The National Institute for Occupational Safety and Health (NIOSH) released big changes to its hazardous meds list.
We’re used to the NIOSH list being divided into 3 tables of hazardous meds...Table 1 for antineoplastics, Table 2 for NON-antineoplastics, and Table 3 for meds primarily with reproductive risks.
But these tables have caused confusion about true risk. For example, some antineoplastics aren’t cytotoxic.
Now there are only 2 tables in the updated NIOSH list. 25 drugs were added...including dihydroergotamine and ivabradine...and 7 drugs were removed...including paliperidone and risperidone.
Keep in mind, meds included in this update were either newly approved or issued updated safety-related warnings by the FDA between January 2014 and December 2015. Newer drugs will need to be evaluated.
Table 1 includes known or probable carcinogens to humans...plus hazardous meds with special handling info in the package insert. Keep in mind, not all these meds are classified as antineoplastics.
Table 2 meds are NOT thought to be carcinogenic, but do meet other hazardous criteria...organ toxicity, reproductive risks, etc.
This means you’ll now see letrozole, megestrol, and some other antineoplastics in Table 2...instead of Table 1.
On the flip side, some NON-antineoplastics have been reclassified to Table 1. But be aware, this isn’t based on new information.
For instance, valganciclovir and estrogens are moving to Table 1...and they’re already known carcinogens.
Be ready to implement changes to your hazardous med policy.
USP <800> has clarified that standards for handling antineoplastics only refer to those that remain in Table 1.
For example, you won’t automatically need to wear double chemo gloves when prepping subcutaneous leuprolide...since it’s in Table 2.
Instead, your hospital will still be able to perform an “assessment of risk” for Table 2 antineoplastics...to decide handling procedures.
Anticipate continuing your current process for NON-antineoplastics...even if the med is moving to Table 1.
Get answers to FAQs in our chart, What’s New in Handling Hazardous Meds...and go to CriticalPoint for more guidance on hazardous med safety.
- NIOSH. NIOSH List of Hazardous Drugs in Healthcare Settings. December 2024. https://www.cdc.gov/niosh/docs/2025-103/default.html (Accessed February 6, 2025).
- USP General Chapter <800>. Hazardous Drugs – Handling in Healthcare Settings. July 1, 2020. https://www.uspnf.com/sites/default/files/usp_pdf/EN/USPNF/revisions/gc-800-rb-notice-20200626.pdf (Accessed February 6, 2025).