<div dir="ltr">Good the day:<div><br></div><div>Jim is addressing an issue - management of the excretions from patients which is a risk to staff and family members. The 1985 OSHA guidance does not address waste disposal of these items as much as protecting oneself from exposure as well as being aware that metabolites may be present. Musgrave et al published data in 1992 regarding the presence of metabolites in excretions - nothing new here but how should this waste be managed is the issue...</div><div><br></div><div><800> does not specifically address this issue to Jim's point and his letter to USP - there is no definition for HD waste or trace in the glossary - it refers you to state and federal regulations. </div><div><br></div><div>In the attached commentary/replies to questions in 2016, USP is asked to define trace and declines as they state it is beyond the purview if the committee ( search for the term "trace")..it comes up several times.</div><div><br></div><div>Regards,</div><div><br></div><div>Ed Krisiunas</div><div class="gmail_extra"><br><div class="gmail_quote">On Thu, Apr 19, 2018 at 8:54 AM, <span dir="ltr"><<a href="mailto:pharmwaste-request@lists.dep.state.fl.us" target="_blank">pharmwaste-request@lists.dep.<wbr>state.fl.us</a>></span> wrote:<br><blockquote class="gmail_quote" style="margin:0 0 0 .8ex;border-left:1px #ccc solid;padding-left:1ex">Send Pharmwaste mailing list submissions to<br>
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<br>Today's Topics:<br>
<br>
1. Re: Chemo drugs (Jim Mullowney)<br>
2. FREE PSI webinar: "Global Best Practices for Drug Take-Back<br>
Programs"? 6/7/2018 (Vivian Futran Fuhrman)<br>
<br><br>---------- Forwarded message ----------<br>From: Jim Mullowney <<a href="mailto:jmullowney@pharma-cycle.com" target="_blank">jmullowney@pharma-cycle.com</a>><br>To: "'Smith, Charlotte'" <<a href="mailto:csmith32@wm.com" target="_blank">csmith32@wm.com</a>>, "'Ed Gottlieb'" <<a href="mailto:EGottlieb@cityofithaca.org" target="_blank">EGottlieb@cityofithaca.org</a>>, <<a href="mailto:pharmwaste@lists.dep.state.fl.us" target="_blank">pharmwaste@lists.dep.state.<wbr>fl.us</a>><br>Cc: <br>Bcc: <br>Date: Wed, 18 Apr 2018 16:26:54 -0400<br>Subject: Re: [Pharmwaste] Chemo drugs<br><div lang="EN-US" link="blue" vlink="purple"><div class="m_1524691813403853507m_-4493243876213236349WordSection1"><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1f497d">Sorry about that again, I looked up my email and I should have said Hazardous Drug, Section 3 Table 1 of USP 800 <u></u><u></u></span></p><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1f497d"><u></u> <u></u></span></p><p class="m_1524691813403853507m_-4493243876213236349Default"><span style="font-size:7.5pt">Patient-care activities ∙ Handling body fluids (e.g., urine, feces, sweat, or vomit) or body-fluid-contaminated clothing, dressings, linens, and other materials <u></u><u></u></span></p><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1f497d"><u></u> <u></u></span></p><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1f497d"><u></u> <u></u></span></p><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1f497d"><u></u> <u></u></span></p><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1f497d">Jim Mullowney, President<u></u><u></u></span></p><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1f497d">Pharma-Cycle, LLC.