Drugs we're not supposed to touch??

[starsweet]

So I just recently began working as an intern at CVS. The pharmacist told me a couple of drugs I shouldn't touch: methotrexate, and either Proscar or Propecia (finasteride), I can't remember which. So my question is, how can these be absorbed through the skin?? People actually ingest these drugs, so if a normal person touches them are they that harmful??

And is there a list of other ones I shouldn't touch?

---

Members don't see this ad.

 

[marine123]

I think I heard not to touch Cytotec (misoprostol) if you're pregnant. I would just not touch that thing at all to make sure.

 

[Caverject]

They are absorbed thru the skin due to the dust of the tablets. They have severe teterogenic effects which is why it's a good idea for women of child bearing age not to mess with it too much. If your a pharmacist, there really isn't much you can do about it other than order exact count bottles. Both versions of finesteride fall under this classification

 

[All4MyDaughter]

I dispense a lot of finasteride (I work at the VA) and I wear gloves when I work with it and clean out the counting tray afterward. We have some other chemo drugs that we wear gloves for as well.

 

[sdn1977]

If you're working at a retail setting, IMO you can count anything!

The amount of drug which is in contact with your skin & can be absorbed in minimal. Now...if you were compounding podophyllin in absolute alcohol - I may have concerns.

There are studies in ASHP which document mutagens when techs & pharmacists compound injectable antineoplastics & there is a statistically significant increase in mutagens. These individuals have been followed & to my knowledge - there have been no incidences of teratogenic effects or cancers due to this.....however, gowning & gloving have been changed significantly since I first started compounding. The risk is not in handling the vial or the tablets - its in inhaling the aerosilized drug - rarely just the powder & not from tablets since they've been compressed to prevent this from occuring. The last study I've seen (which is old, I admit!) was a French study which found no significant difference in urine mutagenicity of pharmacists & nurses handling cytotoxics & those controls who smoked or did not smoke (in other words...the general population). There may be some new stuff I've not seen yet, but I'm not in oncolgy. I think there is someone here who is though....For injectable chemo in recent years, we've always gowned, masked (eyes, nose & mouth) & double gloved.

Zpak - have you seen something additonal on this??? I admit I haven't followed this closely.

However, I would have no problems dispensing any of these drugs. Likewise, I do know of couples in which the male partner has used Proscar & the female is trying to become pregnant. This is very safe & has been documented in not just animal studies, but also post-marketing survelliance. The female should not handle broken tablets...but unbroken tablets are very safe because of their protective coating. So...you as someone who is counting is also considered safe as well.

You can reassure yourself by looking at the literature. You should have Safety Data Sheets available at your workplace.

 

[tussionex]

who compounds podophyllin these days?

 

[bananaface]

I dunno. But alot of people compund estrogen and progesterone products that a tech would need to be protected from.

Advair has a 60 day expiration date once the first inhalation is used. Lantus is 28 days. Prevacid solutabs are suppoed to be used immediately upon opening the package. We came across that when some people were using half in the morning and half in the evening. Many inhalations kept in light sealed containers expire 1 week after the foil is broken. No other manufacturer listed shorter than stamped expiration dates are coming to mind.

 

[greatdeals225]

can't touch Avodart, coz if you are bearing a male infant, he can grow abnormal sex organs....

 

[sdn1977]

can't touch Avodart, coz if you are bearing a male infant, he can grow abnormal sex organs....

'cmon......Avodart is a soft gelatin capsule. Unless you've actually punctured the capsule, you won't come in contact with the drug.

Please - it is the responsibility of a pharmacist to give out correct & noninflammatory information!

 

[sdn1977]

I dunno. But alot of people compund estrogen and progesterone products that a tech would need to be protected from.

Advair has a 60 day expiration date once the first inhalation is used. Lantus is 28 days. Prevacid solutabs are suppoed to be used immediately upon opening the package. We came across that when some people were using half in the morning and half in the evening. Many inhalations kept in light sealed containers expire 1 week after the foil is broken. No other manufacturer listed shorter than stamped expiration dates are coming to mind.

I think you're mixing up compounding & expiration dating.

A tech can compound anything & does - as long as the proper protective gear is worn - for antineoplastics & hormones. Un unskilled tech in compounding gear shouldn't be compounding anything...but there is nothing inherently different physiologically between a skilled compounding tech & a pharmacist. I'd even venture to say...there are may skilled compounding techs who have more experience than many pharmacists! So - it has to do more with your skill & your protective gear than your position.

