Hazardous Medication

List
Reducing occupational exposure to hazardous medications
for ALL STAFF

created by: the Provincial Hazardous

Medication Committee (PHMC)
i
Date: 18 June 2024
 Copyright ©2024 Alberta Health Services (Pharmacy Services, Health Professions Strategy and
Practice and Workplace Health and Safety) and Covenant Health (Pharmacy Services)

This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International
License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/. The license
does not apply to AHS or Covenant Health logos and trademarks or third-party works licensed by AHS or
Covenant Health.

Disclaimer
This material is intended for general information only and is provided on an “as is,” “where is” basis. Although
reasonable efforts were made to confirm the accuracy of the information, neither Alberta Health Services nor
Covenant Health make any representation or warranty, express, implied, or statutory, as to the accuracy,
reliability, completeness, applicability, or fitness for a particular purpose of such information. This material is not
a substitute for the advice of a qualified health professional. Each of Alberta Health Services and Covenant
Health expressly disclaims all liability for the use of these materials, and for any claims, actions, demands or
suits arising from such use.

created by: the Provincial Hazardous

Medication Committee (PHMC)
ii
Date: 18 June 2024
 Contents
Alberta Health Services / Covenant Health Hazardous Medication Classification ......................... iv
KNOWN Hazard Medication ................................................................................................................ iv
POTENTIAL Hazard Medication ............................................................................................................ iv
REPRODUCTIVE Hazard Medication..................................................................................................... iv
Hazardous Medication List – Key Points ................................................................................................ v
COMPLETE List: ....................................................................................................................................... 6
KNOWN Hazardous Medication List ................................................................................................... 9
POTENTIAL Hazardous Medication List: ......................................................................................... 11
REPRODUCTIVE Hazardous Medication List: ................................................................................ 12
Special Handling Considerations for Specified Hazardous Medications ......................................... 13
 Bacillus Calmette-Guérin vaccine (BCG)....................................................................................... 13
Monoclonal Antibodies (mAbs) .......................................................................................................... 13
 Pentamidine ................................................................................................................................. 13
 Gene therapy ................................................................................................................................. 13
Extended Precautionary Period for Hazard Medications ................................................................... 14
A. KNOWN Hazard Medications Requiring PPE for Longer than 48 Hours ............................................. 14
B. POTENTIAL and REPRODUCTIVE Hazardous medications. ................................................................. 14
Appendix A: Reproductive Population Subset ..................................................................................... 15
Appendix B: AHS Classification of Hazardous Medications .............................................................. 16
Appendix C: NIOSH Classification of Hazardous Medications ......................................................... 17

created by: the Provincial Hazardous

Medication Committee (PHMC)
iii
Date: 18 June 2024
Alberta Health Services / Covenant Health Hazardous Medication
Classification

These medications are mainly antineoplastic medications as per

National Institute for Occupational Safety and Health (NIOSH) Table
1, predominantly used in the treatment of cancer (chemotherapy) and
in some cases, used for the treatment of other conditions (e.g.,
KNOWN Hazard
0B

psoriasis, rheumatoid arthritis). KNOWN hazard medications are

Medication carcinogenic, cytotoxic and/or have manufacturer special handling
information (MSHI) to protect workers handling the medications. Not
all KNOWN hazard medications are cytotoxic or anti-neoplastic.
These medications present a serious risk to the health or welfare of
healthcare staff during occupational exposure.

POTENTIAL
1B
These medications meet one or more of NIOSH’s criteria for a
Hazard hazardous medication but are not drugs that are known to be
Medication carcinogenic or probably carcinogenic.

These are mainly non-antineoplastic medications that only meet the

NIOSH criteria as a developmental and/or reproductive hazard. They
are not drugs that are known or probable carcinogenic agents.

These medications may present an occupational exposure risk only

for certain individuals; staff of childbearing years regardless of
gender with a potential to conceive or fertilize, women who are
REPRODUCTIVE
2B

pregnant, or women who are breast feeding.