<u></u><u></u></span></p><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1f497d">Associate Member American Society of Clinical Oncology<u></u><u></u></span></p><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1f497d">Member of the American Chemical Society<u></u><u></u></span></p><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1f497d"><a href="mailto:jmullowney@pharma-cycle.com" target="_blank"><span style="color:blue">jmullowney@pharma-cycle.com</span></a><u></u><u></u></span></p><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1f497d">(617) 755-0883<u></u><u></u></span></p><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1f497d"><u></u> <u></u></span></p><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1f497d"><u></u> <u></u></span></p><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1f497d"><u></u> <u></u></span></p><div><div style="border:none;border-top:solid #b5c4df 1.0pt;padding:3.0pt 0in 0in 0in"><p class="MsoNormal"><b><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif"">From:</span></b><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif""> Smith, Charlotte [mailto:<a href="mailto:csmith32@wm.com" target="_blank">csmith32@wm.com</a>] <br><b>Sent:</b> Wednesday, April 18, 2018 3:31 PM<br><b>To:</b> Jim Mullowney; 'Ed Gottlieb'; <a href="mailto:pharmwaste@lists.dep.state.fl.us" target="_blank">pharmwaste@lists.dep.state.fl.<wbr>us</a><br><b>Subject:</b> RE: RE: Chemo drugs<u></u><u></u></span></p></div></div><p class="MsoNormal"><u></u> <u></u></p><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif"">Thank you, Jim, for your clarification. It’s important that we keep the definitions clear and concise so healthcare facilities can operationalize in compliance and still be cost-effective. <u></u><u></u></span></p><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif""><u></u> <u></u></span></p><div><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif"">Best regards,<u></u><u></u></span></p><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif""><u></u> <u></u></span></p><p class="MsoNormal" style="text-autospace:none"><b><span style="font-size:11.0pt;font-family:"Trebuchet MS","sans-serif";color:#00693c">Charlotte A. Smith, RPh, MS </span></b><span style="font-size:11.0pt;font-family:"Trebuchet MS","sans-serif";color:#00693c"><u></u><u></u></span></p><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Trebuchet MS","sans-serif";color:black">Senior Regulatory Advisor</span><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:black"><u></u><u></u></span></p><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Trebuchet MS","sans-serif"">PharmEcology Services, WM Sustainability Services <u></u><u></u></span></p><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Trebuchet MS","sans-serif""><a href="mailto:csmith32@wm.com" target="_blank">csmith32@wm.com</a><span style="color:black"><u></u><u></u></span></span></p><p class="MsoNormal"><b><span style="font-family:"Trebuchet MS","sans-serif";color:black"> </span></b><span style="font-family:"Trebuchet MS","sans-serif";color:black"> </span><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:black"><u></u><u></u></span></p><p class="MsoNormal" style="text-autospace:none"><b><span style="font-size:11.0pt;font-family:"Trebuchet MS","sans-serif";color:#00693c">Waste Management </span></b><span style="font-size:11.0pt;font-family:"Trebuchet MS","sans-serif";color:#00693c"><u></u><u></u></span></p><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Trebuchet MS","sans-serif";color:black">P.O. Box 1654<u></u><u></u></span></p><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Trebuchet MS","sans-serif";color:black">Brookfield, WI 53008-1654</span><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:black"><u></u><u></u></span></p><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Trebuchet MS","sans-serif";color:black">Cell 713-725-6363 <u></u><u></u></span></p><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Trebuchet MS","sans-serif";color:black"><u></u> <u></u></span></p><p class="MsoNormal"><span style="font-family:"Trebuchet MS","sans-serif";color:black">Waste Management’s Sustainability Services </span><span