Your issue of Advair, Lantus & Prevacid Solutabs are where the reality is a bit different from the "labeling". Yes - we'd give Advair a 60 day dating...why? - contamination from oral microorganisms. But - there is no real difference in 59 or 61 days. Likewise, there is no difference between 28 or 30 days of Lantus - it has more to do with the integrity of the stopper.

Prevacid Solutabs is somewhat like Restasis - they are supposed to be single use only - but, just as in a hospital which uses single use vials - when they are used within a pharmacy (or at home by just one pt) 24 hours is acceptable.

Now - should you advertise these differences - no. But...this is when your professional judgement of how the information will be used & who you are giving the information to is important.

 

[sdn1977]

who compounds podophyllin these days?

You caught me!!!!

Have to admit - I've not done it in about 8 years - thankfully!

 

[cangelilli]

I am not sure the details, but I have been told in multiple pharmacies that females should not touch avodart gelcaps at all. There is a warning on the bottle I think too.

 

[DrugDealer]

I am not sure the details, but I have been told in multiple pharmacies that females should not touch avodart gelcaps at all. There is a warning on the bottle I think too.

Facts and Comparisons states "Dutasteride is absorbed through the skin. Therefore, women who are pregnant or may be pregnant should not handle dutasteride soft gelatin capsules because of the possibility of absorption of dutasteride and the potential risk of a fetal anomaly to a male fetus (see Contraindications). In addition, women should use caution whenever handling dutasteride soft gelatin capsules. If contact is made with leaking capsules, the contact area should be washed immediately with soap and water."

The patient info section states "Women who are pregnant or may become pregnant should not handle dutasteride capsules. If a woman who is pregnant with a male baby gets enough dutasteride into her body after swallowing it or through her skin after handling it, the male baby may be born with abnormal sex organs."

I have personally never worried about it.

 

[greatdeals225]

Facts and Comparisons states "Dutasteride is absorbed through the skin. Therefore, women who are pregnant or may be pregnant should not handle dutasteride soft gelatin capsules because of the possibility of absorption of dutasteride and the potential risk of a fetal anomaly to a male fetus (see Contraindications). In addition, women should use caution whenever handling dutasteride soft gelatin capsules. If contact is made with leaking capsules, the contact area should be washed immediately with soap and water."

The patient info section states "Women who are pregnant or may become pregnant should not handle dutasteride capsules. If a woman who is pregnant with a male baby gets enough dutasteride into her body after swallowing it or through her skin after handling it, the male baby may be born with abnormal sex organs."

I have personally never worried about it.

yup, i read it in the Patient Insert as well, not that I'm giving misinflammatory information. I agree that the risks may be small, but the gelcaps may have been broken in the bottles or while handling them. How many times have you found broken tablets in the adderall combo bottles? i've found them plenty of times, now, avoiding the risks associated with it is better than being sorry for it later on.

 

[Aznfarmerboi]

Gel Capsules and tablets are two whole different package form. Capsules are rarely broken because they are sealed and melted together

 

[BMBiology]

Women shouldn't handle the following drugs:

(1) 5-alpha reductase inhibitors (proscar, propecia, avodart)- antiandrogens & can feminize a male fetus
(2) Flourouracil (efudex)- mutagenic
(3) Rabavirin aerosol (virazole)- teratogenic
(4) Testosterone (androgel, androderm)- may affect fetal sexual development
(5) Mycophenolate (cellcept)- teratogenic
(6) Ganciclovir (Cytovene)- mutagenic & teratogenic
(7) Antineoplastics (methotrexate, cyclophosphamide)- mutagenic

Also, remember not to use the counting machine to count these drugs.

Reference: Pharmacist's Letter/Prescriber's Letter 2006;22(3):220339.

 

[sdn1977]

Women shouldn't handle the following drugs:

(1) 5-alpha reductase inhibitors (proscar, propecia, avodart)- antiandrogens & can feminize a male fetus
(2) Flourouracil (efudex)- mutagenic
(3) Rabavirin aerosol (virazole)- teratogenic
(4) Testosterone (androgel, androderm)- may affect fetal sexual development
(5) Mycophenolate (cellcept)- teratogenic
(6) Ganciclovir (Cytovene)- mutagenic & teratogenic
(7) Antineoplastics (methotrexate, cyclophosphamide)- mutagenic

Also, remember not to use the counting machine to count these drugs.