Hazard
Medication Should staff members have specific questions, they should discuss
with their supervisors in consultation with their personal physicians
and Workplace Health and Safety (WHS) to assess the risk of
occupational exposure to these medications and the option of
temporarily refraining from handling hazardous medications.

Certain Reproductive Hazard Medications may only be applicable to a

subset of the Reproductive population; see key points below.

iv
Hazardous Medication List – Key Points

Indicates the medication is a CYTOTOXIC agent. Cytotoxic refers to a substance or

process which results in cell damage or cell death.

 Indicates REPRODUCTIVE Hazard Medications applicable to a subset of the

reproductive population.
• Some REPRODUCTIVE Hazard medications have been identified to have specific
parameters and may only be applicable to a subset of the reproductive population.
• Refer to Appendix A for more detailed medication-specific information.

 Operational challenges have been identified. Please reach out to

hazardousmedication@ahs.ca for more information.

The following products are NOT listed on the Hazardous Medication List, but may require
special handling precautions:
• Salts, PEGylated and liposomal medication - only the parent compound is
listed (e.g., doxorubicin)
• Combination products containing a hazardous medication.
(e.g., spironolactone-hydrochlorothiazide)
• Investigational / Clinical Trial medication as toxicological data is often
incomplete or unavailable, except where current data indicates a
hazardous risk. Follow the study protocol for safe handling precautions.
• Chemicals and / or raw powders; follow the Safety Data Sheet (SDS) for
safe handling precautions.
• Radiopharmaceuticals: Nuclear Medicine has policies and procedures for
the handling of these products

The Hazardous Medication List will be reviewed and updated on a periodic basis as new
medication or information becomes available.

Refer to Insite for the most current version.

v
 HAZARDOUS MEDICATIONS
COMPLETE List:
K = KNOWN, P = POTENTIAL, R = REPRODUCTIVE

A bicalutamide K clofazimine R enasidenib P

abacavir P bleomycin K clomiPHENE R encorafenib K
abemaciclib R blinatumomab P clonazePAM R enfortumab vedotin K
abiraterone K bortezomib K cobimetinib R entecavir P
acalabrutinib K bosentan R colchicine R entrectinib P
acitretin R bosutinib K crizotinib K enzalutamide K
AFAtinib K brentuximab vedotin K cyclophosphamide K epcoritamab K
alefacept P cycloSPORINE epiRUBicin K
brigatinib R K
(change) 
alitretinoin R buserelin K erdafitinib P
cyproterone P
alpelisib R busulfan K ergonovine (ergometrine) /
cytarabine K R
methylergonovine
altretamine K C D eriBULin K
ambrisentan R cabazitaxel K daBRAFenib K erlotinib K
amifampridine P cabergoline R dacarbazine K eslicarbazepine R
amifostine R cabozantinib K dacomitinib R estradiol P
amsacrine K capecitabine K DACTINomycin K estramustine K
anastrozole K capmatinib R estrogen – conjugated
danazol R K
apalutamide P (change) 
carBAMazepine P darolutamide P estrogen – esterified
apomorphine P K
carbetocin  R daSATinib K (change)
arsenic trioxide K estrogen / progesterone
CARBOplatin K DAUNOrubicin K K
combinations (change)
asciminib R carboprost R decitabine K estropipate P
avacopan R carfilzomib K deferiprone P etoposide K
avapritinib R
carmustine K degarelix K everolimus K
aXitinib K
cenobamate R dexMEDEtomidine R exemestane K
azaCITIDine K
ceritinib R dexrazoxane K exenatide P
azaTHIOprine K cetrorelix acetate R diethylstilbestrol K F
B chlorambucil K dihydroergotamine R fedratinib R
bacillus calmette-
guérin (BCG)  K chloramphenicol K dinoprostone R finasteride R
baricitinib P chlormethine K divalproex sodium R fingolimod P
belantamab choriogonadotropin alpha R DOCEtaxel K floxuridine K
K
mafodotin
cidofovir K DOXOrubicin K fluCONazole R
belinostat K
CISplatin K dronedarone R fluCYTOsine R
belumosudil R
cladribine K drospirenone-estetrol K fludarabine K
belzutifan R
bendamustine K clevidipine R dutasteride R fluorouracil (5FU) K