style="font-family:"Trebuchet MS","sans-serif"">teams <span style="color:black">work with you to devise a strategy that will help achieve your environmental goals while benefitting your financial objectives. Find out more at </span></span><span style="font-size:11.0pt;font-family:"Calibri","sans-serif""><a href="http://www.wmsustainabilityservices.com/" target="_blank"><span style="font-size:12.0pt;color:#0563c1">www.wmsustainabilityservices.c<wbr>om</span></a><span style="color:black"><u></u><u></u></span></span></p><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Trebuchet MS","sans-serif";color:#339933"><u></u> <u></u></span></p><p class="MsoNormal"><b><span style="font-family:"Trebuchet MS","sans-serif";color:black"> </span></b><span style="font-family:"Trebuchet MS","sans-serif";color:black"> </span><span style="font-size:11.0pt;font-family:"Trebuchet MS","sans-serif";color:black"><u></u><u></u></span></p><p class="MsoNormal"><b><span style="font-size:10.0pt;font-family:"Trebuchet MS","sans-serif";color:#525252"><u></u> <u></u></span></b></p></div><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif""><u></u> <u></u></span></p><div><div style="border:none;border-top:solid #e1e1e1 1.0pt;padding:3.0pt 0in 0in 0in"><p class="MsoNormal"><b><span style="font-size:11.0pt;font-family:"Calibri","sans-serif"">From:</span></b><span style="font-size:11.0pt;font-family:"Calibri","sans-serif""> Jim Mullowney [mailto:<a href="mailto:jmullowney@pharma-cycle.com" target="_blank">jmullowney@pharma-cycl<wbr>e.com</a>] <br><b>Sent:</b> Wednesday, April 18, 2018 1:33 PM<br><b>To:</b> Smith, Charlotte <<a href="mailto:csmith32@wm.com" target="_blank">csmith32@wm.com</a>>; 'Ed Gottlieb' <<a href="mailto:EGottlieb@cityofithaca.org" target="_blank">EGottlieb@cityofithaca.org</a>>; <a href="mailto:pharmwaste@lists.dep.state.fl.us" target="_blank">pharmwaste@lists.dep.state.fl.<wbr>us</a><br><b>Subject:</b> [EXTERNAL] RE: Chemo drugs<u></u><u></u></span></p></div></div><p class="MsoNormal"><u></u> <u></u></p><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1f497d">Hello Charlotte, <u></u><u></u></span></p><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1f497d">Good to hear from you and I agree with you completely, trace chemotherapy waste is not a Hazardous waste and is treated as "Trace Chemotherapy waste", not general trash but not a hazardous waste. Not sure where the misunderstanding came from but it most likely was my fault. <u></u><u></u></span></p><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1f497d">I am attaching a letter I wrote to the USP committee last week that may have been a source of the confusion. Very few Hazardous Drugs are Hazardous Wastes and unassimilated Hazardous Drugs contained in urine, sweat, vomit and feces are NOT hazardous wastes and USP 800 has little to do with the EPA, except for the handful or so that are regulated. The dangers still exist and don't go away because the EPA does not regulate them and those working with the Hazardous Drugs and the patient waste should be aware of the dangers. OSHA and FDA still apply.<u></u><u></u></span></p><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1f497d"><u></u> <u></u></span></p><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1f497d">Hope this helps.<u></u><u></u></span></p><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1f497d"><u></u> <u></u></span></p><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1f497d">Jim Mullowney, President<u></u><u></u></span></p><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1f497d">Pharma-Cycle, LLC.