Reference: Pharmacist's Letter/Prescriber's Letter 2006;22(3):220339.

Sorry - I don't agree with this broad statement. "Handling" doesn't imply not doing the dispensing. Women can & do dispense all of these drugs. Additionally, female partners of men who use finansteride continue to have sexual relationships which, in my experience, have been accepted by both the male's physician & the females's ob-gyn. Finansteride is found in seminal fluid. These pts are followed as well as their offspring. I, myself, am a DES child who has been followed for more than 40 years. For exposure, proper monitoring is the key. Fortunately, drug manufactuers have designed these drugs so manipulation by other than the person it is intended for is kept to a minimum (gel caps, unit dose packages of androgel, a 2 week or month's supply of 5-FU in one tube, etc....

There are far more mutagenic drugs which you don't list here & those techs & pharmacists (both male & female) who mix antineoplastics in any large quantity (think MD Anderson, Mayo Clinic, UCSF, etc...) - all employees have routine urine teratogen testing which will go on for the duration of their lives. To date, there are few teratogenic or mutagenic diseases which has been documented by the "proper" compounding of antineoplastics - done in a vertical laminar flow hood. The ones that have been reported are not out of the statistical significance of the disease itself, however, I've not looked at the statistics in a long,long time. Many, many years ago, these were done on the counter of a med room or the doctor's office so those folks have never been followed. I've spent years compounding antineoplastics & am still offered urine monitoring as often as I choose.

Just dispensing these drugs should not be cause for concern - which many technicians, who have little education about "handling" might misinterpret. Now, mixing a 5-FU in a lotion form might be better handled by someone of my age, however, I would still use proper handling techniques - double gloves & mask. But, unpacking a 5-FU tube, counting out Proscar or labeling a box of Androgel should not be cause for concern. In addition, the form of the drug itself is deliberately designed so those who dispense it (pharmacists & nurses) are not exposed to the raw material. Have you EVER seen an Avodart broken? I've not & I've actually tried! Its tough to do! The manufacturer does this on purpose so you don't get exposed!

I don't mean to criticize, just keep the "hysteria" which can develop unnecessarily down.

Here are a few links to more detailed studies which might provide some exposure data for personal security:

http://caonline.amcancersoc.org/cgi/content/full/56/6/354

http://www.cdc.gov/niosh/topics/antineoplastic/effects.html

 

[BMBiology]

You are certainly entitle to your opinion but I trust that the pharmacist's letter did its research and that's the list of drugs they generated. I agree the risk is small but why take the risk?

 

[sdn1977]

You are certainly entitle to your opinion but I trust that the pharmacist's letter did its research and that's the list of drugs they generated. I agree the risk is small but why take the risk?

Because that's the job I'm paid to do & I do it. My employer offers me state of the art protection & monitoring for the whole life, which I'v taken advantage of.

I also have done this job a long, long time & I know that dispensing an Avodart capsule will not expose me to any drug which will cause me harm. Why? because I called the company & asked! In fact, the monitoring device I wear daily has not shown any harm from any drug I've dispensed, nor has my urine samples (too much info!!!).

The question as a potential manager or someone who might be in a mangement position is, how would you deal with your primary female employee population who chooses not do fill terazocin or mix methotrexate? That can bring your operation to a halt fast. Are you willing to have that happen or are you willing to educate yourself & them on the ways & means exposure takes places & the policies & procedures which are in place to prevent an exposure. Likewise, do they know what to do if they feel they have had an exposure? (like getting stuck with a sryinge in a pyxis retun bin...)

This is all part of management.

 

[BMBiology]

I also have done this job a long, long time & I know that dispensing an Avodart capsule will not expose me to any drug which will cause me harm. Why? because I called the company & asked!

All due respect but calling the company is probably not the best option because you don't know who's giving you the advise. This is from the Avodart's package insert: http://www.fda.gov/medwatch/SAFETY/2005/Dec_PI/Avodart_PI.pdf

Storage and Handling:
Dutasteride is absorbed through the skin. AVODART Soft Gelatin capsules should not be handled by women who are pregnant or who may become pregnant because of the potential for absorption of dutasteride and the subsequent potential risk to a developing male fetus (see CLINICAL PHARMACOLOGY: Pharmacokinetics, WARNINGS: Exposure of Women—Risk to Male Fetus, and PRECAUTIONS: Information for Patients and Pregnancy).

