic agents
0:00 Antineoplastic agents
0:00 Antineoplastic agents
0:00 Antineoplastic agents
0:00 Antineoplastic agents
0:00 Antineoplastic agents
0:00 Antineoplastic agents
0:00 Antineoplastic agents
ot in AHFS (nonsteroidal
synthetic estrogen)
6:00 Oxytocics
0:00 Antineoplastic agents
0:00 Antineoplastic agents
4:04.04 Antiarrythmics
2:08 5-alpha reductase inhibitors
:18.32 Nucleosides and
nucleotides
0:00 Antineoplastic agents
6:00 Oxytocics
8:16.04 Estrogens
0:00 Antineoplastic agents
8:12 Contraceptives
8:16.04 Estrogens
8:16.04 Estrogens
HFS Pharmacologic-therapeutic
classification
68:16.04 Estrogens
68:16.04 Estrogens
10:00 Antineoplastic agents
10:00 Antineoplastic agents
Drug
Source
Exemestane
Finasteride
1,5
1,3,5
Floxuridine
Fludarabine
Fluorouracil
Fluoxymesterone
Flutamide
Fulvestrant
Ganciclovir
1,2,3,4,5
1,2,3,4,5
1,2,3,4,5
5
1,2,5
5
1,2,3,4,5
Ganirelix acetate
5
Gemcitabine
Gemtuzumab ozogamicin
Gonadotropin, chorionic
Goserelin
Hydroxyurea
Idarubicin
Ifosfamide
Imatinib mesylate
Irinotecan HCl
Ixabepilone
Leflunomide
1,2,3,4,5
1,3,4,5
5
1,2,5
1,2,3,4,5
1,2,3,4,5
1,2,3,4,5
1,3,4,5
1,2,3,4,5
7
3,5
Lenalidomide
6
Letrozole
Leuprolide acetate
Lomustine
Mechlorethamine
Medroxyprogesterone
acetate
Megestrol
9 Drug
1,5
1,2,5
1,2,3,4,5
1,2,3,4,5
6
Melphalan
Menotropins
Mercaptopurine
Methotrexate
Methyltestosterone
Mifepristone
Mitomycin
Mitotane
1,2,3,4,5
5
1,2,3,4,5
1,2,3,4,5
5
5
1,2,3,4,5
1,4,5
1,5
Source
AHFS Pharmacologictherapeutic classification
10:00 Antineoplastic agents
92:08 5-alpha reductase
inhibitors
10:00 Antineoplastic agents
10:00 Antineoplastic agents
10:00 Antineoplastic agents
68:08 Androgens
10:00 Antineoplastic agents
10:00 Antineoplastic agents
8:18.32 Nucleosides and
nucleotides
2:40 Gonadotropin-releasing
hormone antagonists
10:00 Antineoplastic agents
10:00 Antineoplastic agents
68:18 Gonadotropins
10:00 Antineoplastic agents
10:00 Antineoplastic agents
10:00 Antineoplastic agents
10:00 Antineoplastic agents
10:00 Antineoplastic agents
10:00 Antineoplastic agents
10:00 Antineoplastic agents
92:36 Disease-modifying
antirheumatic agents
92:20 Biologic response
modifiers
10:00 Antineoplastic agents
10:00 Antineoplastic agents
10:00 Antineoplastic agents
10:00 Antineoplastic agents
68:32 Progestins
10:00 Antineoplastic agents
AHFS Pharmacologictherapeutic classification
10:00 Antineoplastic agents
68:18 Gonadotropins
10:00 Antineoplastic agents
10:00 Antineoplastic agents
68:08 Androgens
76:00 Oxytocics
10:00 Antineoplastic agents
10:00 Antineoplastic agents
Mitoxantrone HCl
Mycophenolate mofetil
1,2,3,4,5
1,3,5
Drug
Source
Mycophenolic acid
7
Nafarelin
Nelarabine
Nilotinib
Nilutamide
Oxaliplatin
Oxcarbazepine
5
6
7
1,5
1,3,4,5
7
Oxytocin
Paclitaxel
Palifermin
5
1,2,3,4,5
6
Paroxetine**
6, 7
Pazopanib HCl
Pegaspargase
Pemetrexed
Pentamidine isethionate
7
1,2,3,4,5
6
1,2,3,5
Pentetate calcium
trisodium††
Pentostatin
Phenoxybenzamine HCl
6
Pipobroman
3,5
Plerixafor
Podofilox
7
5
10 Drug
Source
Podophyllum resin
5
Pralatrexate
Procarbazine
Progesterone
Progestins
Raloxifene
7