<u></u><u></u></span></p><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1f497d">Associate Member American Society of Clinical Oncology<u></u><u></u></span></p><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1f497d">Member of the American Chemical Society<u></u><u></u></span></p><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1f497d"><a href="mailto:jmullowney@pharma-cycle.com" target="_blank">jmullowney@pharma-cycle.com</a><u></u><u></u></span></p><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1f497d">(617) 755-0883<u></u><u></u></span></p><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1f497d"><u></u> <u></u></span></p><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1f497d"><u></u> <u></u></span></p><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1f497d"><u></u> <u></u></span></p><div><div style="border:none;border-top:solid #b5c4df 1.0pt;padding:3.0pt 0in 0in 0in"><p class="MsoNormal"><b><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif"">From:</span></b><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif""> Smith, Charlotte [<a href="mailto:csmith32@wm.com" target="_blank">mailto:csmith32@wm.com</a>] <br><b>Sent:</b> Wednesday, April 18, 2018 2:10 PM<br><b>To:</b> Ed Gottlieb; <a href="mailto:pharmwaste@lists.dep.state.fl.us" target="_blank">pharmwaste@lists.dep.state.fl.<wbr>us</a><br><b>Cc:</b> Mullowney, Jim<br><b>Subject:</b> RE: Chemo drugs<u></u><u></u></span></p></div></div><p class="MsoNormal"><u></u> <u></u></p><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif"">With all due respect, I have carefully re-read the final USP General Chapter <800> Handling Hazardous Drugs and I do not find any reference to the requirement to dispose of trace chemotherapy as a hazardous waste. The chapter repeatedly refers to the complying with EPA regulations, which do not currently address trace chemotherapy waste. There is one reference to disposal in a container appropriate for trace contaminated HD waste and also a reference to “HD containers” but that is a hazardous drug container, not necessarily a hazardous waste container. It is also my understanding that the current version available from USP is the final version with no additional drafts being contemplated. There is often confusion between a hazardous drug and a hazardous waste, but the definitions are very different. <u></u><u></u></span></p><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif""><u></u> <u></u></span></p><div><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif"">Best regards,<u></u><u></u></span></p><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif""><u></u> <u></u></span></p><p class="MsoNormal" style="text-autospace:none"><b><span style="font-size:11.0pt;font-family:"Trebuchet MS","sans-serif";color:#00693c">Charlotte A. Smith, RPh, MS </span></b><span style="font-size:11.0pt;font-family:"Trebuchet MS","sans-serif";color:#00693c"><u></u><u></u></span></p><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Trebuchet MS","sans-serif";color:black">Senior Regulatory Advisor</span><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:black"><u></u><u></u></span></p><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Trebuchet MS","sans-serif"">PharmEcology Services, WM Sustainability Services <u></u><u></u></span></p><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Trebuchet MS","sans-serif""><a href="mailto:csmith32@wm.com" target="_blank">csmith32@wm.com</a><span style="color:black"><u></u><u></u></span></span></p><p class="MsoNormal"><b><span style="font-family:"Trebuchet MS","sans-serif";color:black"> </span></b><span style="font-family:"Trebuchet MS","sans-serif";color:black"> </span><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:black"><u></u><u></u></span></p><p class="MsoNormal" style="text-autospace:none"><b><span style="font-size:11.0pt;font-family:"Trebuchet MS","sans-serif";color:#00693c">Waste Management </span></b><span