benznidazole R cloBAZam R E fluoxymesterone P

bexarotene K clofarabine K edaravone R flutamide K

Bold BLUE type indicates a medication newly listed as of June 2024

 Reproductive Hazard Medication applicable to a subset of the reproductive population. See Appendix A
 Indicates a special circumstance. See information on page v.
, , and  See special handling precautions on page 10.
6
 HAZARDOUS MEDICATIONS
COMPLETE List (continued):
K = KNOWN, P = POTENTIAL, R = REPRODUCTIVE

fosphenytoin P levonorgestrel P nafarelin R piritrexim isethionate K

fostamatinib R liraglutide recombinant P nelarabine K plerixafor R
fulvestrant K lomitapide R neratinib P polatuzumab vedotin K
G/H lomustine K nevirapine P pomalidomide K
ganciclovir lonafarnib R niLOtinib K
K PONATinib K
(change) 
loncastuximab niraparib K ponesimod P
ganirelix acetate R K
tesirine
gefitinib K lorlatinib R O porfimer K

gemcitabine K lurbinectedin K olaparib P posaconazole R

gemtuzumab omacetaxine K
K M PRALAtrexate K
ozogamicin onasemnogene
macitentan R  K pralsetinib P
gilteritinib P abeparvovec
glasdegib P maribavir R ospemifene P procarbazine K
gonadotropin, mavacamten P oxaliplatin K progesterone P
R
chorionic
mecasermin K oxandrolone R progestins P
goserelin K
medroxyPROGESTERone P OXcarbazepine P propylthiouracil P
guadecitabine K
megestrol K oxytocin  R Q/R
histrelin K
melphalan K P raloxifene P
hydroxyUREA K melphalan
K PACLitaxel K raltitrexed K
I flufenamide
menotropins R pacritinib R rasagiline P
icatibant R
mercaptopurine K palifermin P regorafenib K
IDArubicin K
palovarotene R remdesivir P
methIMAzole P
ifosfamide K
pamidronate R ribavirin R
methotrexate K
iMAtinib K
panobinostat K ribociclib R
inotuzumab methylTESTOSTERone R
K riociguat R
ozogamicin midostaurin K PARoxetine R
irinotecan K pasireotide R ripretinib R
miFEPRIStone R
isatuximab R PAZOPanib K risdiplam K
miltefosine R
ISOtretinoin R pegcetacoplan P romiDEPsin K
mipomersen P
ivabradine R mirvetuximab peginesatide R S
K
ixabepilone K soravtansine pegvaliase P sacituzumab
K
miSOPROStol R govitecan
ixazomib K PEMEtrexed K selinexor R
mitoMYcin K
J/K/L pemigatinib P selpercatinib R
mitotane K
larotrectinib R pentamidine  R selumetinib R
leflunomide P mitoXANTRONE K
pentetate calcium R semaglutide K
lenalidomide K mycophenolate mofetil P
pentostatin K siponimod R
lenvatinib R mycophenolic acid P
phenoxybenzamine P sirolimus P
letrozole K N phenyTOIN P sodium phenylbutyrate -
R
nab-sirolimus P ursodoxicoltaurine
leuprolide K pipobroman K

