• Stored separately in pharmacy. • Drugs are transported in plastic bags/designated transport containers labeled with sticker indicating CHEMOTHERAPY DRUG.
High Alert Drug: Oral methotrexate
• The only frequency option for oral dosing in order entry system is weekly • Verification by pharmacist of appropriate oncologic indication for any daily oral orders • Continuous monitoring of all methotrexate oral orders for appropriateness
Per policy, these hazardous drugs have special waste requirements.
Generic (Brand)
Waste Requirements
methotrexate (Trexall)
If > 3% by weight of drug remains ⇒ BLACK BUCKET Trace amounts/uncontaminated PPE ⇒ YELLOW BUCKET
Adult Extravasation Management
Generic (Brand)
Vesicant / irritant
Local Care
methotrexate (Trexall)
N/A
Warm compress
USP <800> Hazardous Drug Assessment of Risk (AOR)
Per policy, these drugs are exempt from USP <800> handling requirements under normal circumstances. The following outlines must be followed.
generic (Brand) Route [Packaging: Mfg ⇒ Dispense]
NIOSH Group
methotrexate (Otrexup, Rasuvo, Rheumatrex, Trexall, Xatmep) PO [UD ⇒ UD]
Antineoplastic
Pharmacy: Receiving / Storage / Preparation
Exposure Risk: minimal
• Handling/preparation PPE Requirements: n/a
• Receiving from Distributor: Designated area/ CX gloves
• Pharmacy Storage Area: Hazardous
• Packaging/Reconstitution Location: n/a
• Compounding (Non-Sterile/Sterile) Location: n/a
• Omnicell Load: No
Transport
• Transport (dose is placed inside a plastic sealable bag): Standard
Nursing: Storage / Admin.
Exposure Risk: low
• Handling/administration PPE Requirements: Single CX gloves , wash hands after handling
• Storage of Finished dose in Nursing Area/Procedural Area: Patient Med Drawer
• Signage on Patient Door Required: Yes
• Manipulation of Dosage Form: Done in Pharmacy
• Special Manipulation for Administration: do not crush tablet
Disposal / Spills
• Disposal of Drug Waste: Full- black bin , trace- yellow bin
• Disposol of Used PPE: yellow bin
• Spill management: n/a
Reason for exemption of USP<800> Containment Requirements: Purchased in final dosage form; packaged as unit dose. Does not require additional manipulation for dispensing.
Last updated: Jun. 12, 2024
Hazard.Drug Handling(USP 800) USP<800> Hazardous Drug / Assessment of Risk
• Drugs are transported in plastic bags/designated transport containers labeled with sticker indicating CHEMOTHERAPY DRUG.
• Verification by pharmacist of appropriate oncologic indication for any daily oral orders
• Continuous monitoring of all methotrexate oral orders for appropriateness
Trace amounts/uncontaminated PPE ⇒ YELLOW BUCKET
The following outlines must be followed.
Receiving /
Storage /
Preparation
minimal
Storage /
Admin.
low
Spills