1,2,3,4,5
5
5
5
1,2,3,4,5
7
10:00 Antineoplastic agents
92:44 Immunosuppressive
agents
AHFS Pharmacologictherapeutic classification
92:44 Immunosuppressive
agents
68:18 Gonadotropins
10:00 Antineoplastic agents
10:00 Antineoplastic agents
10:00 Antineoplastic agents
10:00 Antineoplastic agents
28:12.92 Anticonvulsants,
miscellaneous
76:00 Oxytocics
10:00 Antineoplastic agents
84:16 Cell stimulants and
proliferants
28:16.04.20 Selective serotonin
uptake inhibitors
10:00 Antineoplastic agents
10:00 Antineoplastic agents
10:00 Antineoplastic agents
8:30.92 Antiprotozoals,
miscellaneous
Not in AHFS
10:00 Antineoplastic agents
12:16.04.04 Non-selective
alpha-adrenergic blocking
agents
Not in AHFS (antineoplastic
agent)
20:16 Hematopoietic agents
84:92 Miscellaneous skin and
mucous membrane agents
(mitotic inhibitor)
AHFS Pharmacologictherapeutic classification
84:92 Skin and mucous
membrane agents,
miscellaneous
10:00 Antineoplastic agents
10:00 Antineoplastic agents
68:32 Progestins
68:12 Contraceptives
68:16.12 Estrogen agonists-
Rasagiline mesylate
Ribavirin
6
1,2,5
Drug
Source
Risperidone
6
Romidepsin
Sirolimus
7
6
Sorafenib
Streptozocin
Sunitinib malate
Tacrolimus
6
1,2,3,4,5
6
1,5
Tamoxifen
Televancin
Temozolomide
Temsirolimus
Teniposide
Testolactone
Testosterone
Tetracycline HCl
Thalidomide
1,2,5
7
3,4,5
7
1,2,3,4,5
5
5
7
1,3,5
Thioguanine
Thiotepa
Topotecan
Toremifene citrate
Tretinoin
1,2,3,4,5
1,2,3,4,5
1,2,3,4,5
1,5
1,2,3,5
Trifluridine
Triptorelin
Uracil mustard
1,2,5
5
3,5
11 Drug
Source
Valganciclovir
1,3,5
Valproic acid/ divalproex Na
7
Valrubicin
Vidarabine
Vigabatrin
1,2,3,5
1,2,5
7
Vinblastine sulfate
1,2,3,4,5
antagonists
28:36 Antiparkinsonian agents
8:18.32 Nucleosides and
nucleotides
AHFS Pharmacologictherapeutic classification
28:16.08.04 Atypical
antipsychotics
10:00 Antineoplastic agents
92:44 Immunosuppressive
agents
10:00 Antineoplastic agents
10:00 Antineoplastic agents
10:00 Antineoplastic agents
92:44 Immunosuppressive
agents
10:00 Antineoplastic agents
8:12.28.16 Glycopeptides
10:00 Antineoplastic agents
10:00 Antineoplastic agents
10:00 Antineoplastic agents
10:00 Antineoplastic agents
68:08 Androgens
8:12.24 Tetracyclines
92:20 Biologic response
modifiers
10:00 Antineoplastic agents
10:00 Antineoplastic agents
10:00 Antineoplastic agents
10:00 Antineoplastic agents
84:16 Cell stimulants and
proliferants
52:04.20 Antivirals
10:00 Antineoplastic agents
Not in AHFS (antineoplastic
agent)
AHFS Pharmacologictherapeutic classification
8:18.32 Nucleosides and
nucleotides
28:12.92 Anticonvulsants,
miscellaneous
10:00 Antineoplastic agents
Not in AHFS
28:12.92 Anticonvulsants,
miscellaneous
10:00 Antineoplastic agents
Vincristine sulfate
Vinorelbine tartrate
Vorinostat
Zidovudine
Ziprasidone HCl
1,2,3,4,5
1,2,3,4,5
6
1,2,5
7
Drug
Source
Zoledronic acid
7
Zonisamide
6
10:00 Antineoplastic agents
10:00 Antineoplastic agents
10:00 Antineoplastic agents
8:18:08 Antiretroviral agents
28:16.08.04 Atypical
antipsychotics
AHFS Pharmacologictherapeutic classification
92:24 Bone resorption
inhibitors