style="font-size:11.0pt;font-family:"Trebuchet MS","sans-serif";color:#00693c"><u></u><u></u></span></p><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Trebuchet MS","sans-serif";color:black">P.O. Box 1654<u></u><u></u></span></p><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Trebuchet MS","sans-serif";color:black">Brookfield, WI 53008-1654</span><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:black"><u></u><u></u></span></p><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Trebuchet MS","sans-serif";color:black">Cell 713-725-6363 <u></u><u></u></span></p><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Trebuchet MS","sans-serif";color:black"><u></u> <u></u></span></p><p class="MsoNormal"><span style="font-family:"Trebuchet MS","sans-serif";color:black">Waste Management’s Sustainability Services </span><span style="font-family:"Trebuchet MS","sans-serif"">teams <span style="color:black">work with you to devise a strategy that will help achieve your environmental goals while benefitting your financial objectives. Find out more at </span></span><span style="font-size:11.0pt;font-family:"Calibri","sans-serif""><a href="http://www.wmsustainabilityservices.com/" target="_blank"><span style="font-size:12.0pt;color:#0563c1">www.wmsustainabilityservices.c<wbr>om</span></a><span style="color:black"><u></u><u></u></span></span></p><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Trebuchet MS","sans-serif";color:#339933"><u></u> <u></u></span></p><p class="MsoNormal"><b><span style="font-family:"Trebuchet MS","sans-serif";color:black"> </span></b><span style="font-family:"Trebuchet MS","sans-serif";color:black"> </span><span style="font-size:11.0pt;font-family:"Trebuchet MS","sans-serif";color:black"><u></u><u></u></span></p><p class="MsoNormal"><b><span style="font-size:10.0pt;font-family:"Trebuchet MS","sans-serif";color:#525252"><u></u> <u></u></span></b></p></div><p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif""><u></u> <u></u></span></p><div><div style="border:none;border-top:solid #e1e1e1 1.0pt;padding:3.0pt 0in 0in 0in"><p class="MsoNormal"><b><span style="font-size:11.0pt;font-family:"Calibri","sans-serif"">From:</span></b><span style="font-size:11.0pt;font-family:"Calibri","sans-serif""> Pharmwaste [<a href="mailto:pharmwaste-bounces@lists.dep.state.fl.us" target="_blank">mailto:pharmwaste-bounces@lis<wbr>ts.dep.state.fl.us</a>] <b>On Behalf Of </b>Ed Gottlieb<br><b>Sent:</b> Monday, April 9, 2018 1:43 PM<br><b>To:</b> <a href="mailto:pharmwaste@lists.dep.state.fl.us" target="_blank">pharmwaste@lists.dep.state.fl.<wbr>us</a><br><b>Cc:</b> Mullowney, Jim <<a href="mailto:jmullowney@pharma-cycle.com" target="_blank">jmullowney@pharma-cycle.com</a>><br><b>Subject:</b> [EXTERNAL] [Pharmwaste] Chemo drugs<u></u><u></u></span></p></div></div><p class="MsoNormal"><u></u> <u></u></p><div><div><p><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black">New info from Jim Mullowney below. Contact him for more information: <span class="m_1524691813403853507m_-4493243876213236349rwrr"> <a href="mailto:jmullowney@pharma-cycle.com" target="_blank">jmullowney@pharma-cycle.com</a></span><u></u><u></u></span></p><p><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black"> <u></u><u></u></span></p><p><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black">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. <u></u><u></u></span></p><p><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black"> <u></u><u></u></span></p><p><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black">Problem Chemotherapy Drugs That Are Excreted at High Concentrations & Can Damage Others at Ultra-low Doses1<u></u><u></u></span></p><p><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black">Generic Name Other Names <wbr> Excretion <wbr> Administered Dose<u></u><u></u></span></p><p><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black"> <wbr> <wbr> % Danger Period Dose/Weight Amo<wbr>unt<u></u><u></u></span></p><p><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black">Actinomycin D Dactinomycin, Cosmenogen 30% 7 Days ≤ 50 ug/Kg ≤ 4 mg<br>Bleomycin Blenoxane <wbr> 60-7<wbr>0% 1 Day ≤ 50 units (mg)/Kg ≤ 4000 mg<br>Carboplatin Paraplatin<wbr> <wbr>65-75% 1 Day ≤ 12 mg/Kg ≤ 960 mg<br>Cisplatin Platin <wbr> <wbr> 13-17% 1 Day ≤ 3.3 mg/Kg ≤ 264 mg<br>Cyclophosphamide Endoxan, Cytoxan, Neosar, Procytox, Revimmune <u></u><u></u></span></p><p><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black"> <wbr> <wbr> 5-25% 1 Day ≤ 50 mg/Kg ≤ 4000 mg<br>Dacarbazine DTIC, DTIC-Dome <wbr>40% 1 Day ≤ 4.5 mg/Kg ≤ 360 mg<br>Daunorubicin HCl Cerubidine <wbr> 65% 3 Days ≤ 1.5 mg/Kg ≤120 mg<br>Doxorubicin Adriamycin, Rubex, Doxil, Caelyx, Myocet <u></u><u></u></span></p><p><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black"> <wbr> <wbr> 45-55% 5 Days ≤ 2.5 mg/Kg ≤ 200 mg<br>Epirubicin Ellence, Pharmorubicin <wbr>55% 4 Days ≤ 40 mg/Kg ≤ 3200 mg<br>Etoposide Eposin, Etopophos, Vepesid, VP-16 45% 5 Days ≤ 3.3 mg/Kg ≤ 264 mg<br>Floxuridine Fdur <wbr> <wbr> 20% 1 Day ≤ 0.6 mg/Kg ≤ 48 mg<br>Fludarabine Fludara <wbr> <wbr>40-60% 1 Day ≤ 0.83 mg/Kg ≤ 66.4 mg<br>Fluorouracil 5-FU, Adrucil, Carac, Efudix, Efudex, Fluoroplex<u></u><u></u></span></p><p><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black"> <wbr> <wbr> 7-20% 1 Day ≤ 12 mg/Kg ≤ 960 mg<br>Idarubicin Zavedos, Idamycin <wbr> 20% 8 Days ≤ 0.4 mg/Kg ≤ 32 mg<br>Ifosfamide Mitoxana, Ifex <wbr> 12-18% 1 Day ≤ 40 mg/Kg ≤ 3200 mg<br>Irinotecan Camptosar, Campto 25-<wbr>50% 2 Days ≤ 11.7 mg/Kg ≤ 936 mg<br>Mitomycin Mitosol <wbr> <wbr> 10% 1 Day ≤ 0.67 mg/Kg ≤ 53.6 mg<br>Mitoxantrone <wbr> <wbr> 24% 5 Days ≤ 0.47 mg/Kg ≤ 37.6 mg<br>Oxaliplatin Eloxatin <wbr> <wbr> 35% 1 Day ≤ 2.8 mg/Kg ≤ 224 mg<br>Methotrexate Trexall, MTX, Amethopterin 80-90% <wbr> 1 Day ≤ 15 mg/Kg ≤ 1200 mg<br>Temozolomide Temodar <wbr> 18%<wbr> 7 Days ≤ 50 mg/Kg ≤ 4000 mg<br>Topotecan Hycamtin <wbr> 7<wbr>0 -75% 9 Days ≤ 0.05 mg/Kg ≤ 4 mg<br>Restricted use<br>Arsenic trioxide Trisenox <wbr> 15% <wbr> 1 Day ≤ 15 mg/Kg ≤ 1200 mg<br>Clofarabine <wbr> <wbr> 49-60% 1 Day ≤ 1.7 mg/Kg ≤ 138 mg<br>Melphalan Alkeran <wbr> 10<wbr>-15% 1 Day 6 mg 6 mg<br>Teniposide Vumon <wbr> <wbr> 4-12% 5 Days ≤ 8.3 mg/Kg ≤ 666 mg<br>Valrubicin Valstar <wbr> <wbr> 99% 1 Day 800 mg 800 mg<br>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.<u></u><u></u></span></p><p><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black">2. Estimated percent of drug dose that exits patient's body as parental drug or active metabolite as well as excretion period.<u></u><u></u></span></p><p><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black">3. Doses will vary depending on disease and doctors' recommendations. See individual Drug Inserts for more details.<br>4. Where needed, converted from mg/m2 to mg/Kg<u></u><u></u></span></p><p><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black"> <u></u><u></u></span></p><div><div><div><div><p class="MsoNormal"><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black">Ed Gottlieb <br>Industrial Pretreatment Coordinator<br>Ithaca Area Wastewater Treatment Facility<br>525 3<sup>rd</sup> Street<br>Ithaca, NY 14850<br></span><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:blue"><a href="tel:(607)%20273-8381" target="_blank">(607) 273-8381</a><br></span><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black">fax: <a href="tel:(607)%20273-8433" target="_blank"><span style="color:#0066cc">(607) 273-8433</span></a></span><span style="font-family:"Tahoma","sans-serif";color:black"><u></u><u></u></span></p></div><div><p