Bold BLUE type indicates a medication newly listed as of June 2024

 Reproductive Hazard Medication applicable to a subset of the reproductive population. See Appendix A
 Indicates a special circumstance. See information on page v.
, , and  See special handling precautions on page 13.
7
 HAZARDOUS MEDICATIONS
COMPLETE List (continued):
K = KNOWN, P = POTENTIAL, R = REPRODUCTIVE

sonidegib R teriflunomide P treosulfan K vigabatrin R

sotorasib P testosterone R tretinoin R vinBLAStine K
SORAfenib K thalidomide K trifluridine / tipiracil vinCRIStine K
K
(combination only)
spironolactone P thioguanine K vinorelbine K
triptorelin K
streptozocin K thiotepa K vismodegib K
tucatinib R
SUNItinib K tirzepatide K voretigene
U/V neparvovec  K
T tisotumab vedotin K ulipristal R voriconazole R
tacrolimus P tofacitinib P upadacitinib P vorinostat K
tagraxofusp K topiramate R uracil mustard K W/X/Y/Z
talazoparib K topotecan K urofollitropin R warfarin R
tamoxifen K toremifene R valGANciclovir
K zanubrutinib K
(change) 
temazepam R trabectedin K
valproate / valproic acid R zidovudine P
temozolomide K trametinib K
valrubicin K ziprasidone R
temsirolimus K trastuzumab R
vanDETanib K ziv- aflibercept K
teniposide K trastuzumab
K zoledronic acid R
deruxtecan vemURAFenib K
tepotinib R trastuzumab zonisamide R
K venetoclax K
emtansine

Bold BLUE type indicates a medication newly listed as of June 2024

 Reproductive Hazard Medication applicable to a subset of the reproductive population. See Appendix A
 Indicates a special circumstance. See information on page v.
, , and  See special handling precautions on page 13.
8
 KNOWN HAZARDOUS MEDICATIONS

KNOWN Hazardous Medication List

A cidofovir everolimus megestrol

abiraterone CISplatin exemestane melphalan
acalabrutinib cladribine F melphalan
flufenamide
AFAtinib clofarabine floxuridine
mercaptopurine
altretamine crizotinib fludarabine
methotrexate
amsacrine cyclophosphamide fluorouracil (5FU)
midostaurin
anastrozole cycloSPORINE (change)  flutamide mirvetuximab
arsenic trioxide cytarabine fulvestrant soravtansine
mitoMYcin
aXitinib D G/H
ganciclovir (change) mitotane
azaCITIDine daBRAFenib

mitoXANTRONE
azaTHIOprine dacarbazine gefitinib
N
B DACTINomycin gemcitabine
bacillus calmette- nelarabine
 daSATinib gemtuzumab
guérin (BCG) ozogamicin niLOtinib
belantamab DAUNOrubicin
mafodotin goserelin niraparib
decitabine
belinostat guadecitabine O
degarelix
bendamustine histrelin omacetaxine
dexrazoxane
bexarotene hydroxyUREA onasemnogene
diethylstilbestrol abeparvovec 
bicalutamide I
DOCEtaxel oxaliplatin
bleomycin IDArubicin
DOXOrubicin P
bortezomib ifosfamide
drospirenone-estetrol PACLitaxel
bosutinib iMAtinib
E inotuzumab panobinostat
brentuximab vedotin
encorafenib ozogamicin PAZOPanib
buserelin irinotecan
enfortumab vedotin PEMEtrexed
busulfan ixabepilone
enzalutamide pentostatin
C ixazomib
epcoritamab pipobroman
cabazitaxel J/K/L
epiRUBicin piritrexim isethionate
cabozantinib lenalidomide
eriBULin polatuzumab vedotin
capecitabine letrozole
erlotinib pomalidomide
CARBOplatin leuprolide
estramustine PONATinib
carfilzomib lomustine
estrogen – conjugated porfimer
carmustine (change)  loncastuximab
estrogen – esterified tesirine PRALAtrexate
chlorambucil (change) lurbinectedin procarbazine
chloramphenicol estrogen / progesterone
combinations (change) M
chlormethine etoposide mecasermin