 

[sdn1977]

Again...."handling" - this might be interpreted by a tech by meaning they can't unpack it, sticker it, put it on the shelf, label the unit of use package....

That's not what that means. In fact, when Avodart is shipped, it is not shipped in a chemo bag the same way methotrexate is shipped.

Now, if a female pharmacist of childbearing age is dispensing a "few" out of a bottle, which could happen while waiting for an rx ok....she might not want to count a few out into her hands....she might want to wear gloves. Again - following the accepted guidelines for the real "handling" of any drug which might have a negative impact on the dispenser reduces the risk to neglible.

How do you think pharmacies function when only women are staffing? We just use good judgement & proper precautions.

I used to work with a pharmacist who was allergic to pcn - just this side of anaphylaxis. She worked the graveyard by herself & she was often called on to mix a pcn type IV. She had no issues - gowned, gloved & masked & never had an issue.

My husband had a classmate who developed an anaphylaxis reaction to mercury. To get thru dental school, you had to be able to do an amalgam filling (which in that day contained mercury which would get aerosolized while drilling.) He gowned, gloved & masked - far before it was standard practice, just so he wouldn't kill himself and he could make it thru school.

So.....there are ways to properly "handle" these drugs & its our job to help educate those who don't clearly understand the risks & the ways to protect them. Fear is a horrible thing for someone to have to live with & I don't know any employer who will allow young women to not dispense something just because they are of childbearing age. Now, its expected that if you're pregnant, you don't mix chemo or nuclear medications. But, beyond that, its the standard of practice you use proper precautionary techniques & you dispense everything.

Zpak might have another take on this since he was a dop for years & dealt with multiple female personnel issues.

 

[BMBiology]

I agree the risk is small and caution should be taken when handling these drugs but you are factually incorrect to believe there is no risk when the package insert says otherwise.

I also have done this job a long, long time & I know that dispensing an Avodart capsule will not expose me to any drug which will cause me harm. Why? because I called the company & asked!

 

[DrugDealer]

Dutasteride is absorbed through the skin.

I don't disagree with this (have you looked at the structure? it's a steroid derivative and thus, lipophilic). However, the actual dutasteride is embedded within the capsule--the purpose of that hard outer shell is to isolate you from the actual chemical until you've swallowed it. I suspect they chose to formulate it as a capsule so that the capsule shell could provide this barrier--it they had made a non-coated tablet, the drug would be right on the outer surface and could also be quite dusty.

So, I view it much more of an issue when the capsule is broken, because that's when the dutasteride can actually come into contact with you. I posted before in this thread, and my reference specifically mentioned the broken capsules. But, as others have pointed out, breaking an Avodart capsule in much more of a theoretical concern than a pratical one.

 

[BMBiology]

I agree.

 

[tussionex]

i think this may be much ado about nothing...yes, we should all be careful and take proper precautions. yes, we shouldnt endanger fetuses. but, using common sense is all that is needed. i don't believe in painting certain drugs with such a broad brush. i'm a female, under 30, who doesn't want children so exposure beyond what may be carcinogenic is irrelevant to me.
however, i do take proper precautions when making chemo, not b/c i'm a girl, but because it's good practice.
once again, just plain old common sense. chill, people.

ps - now i'm going to try and break an avodart.

 

[PharmDstudent]

We shouldn't handle the magic ones, you know, the drugs that turn your fingers into goblins .

 

[tussionex]

i thought those were magic beans!

 

[PharmDstudent]

i thought those were magic beans!

I like beans. They're a major source of protein for vegetarians. Beans are nice.

Pharmacy is also nice. Pharmacists rarely have to confront substances which directly pose a significant health risk to themselves. Drugs are controlled in the sense that they're composed of predictable amounts of chemicals.
Bloodborne diseases and viruses are much more dangerous than any of the contact that pharmacists have with drugs, in my opinion.

Pharmacists handle medications, because they're drug experts. Some drugs are 99.9% harmless, while other drugs need to be handled with proper protection.
So, if someone doesn't want to handle medications, because they have unjustifiable reservations, then they shouldn't be in pharmacy.

If you can't stand the heat, get out of the kitchen.