Working safely with hazardous drugs: Fluorouracil
From the Massachusetts Nurse Newsletter
March 2007 Edition
As the MNA’s Congress on Health and Safety has been focusing on nurses’ exposures to hazardous drugs, the drug thalidomide was discussed. As a result of that discussion, it was decided to begin a column in the Massachusetts Nurse addressing hazardous drugs that are in use today and to provide information on their toxicity and safe handling methods.
By Thomas P. Fuller, ScD, CIH
Synonymous with 5-FU, adrucil, carzonal, efudez, fluoroblastin and others1, fluorouracil is a hazardous drug belongs to the general group known as antimetabolites and is used to treat several types of cancer, including colon, head and neck cancers.2
This chemotherapy agent has been used for about 40 years. Fluorouracil works by preventing cells from making DNA and RNA by interfering with the synthesis of nucleic acids, thus disrupting the growth of cancer cells. It is typically administered intravenously by short or continuous infusions, or by the intravenous push method. It is also given topically to treat superficial basal cell carcinoma, keratosis, psoriasis and viral warts.3
Side effects to patients taking this medication include sore mouth and taste change, diarrhea, gritty eyes and blurred vision, blood in urine or feces, hair loss, lowered resistance to infection, leukopenia, and infertility in both men and women.4 Some effects do not occur until months or years after treatment.
The International Agency for Research on Cancer has classified fluorouracil as a Group 3 agent defined as, “Not classifiable as to carcinogenicity to humans.”5 It is classified between Group 2B “possibly carcinogenic” and Group 4 “probably not carcinogenic.” The National Institute for Occupational Safety and Health has included it on its list of hazardous drugs.6
Although the long-term affects from chronic exposures to this chemical in the workplace are somewhat undocumented due to the hazardous nature of the drug, several workplace precautions are recommended. Procedures for the safe use, storage, handling and disposal of fluorouracil should be written and followed. Workers should avoid all direct contact with the chemical and wear protective gloves, lab coats and face shields. Treatment rooms should have adequate ventilation and workers should follow good housekeeping practices. Any spills or personal contaminations should be cleaned up immediately.
As the health effects to an embryo or fetus could be potentially most drastic due to the mode of operation of the chemical on living tissue, serious consideration should be given to whether a pregnant worker or those trying to conceive should work with this drug. At a minimum, workplace controls should be in place and followed closely and environmental monitoring should be considered.
- Safety MSDS for 5 fluorouracil, http://ptcl.chem.ox.ac.uk/MSDS/FL/5-fluorouracil.html
- ACS: Cancer Drug Guide: fluorouracil, www.cancer.org/ docroot/cdg/content/cdg_fluorouracil.asp
- DermNet NZ, www.dermnetnz.org/treatments/5-fluorouracil.html
- Cancerbackup, www.cancerbackup.org
- International Agency for Research on Cancer, Agents Reviewed by the IARC Monographs, http://monographs.iarc.fr/ENG/Classification/ListagentsCASnos.pdf
- NIOSH, Department of Health and Human Services, Centers for Disease Control, National Institute of Occupational Health and Safety, NIOSH Alert: Preventing occupational exposures to antineoplastic and other hazardous drugs in health care settings (September 2004) DHHS (NIOSH) publication number 2004-165