Bold BLUE type indicates a medication newly listed as of June 2024

 Reproductive Hazard Medication applicable to a subset of the reproductive population. See Appendix A
 Indicates a special circumstance. See information on page v.
, , and  See special handling precautions on page 13.
9
 KNOWN HAZARDOUS MEDICATIONS
KNOWN Hazardous Medications (continued):

Q/R T trabectedin vanDETanib

raltitrexed tagraxofusp trametinib vemURAFenib
regorafenib talazoparib trastuzumab venetoclax
deruxtecan
risdiplam tamoxifen trastuzumab vinBLAStine
romiDEPsin emtansine
temozolomide vinCRIStine
treosulfan
S temsirolimus vinorelbine
trifluridine / tipiracil
sacituzumab (combination only)
teniposide vismodegib
govitecan
triptorelin voretigene
semaglutide thalidomide 
neparvovec
U/V
SORAfenib thioguanine vorinostat
uracil mustard
streptozocin thiotepa W/X/Y/Z
valGANciclovir (change) 
SUNItinib tirzepatide zanubrutinib
valrubicin
tisotumab vedotin ziv- aflibercept
topotecan

Bold BLUE type indicates a medication newly listed as of June 2024

 Reproductive Hazard Medication applicable to a subset of the reproductive population. See Appendix A
 Indicates a special circumstance. See information on page v.
, , and  See special handling precautions on page 13.
10
 POTENTIAL HAZARDOUS MEDICATIONS

POTENTIAL Hazardous Medication List:

A estradiol mycophenolic acid propylthiouracil

abacavir estropipate N Q/R
alefacept exenatide nab-sirolimus raloxifene
amifampridine F neratinib rasagiline
apalutamide fingolimod nevirapine remdesivir
apomorphine fluoxymesterone O S
B fosphenytoin olaparib sirolimus
baricitinib G/H ospemifene sotorasib
blinatumomab gilteritinib OXcarbazepine spironolactone
C glasdegib P T
carBAMazepine I/J/K/L palifermin tacrolimus
cyproterone leflunomide pegcetacoplan teriflunomide
D levonorgestrel pegvaliase tofacitinib
darolutamide liraglutide recombinant pemigatinib U/V
deferiprone M phenoxybenzamine upadacitinib
E mavacamten phenyTOIN W/X/Y/Z
enasidenib medroxyPROGESTERone ponesimod zidovudine
entecavir methIMAzole pralsetinib
entrectinib mipomersen progesterone
erdafitinib mycophenolate mofetil progestins

Bold BLUE type indicates a medication newly listed as of June 2024

 Reproductive Hazard Medication applicable to a subset of the reproductive population. See Appendix A
 Indicates a special circumstance. See information on page v.
, , and  See special handling precautions on page 13.
11
 REPRODUCTIVE HAZARDOUS MEDICATIONS
REPRODUCTIVE Hazardous Medication List:
(applicable to staff members of any gender with reproductive potential)

A colchicine lomitapide ripretinib

abemaciclib D lonafarnib S
acitretin dacomitinib lorlatinib selinexor
alitretinoin danazol M selpercatinib
alpelisib dexMEDEtomidine macitentan selumetinib
ambrisentan dihydroergotamine maribavir siponimod
amifostine dinoprostone menotropins sodium phenylbutyrate -
ursodoxicoltaurine
asciminib divalproex sodium methylTESTOSTERone
sonidegib
avacopan dronedarone miFEPRIStone
T
avapritinib dutasteride miltefosine
temazepam
B E miSOPROStol
tepotinib
belumosudil edaravone N
testosterone
belzutifan ergonovine (ergometrine) / nafarelin
methylergonovine topiramate
benznidazole O
eslicarbazepine toremifene
bosentan oxandrolone
F trastuzumab
brigatinib oxytocin 
fedratinib tretinoin
C P
finasteride tucatinib
cabergoline pacritinib
fluCONazole U/V
capmatinib palovarotene
fluCYTOsine ulipristal
carbetocin  pamidronate
fostamatinib urofollitropin
carboprost PARoxetine
G/H valproate / valproic acid
cenobamate pasireotide
ganirelix acetate vigabatrin
ceritinib peginesatide
gonadotropin, chorionic voriconazole
cetrorelix acetate pentamidine 
I W/X/Y/Z
choriogonadotropin alpha pentetate calcium
icatibant warfarin
clevidipine plerixafor
isatuximab ziprasidone
cloBAZam posaconazole
ISOtretinoin zoledronic acid
clofazimine Q/R
ivabradine zonisamide
clomiPHENE ribavirin
J/K/L
clonazePAM ribociclib
larotrectinib
cobimetinib riociguat
lenvatinib