28:12.92 Anticonvulsants,
miscellaneous
*These lists of hazardous drugs were used with the permission of the institutions that provided them and were adapted for
use by NIOSH. The sample lists are intended to guide health care providers in diverse practice settings and should not
be construed as complete representations of all of the hazardous drugs used at the referenced institutions. Some drugs
defined as hazardous may not pose a significant risk of direct occupational exposure because of their dosage formulation
(for example, intact medications such as coated tablets or capsules that are administered to patients without modifying
the formulation). However, they may pose a risk if solid drug formulations are altered outside a ventilated cabinet (for
example, if tablets are crushed or dissolved, or if capsules are pierced or opened).
BCG preparation should be done using aseptic techniques. To avoid cross-contamination, parenteral drugs should not be
prepared in areas where BCG has been prepared. A separate area for the preparation of BCG suspension is
recommended. All equipment, supplies, and receptacles in contact with BCG should be handled and disposed of as
biohazardous. If preparation cannot be performed in a containment device, then respiratory protection, gloves and a
gown should be worn to avoid inhalation or contact with BCG organisms.
1. The NIH Clinical Center, Bethesda, MD (Revised 8/2002). The NIH Health Clinical Center Hazardous Drug (HD)
List is part of the NIH Clinical Center’s hazard communication program. It was developed in compliance with the
OSHA hazard communication standard [29 CFR 1910.1200] as it applies to hazardous drugs used in the workplace.
The list is continually revised and represents the diversity of medical practice at the NIH Clinical Center; however,
its content does not reflect an exhaustive review of all FDA-approved medications that may be considered
hazardous, and it is not intended for use outside the NIH.
2. The Johns Hopkins Hospital, Baltimore, MD (Revised 9/2002).
3. The Northside Hospital, Atlanta, GA (Revised 8/2002).
4. The University of Michigan Hospitals and Health Centers, Ann Arbor, MI (Revised 2/2003)
5. This sample listing of hazardous drugs was compiled by the Pharmaceutical Research and Manufacturers of
America (PhRMA) using information from the AHFS DI monographs published by ASHP in selected AHFS
Pharmacologic-Therapeutic Classification categories [ASHP/AHFS DI 2003] and applying the definition for
hazardous drugs. The list also includes drugs from other sources that satisfy the definition for hazardous drugs
[PDR 2004; Sweetman 2002; Shepard 2001; Schardein 2000; REPROTOX 2003]. Newly approved drugs that have
structures or toxicological profiles that mimic the drugs on this list should also be included. This list was revised in
June 2004.
6. NIOSH addition 2010 updated using ASHP/AHFS DI 2010.
7. NIOSH addition 2012 updated using ASHP/AHFS DI 2011.
**2010, Paroxetine HCl; 2012, Paroxetine mesylate
††Refers to non-radio-labeled formulation only.
†