[Pharmwaste] Chemo drugs

Ed Gottlieb EGottlieb at cityofithaca.org
Mon Apr 9 14:42:30 EDT 2018


New info from Jim Mullowney below.  Contact him for more information:  jmullowney at pharma-cycle.com<mailto:jmullowney at pharma-cycle.com>



Unofficial draft of the updated USP [set standards, publish International Pharmacopoeia] "General Chapter <800> on Hazardous Drugs, handling in healthcare settings" states that materials with trace amounts of Hazardous Drugs must be discarded as a Hazardous Waste.  This includes items contaminated in the medical care facility and patient-care environment, which can include the home.



Problem Chemotherapy Drugs That Are Excreted at High Concentrations & Can Damage Others at Ultra-low Doses1

Generic Name        Other Names                            Excretion                   Administered Dose

                                                                        %     Danger Period    Dose/Weight      Amount

Actinomycin D     Dactinomycin, Cosmenogen     30%         7 Days         ≤ 50 ug/Kg          ≤ 4 mg
Bleomycin         Blenoxane                             60-70%     1 Day          ≤ 50 units (mg)/Kg  ≤ 4000 mg
Carboplatin         Paraplatin                             65-75%     1 Day         ≤ 12 mg/Kg         ≤ 960 mg
Cisplatin             Platin                                    13-17%     1 Day         ≤ 3.3 mg/Kg         ≤ 264 mg
Cyclophosphamide     Endoxan, Cytoxan, Neosar, Procytox, Revimmune

                                                                    5-25%         1 Day         ≤ 50 mg/Kg     ≤ 4000 mg
Dacarbazine     DTIC, DTIC-Dome                     40%         1 Day          ≤ 4.5 mg/Kg     ≤ 360 mg
Daunorubicin HCl     Cerubidine                         65%         3 Days         ≤ 1.5 mg/Kg     ≤120 mg
Doxorubicin     Adriamycin, Rubex, Doxil, Caelyx, Myocet

                                                                    45-55%     5 Days         ≤ 2.5 mg/Kg     ≤ 200 mg
Epirubicin         Ellence, Pharmorubicin                 55%     4 Days         ≤ 40 mg/Kg     ≤ 3200 mg
Etoposide     Eposin, Etopophos, Vepesid, VP-16     45%     5 Days         ≤ 3.3 mg/Kg     ≤ 264 mg
Floxuridine     Fdur                                             20%     1 Day             ≤ 0.6 mg/Kg     ≤ 48 mg
Fludarabine     Fludara                                     40-60%     1 Day         ≤ 0.83 mg/Kg     ≤ 66.4 mg
Fluorouracil     5-FU, Adrucil, Carac, Efudix, Efudex, Fluoroplex

                                                                     7-20%     1 Day         ≤ 12 mg/Kg         ≤ 960 mg
Idarubicin     Zavedos, Idamycin                         20%         8 Days         ≤ 0.4 mg/Kg     ≤ 32 mg
Ifosfamide     Mitoxana, Ifex                             12-18%     1 Day         ≤ 40 mg/Kg     ≤ 3200 mg
Irinotecan     Camptosar, Campto                     25-50%     2 Days         ≤ 11.7 mg/Kg     ≤ 936 mg
Mitomycin     Mitosol                                         10%         1 Day         ≤ 0.67 mg/Kg     ≤ 53.6 mg
Mitoxantrone                                                     24%         5 Days     ≤ 0.47 mg/Kg     ≤ 37.6 mg
Oxaliplatin     Eloxatin                                         35%         1 Day     ≤ 2.8 mg/Kg         ≤ 224 mg
Methotrexate     Trexall, MTX, Amethopterin         80-90%     1 Day     ≤ 15 mg/Kg         ≤ 1200 mg
Temozolomide     Temodar                                 18%         7 Days     ≤ 50 mg/Kg     ≤ 4000 mg
Topotecan     Hycamtin                                     70 -75%     9 Days     ≤ 0.05 mg/Kg     ≤ 4 mg
Restricted use
Arsenic trioxide     Trisenox                                 15%         1 Day     ≤ 15 mg/Kg         ≤ 1200 mg
Clofarabine                                                     49-60%         1 Day     ≤ 1.7 mg/Kg         ≤ 138 mg
Melphalan     Alkeran                                     10-15%             1 Day     6 mg                 6 mg
Teniposide     Vumon                                         4-12%         5 Days     ≤ 8.3 mg/Kg     ≤ 666 mg
Valrubicin     Valstar                                             99%         1 Day         800 mg             800 mg
1. Information summarized from the Drug Package Inserts - information required by the FDA from pharmaceutical companies before each drug is approved for use in humans.

2. Estimated percent of drug dose that exits patient's body as parental drug or active metabolite as well as excretion period.

3. Doses will vary depending on disease and doctors' recommendations. See individual Drug Inserts for more details.
4. Where needed, converted from mg/m2 to mg/Kg



Ed Gottlieb
Industrial Pretreatment Coordinator
Ithaca Area Wastewater Treatment Facility
525 3rd Street
Ithaca, NY  14850
(607) 273-8381<tel:(607)%20273-8381>
fax: (607) 273-8433<tel:(607)%20273-8433>

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