Bold BLUE type indicates a medication newly listed as of June 2024

 REPRODUCTIVE Hazard Medication applicable to a subset of the reproductive population. See Appendix A
 Special handling conditions. See page 10.
12
Special Handling Considerations for Specified Hazardous Medications

 Bacillus Calmette-Guérin vaccine (BCG)

BCG, although classified as a vaccine, is used in the treatment of certain cancers. BCG
should be prepared with 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. Follow special handling
guidelines.

BCG requires specialized clean up if spilled. AHS/COV staff: see the Hazardous Medication
Insite page to access Lippincott Procedures: Hazardous medication spill response for
information on handling hazardous medication spills including BCG.

4B Monoclonal Antibodies (mAbs)

While many monoclonal antibodies are classified by American Hospital Formulary Service
(AHFS) as 10:00 antineoplastic medication, they are not typically classified as hazardous
medication by NIOSH.

Monoclonal antibodies included on the Hazardous Medication List require handling

precautions as per the PPE Guide.

5B  Pentamidine
For inhalation (administered by respiratory therapist). AHS/COV staff: follow special handling
guidelines on the Respiratory Therapy Insite Page linked under Resources on the Hazardous
Medication Insite page.
 Gene therapy
These products require specialized clean up if spilled. AHS/COV staff: see the Hazardous
Medication Insite page to access Lippincott Procedures: Hazardous medication spill response
for information on handling hazardous medication spills including gene therapies. Others,
please contact the Hazardous Medication team at hazardousmedication@albertahealthservices.ca for
details.

13
Extended Precautionary Period for Hazard Medications
A. KNOWN Hazard Medications Requiring PPE for Longer than 48 Hours i 0F

Some hazardous medications require a longer precautionary period based on the time of excretion from
the body. The following hazardous medications require the appropriate PPE from the start of the time of
administration of the KNOWN hazard medication up to the number of days listed. ii 1F

Suggested
Hazardous Medication
precautionary period
brentuximab vedotin 14 days
carmustine 7 days
cyclophosphamide 5 days
DOXOrubicin 7 days
enfortumab vedotin 7 days
eriBULin mesylate 5 days
etoposide 5 days
imatinib mesylate 7 days
inotuzumab ozogamicin 28 days
ixabepilone 5 days
lurbinectedin 5 days
midostaurin 42 days
mirvetuximab soravtansine 14 days
mitoXANTRONE 7 days
niraparib 5 days
onasemnogene abeparvovec 28 days
polatuzumab vedotin 28 days
semaglutide (new precautionary period) 14 days
talazoparib 7 days
temsirolimus 14 days
tisotumab vedotin 7 days
trabectedin 14 days
trastuzumab deruxtecan 28 days
voretigene neparvovec 14 days
vinCRIStine 7 days
vinorelbine 5 days

B. POTENTIAL and REPRODUCTIVE Hazardous medications.

POTENTIAL and REPRODUCTIVE RISK hazard medications on the AHS Hazardous Medication List do
not require a precautionary period.

This document is subject to change.

Bold BLUE type indicates a medication newly listed as of June 2024

14
 Appendix A: Reproductive Population Subset
(REPRODUCTIVE Hazardous medications with special handling parameters are indicated with an asterisk in the
hazardous medication list.)