class="MsoNormal"><span style="font-family:"Tahoma","sans-serif";color:black"> <u></u><u></u></span></p></div></div></div></div></div></div><div class="MsoNormal" align="center" style="text-align:center"><hr size="2" width="100%" align="center"></div><p><strong><span style="font-family:"Arial","sans-serif";color:green">Recycling is a good thing. Please recycle any printed emails. <u></u><u></u></span></strong></p></div></div><br><br>---------- Forwarded message ----------<br>From: Vivian Futran Fuhrman <<a href="mailto:vivian@productstewardship.us" target="_blank">vivian@productstewardship.us</a>><br>To: "<a href="mailto:pharmwaste@lists.dep.state.fl.us" target="_blank">pharmwaste@lists.dep.<wbr>state.fl.us</a>" <<a href="mailto:pharmwaste@lists.dep.state.fl.us" target="_blank">pharmwaste@lists.dep.state.<wbr>fl.us</a>><br>Cc: <br>Bcc: <br>Date: Thu, 19 Apr 2018 12:54:11 +0000<br>Subject: [Pharmwaste] FREE PSI webinar: "Global Best Practices for Drug Take-Back Programs"– 6/7/2018<br>
<div lang="EN-US" link="#0563C1" vlink="#954F72">
<div class="m_1524691813403853507m_4343434329345667747WordSection1">
<p class="MsoNormal">Good Morning,<u></u><u></u></p>
<p class="MsoNormal"><u></u> <u></u></p>
<p class="MsoNormal">PSI is holding a free webinar, <b><i>Global Best Practices for Drug Take-Back Programs</i></b>, on
<b>June 7, 11am - 12:30pm EDT (8am PDT / 5pm CEST)</b>. This is the third in a four-webinar global series that will connect stakeholders worldwide and launch an ongoing dialogue about best practices for safely managing waste pharmaceuticals.
<u></u><u></u></p>
<p class="MsoNormal"><u></u> <u></u></p>
<p class="MsoNormal">The 90 minute webinar will feature speakers from Canada, the United States, France, and Sweden who will share their program best practices. The presentations will be followed by a 45 minute question/answer session. The entire webinar will
be held in English.<u></u><u></u></p>
<p class="MsoNormal"><u></u> <u></u></p>
<p class="MsoNormal">More details and a link to register can be found online: <a href="https://productstewardship.site-ym.com/events/EventDetails.aspx?id=1096126" target="_blank">
https://productstewardship.sit<wbr>e-ym.com/events/EventDetails.<wbr>aspx?id=1096126</a>. <u></u>
<u></u></p>
<p class="MsoNormal">We hope to see you there!<u></u><u></u></p>
<p class="MsoNormal"><u></u> <u></u></p>
<p class="MsoNormal">Best,<u></u><u></u></p>
<p class="MsoNormal">Vivian<u></u><u></u></p>
<p class="MsoNormal"><b><span style="font-size:10.0pt;color:#333333">______________________________<br>
Vivian Fuhrman, Ph.D.<u></u><u></u></span></b></p>
<p class="MsoNormal"><span style="font-size:10.0pt;color:#404040">Sr. Associate for Policy and Programs</span><span style="color:#404040"><u></u><u></u></span></p>
<p class="MsoNormal"><i><span style="font-size:10.0pt;color:#333333">Product Stewardship Institute, Inc.<br>
</span></i><span style="font-size:10.0pt;color:#333333">29 Stanhope St., 3rd Floor, Boston, MA 02116<br>
P: (617) 236-4771 F: (617) 236-4766<br>
</span><span style="font-size:10.0pt;color:#1f497d"><a href="http://www.productstewardship.us/" target="_blank"><span style="color:#333333">www.productstewardship.us</span></a><br>
<a href="mailto:vivian@productstewardship.us" target="_blank"><span style="color:#333333">vivian@productstewardship.us</span></a></span><span style="color:#1f497d"><u></u><u></u></span></p>
<p class="MsoNormal"><i><span style="font-size:10.0pt;color:#333333">The Product Stewardship Institute, Inc. is an equal opportunity provider and employer.</span></i><u></u><u></u></p>
<p class="MsoNormal"><u></u> <u></u></p>
</div>
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<div><font lang="0" size="2" face="Arial">Ed Krisiunas,
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