Hazardous
Background Mechanism of Action PPE Recommendations
Medication

Oxytocin has been Oxytocin stimulates uterine Oxytocin is considered a

identified as a contraction by activating G- REPRODUCTIVE Risk
hazardous protein-coupled receptors that Medication. Per the references,
medication by trigger increases in intracellular the reproductive risk is identified
NIOSH. It is calcium levels in uterine to be in pregnant women in the 2
considered a Table 2, myofibrils. Oxytocin also or 3rd trimester.
primarily having increases local prostaglandin
adverse reproductive production, further stimulating It is recommended that the
oxytocin effects. PPE uterine contraction. Hazardous Medication PPE
requirements are only described in the Guide be worn
applicable to a subset Oxytocin has specific receptors by this select group. Other
of the reproductive in the muscle lining of the individuals in the reproductive
population. uterus and the receptor population (as described in the
concentration increases greatly guide) may also choose to wear
during pregnancy, reaching a the PPE when handling oxytocin
maximum in early labor at term. if they prefer

Carbetocin has not Carbetocin is a synthetic Carbetocin is considered a

been identified as a analogue of oxytocin. REPRODUCTIVE Risk
hazardous Medication. Per the references,
medication by NIOSH Carbetocin binds oxytocin the reproductive risk is identified
as it is not available receptors located in uterine to be in pregnant women in the 2
in the USA, however smooth muscle producing or 3rd trimester.
PHMC has rhythmic uterine contractions
determined it should characteristic to deliver, as well It is recommended that the
be handled in a as increasing both the Hazardous Medication PPE
carbetocin similar manner as frequency of existing described in the Guide be worn
oxytocin. PPE contractions and uterine tone. by this select group. Other
requirements are only Enhances uterine involution individuals in the reproductive
applicable to a subset early in postpartum. population (as described in the
of the reproductive guide) may also choose to wear
population. the PPE when handling
carbetocin if they prefer.

If you require more detailed information, please contact hazardousmedication@ahs.ca

This document is subject to change

15
Appendix B: AHS Classification of Hazardous Medications

AHS Hazardous Medication List Review

NIOSH has not published a Hazardous Drug list since 2016. Although a 2018 list was drafted it
was never published, and a 2020 list remains in draft form. The Provincial Hazardous Medication
Committee (PHMC) recognized that many new medications have come to market since the last
NIOSH list and staff needs to be able to handle these medications safely. As such, a working
group within PHMC has developed the AHS Hazardous Medication List, using NIOSH
publications as the basis for review.

The general process is described below:

1. Review the references:
a. Is there a Manufacturer Special Handling Information (MSHI) attached?
b. Do the references mention carcinogenicity?
c. Do the references mention cytotoxicity?
If YES place on AHS KNOWN Hazardous Medication List unless it is a monoclonal
antibody (mAb). If NO OR a mAb, proceed to step 2.
2. If the medication is a mAb, review for specific hazardous handling:
a. Is there specific hazardous handling (safe handling) information that indicates a
risk to handle this medication? If YES place on AHS KNOWN Hazardous
Medication List. If NO proceed to step 3.
3. Determine if the medication meets the NIOSH definition of a hazardous drug but does
NOT have a MSHI and the information includes one or more of the types of toxicity
described in the NIOSH definition including:
• developmental toxicity (including teratogenicity)
• reproductive toxicity
• genotoxicity
• organ toxicity at low doses
• structure and toxicity profile that mimics existing drugs determined
hazardous by the above criteria.
a. View Lexicomp information
i. Search for hazardous handling information (note: Lexicomp may refer to
2016 NIOSH list) related to the toxicities above; review any precautions
listed.
b. View the product monograph.
i. Does the product monograph list any of the toxicities mentioned above at
doses lower than the human therapeutic dose?
If NO, do not add to the AHS Hazardous Medication List. If YES proceed to step 4.
4. Does the medication ONLY meet NIOSH criteria as a developmental and/or reproductive
hazard?
If YES, add to the AHS REPRODUCTIVE Hazard list; If NO (i.e., has genotoxicity, organ
toxicity etc.) then add to the AHS POTENTIAL Hazard medication list.

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Appendix C: NIOSH Classification of Hazardous Medications

NIOSH List of Hazardous Drugs in Healthcare Settings, 2020

(currently in draft)

Group 1:
Drugs that meet the NIOSH definition of a hazardous drug and contain MSHI in the
package insert; and/or are classified by the NTP as “known to be a human carcinogen,”
or classified by IARC as “carcinogenic” or “probably carcinogenic.” In the 2016 List this
table identified antineoplastic drugs, however, in this update not all the drugs on Table 1
are antineoplastic drugs. Note that many of these medications may also pose a
reproductive risk for susceptible populations. (NIOSH Table 1)
Group 2:
Drugs that meet one or more of the NIOSH definitions of a hazardous drug but are not
drugs which have MSHI or are classified by the NTP as “known to be a human
carcinogen,” or classified by the IARC as “carcinogenic” or “probably carcinogenic,” some
of which also have adverse reproductive effects for populations at risk. This table now
also includes drugs that only meet the NIOSH criteria as a developmental (including
teratogenicity) and/or reproductive hazard. In the 2016 update of the List this table did not
include drugs that only posed a developmental and/or reproductive hazard. (NIOSH
Table 2)
In the 2016 List, Table 3 provided a list of drugs that met the NIOSH criteria of a reproductive
hazard (damaging to a male or female person’s ability to conceive or carry to term an offspring)
or developmental hazard (able to cause disruption in the development of unborn children
including teratogenic outcomes). In this 2020 List, those drugs that only meet NIOSH’s criteria as
a developmental and/or reproductive hazard are identified in the supplemental information
column with a blue notification; a separate Table is no longer provided.

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Developed by: AHS – Provincial Hazardous Medication Committee (PHMC); Hazardous
Medication Evaluation Panel; PHMC Hazardous Medication List Working Group; Pharmacy
Services Medication Quality and Safety Team (MQST); Health Professions, Strategy and
Practice (HPSP); Pharmacy Services Technical Practice Leads, Human Factors, Workplace
Health and Safety (WHS), and COV Medication Management & Safety Team.

Acknowledgements to: Cancer Care Alberta (CCA), Eastern Health - Newfoundland, British
Columbia Cancer Agency (BCCA), and Winnipeg Regional Health Authority (WRHA) for their
work on hazardous medications.
Please direct questions related to safe handling of hazardous medications to the WHS Services
Team in your Zone or send your questions to hazardousmedication@albertahealthservices.ca

Document History
Document Version Revision Date

Original Document (V1.0) Dec 2017

Revision #1 (V1.1) April 2018

Revision #2 (V1.2) May 2018

Revision #3 (V1.3) June 2018

Revision #4 (V2.0) June 2021

Revision #5 (v2.1) Nov 2021

Revision #6 (v2.2) June 2022

Revision #7 (v2.3) February 2023

Revision #8 (v2.4) August 2023

Revision #9 (v2.5) June 2024

Product information and monographs at Drug Product Database, Lexicomp, DrugBank, and U.S. National Library of
i

Medicine (Dailymed)

Government of South Australia, Cytotoxic Drugs and Related Waste [Internet]Department for Health and Ageing,
ii

Government of South Australia; June 2015 [cited 2021 October 22]. Available from
https://www.sahealth.sa.gov.au/wps/wcm/connect/f8aa68004b3f6cf6a340afe79043faf0/Safe+Handling+Cytotoxic
+Guidelines.pdf?MOD=AJPERES&%3bCACHEID=ROOTWORKSPACE-f8aa68004b3f6cf6a340afe79043faf0-nwLgTKw

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