NIOSH List of Antineoplastic 

and Other Hazardous Drugs 

in Healthcare Settings 2012

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Institute for Occupational Safety and Health

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Institute for Occupational Safety and Health

NIOSH List of Antineoplastic and Other

Hazardous Drugs in Healthcare Settings 2012
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DHHS (NIOSH) Publication Number 2012−150 (Supersedes 2010–167)

June 2012
1

Preamble: The National Institute for Occupational Safety and Health (NIOSH) Alert: Preventing 

Occupational Exposures to Antineoplastic and Other Hazardous Drugs in Health Care Settings was 

published in September 2004 (http://www.cdc.gov/niosh/docs/2004-165/). In Appendix A of the 

Alert, NIOSH identified a sample list of major hazardous drugs. The list was compiled from information provided by four institutions that have generated lists of hazardous drugs for their respective facilities and by the Pharmaceutical Research and Manufacturers of America (PhRMA) from 

the American Hospital Formulary Service Drug Information (AHFS DI) monographs [ASHP/

AHFS DI 2003]. The 2004 list was updated in 2010; this update adds 26 drugs to the 2010 list. These 

additions are new drugs or existing drugs that had new warnings from 2007 to 2009. The review 

process for the addition of the new listings is described in the Federal Register: http://www.cdc.gov/

niosh/docket/archive/pdfs/NIOSH-190/0190-080211-frn.pdf

Appendix A · Drugs Considered Hazardous

General Approach to Handling 

Hazardous Drugs

In the Alert, NIOSH presents a standard precautions or universal precautions approach 

to handling hazardous drugs safely: that is, 

NIOSH recommends that all hazardous drugs 

be handled as outlined in the Alert. Therefore, 

no attempt has been made to perform drug 

risk assessments or propose exposure limits. 

The area of new drug development is rapidly 

evolving as unique approaches are being taken 

to treat cancer and other serious diseases.

Defining Hazardous Drugs

Hazardous drugs include those used for cancer chemotherapy, antiviral drugs, hormones, 

some bioengineered drugs, and other miscellaneous drugs. The definition of hazardous drugs 

used in the Alert is based on an ASHP definition that was originally developed in 1990 

[ASHP 1990]. Thus the definition may not accurately reflect the toxicity criteria associated 

with the newer generation of pharmaceuticals 

entering the health care setting. For example, 

bioengineered drugs target specific sites in the 

body; and although they may or may not be 

toxic to the patient, some may not pose a risk 

to health care workers. 

NIOSH and other organizations are still gathering data on the potential toxicity and health 

effects related to highly potent drugs and bioengineered drugs. Therefore, when working 

with any hazardous drug, health care workers 

should follow a standard precautions approach 

along with any recommendations included in 

the manufacturer’s MSDSs.

ASHP Definition of Hazardous 

Drugs

ASHP defines hazardous drugs in their 1990 

revision of Technical Assistance Bulletin on 

Handling Hazardous Drugs [ASHP 1990]. The 

bulletin gives criteria for identifying potentially hazardous drugs that should be handled 

in accordance with an established safety program [McDiarmid et al. 1991; Arrington and 

McDiarmid 1993]. The criteria are prioritized 

to reflect the hierarchy of potential toxicity described below. Since the hazardous drugs covered by the Alert were designed as therapeutic agents for humans, human toxicity profiles 

should be considered superior to any data from 

animal models or in vitro systems. Additional 
2

guidance for defining hazardous drugs is available in the following citations: carcinogenicity [61 Fed. Reg. 17960–18011 (1996b); IARC 

2010], teratogenicity [56 Fed. Reg. 63798–63826 

(1991)], developmental toxicity [56 Fed. Reg. 

63798–63826 (1991)], and reproductive toxicity [61 Fed. Reg. 56274–56322 (1996a)]. Physical characteristics of the agents (such as liquid 

versus solid, or water versus lipid solubility) 

also need to be considered in determining the 

potential for occupational exposure.

NIOSH Revision of ASHP Definition

The 1990 ASHP definition of hazardous drugs*

was revised by the NIOSH Working Group on 

Hazardous Drugs for the Alert. Drugs considered hazardous include those that exhibit one 

or more of the following six characteristics in 

humans or animals:

 Carcinogenicity 

 Teratogenicity or other developmental 

toxicity†

 Reproductive toxicity†

*ASHP [1990] definition of hazardous drugs

1. Genotoxicity (i.e., mutagenicity and clastogenicity 

in short-term test systems)

2. Carcinogenicity in animal models, in the patient 

population, or both, as reported by the International Agency for Research on Cancer (IARC)

3. Teratogenicity or fertility impairment in animal 

studies or in treated patients

4. Evidence of serious organ or other toxicity at low 

doses in animal models or treated patients.

†

All drugs have toxic side effects, but some exhibit toxicity at low doses. The level of toxicity reflects a continuum from relatively nontoxic to production of toxic 

effects in patients at low doses (for example, a few milligrams or less). For example, a daily therapeutic dose 

of 10 mg/day or a dose of 1 mg/kg per day in laboratory animals that produces serious organ toxicity, developmental toxicity, or reproductive toxicity has been 

used by the pharmaceutical industry to develop occupational exposure limits (OELs) of less than 10 μg/m3

after applying appropriate uncertainty factors [Sargent 

and Kirk 1988; Naumann and Sargent 1997; Sargent et 

 Organ toxicity at low doses†

 Genotoxicity‡

 Structure and toxicity profiles of new drugs 

that mimic existing drugs determined hazardous by the above criteria

Determining Whether a Drug is 

Hazardous

Many hazardous drugs used to treat cancer 

bind to or damage DNA (for example, alkylating agents). Other antineoplastic drugs, some 

antivirals, antibiotics, and bioengineered drugs 

interfere with cell growth or proliferation, or 

with DNA synthesis. In some cases, the nonselective actions of these drugs disrupt the 

growth and function of both healthy and diseased cells, resulting in toxic side effects for 

treated patients. These nonselective actions 

can also cause adverse effects in health care 

workers who are inadvertently exposed to hazardous drugs.

Early concerns about occupational exposure to 

antineoplastic drugs first appeared in the 1970s. 

Although the antineoplastic drugs remain the 

principal focus of the Alert, other drugs may 

also be considered hazardous because they are 

potent (small quantities produce a physiological effect) or cause irreversible effects. As the 

use and number of these potent drugs increase, 

so do opportunities for hazardous exposures 

among health care workers. For example, anal. 2002]. OELs in this range are typically established 

for potent or toxic drugs in the pharmaceutical industry. Under all circumstances, an evaluation of all available data should be conducted to protect health care 

workers.

‡

In evaluating mutagenicity for potentially hazardous 

drugs, responses from multiple test systems are needed 

before precautions can be required for handling such 

agents. The EPA evaluations include the type of cells affected and in vitro versus in vivo testing [51 Fed. Reg. 

34006–34012 (1986)].
3

tineoplastic drugs such as cyclophosphamide 

have immunosuppressant effects that proved 

beneficial for treating nonmalignant diseases such as rheumatoid arthritis and multiple 

sclerosis [Baker et al. 1987; Moody et al. 1987; 

Chabner et al. 1996; Abel 2000].

This document presents criteria and sources of 

information for determining whether a drug is 

hazardous. When a drug has been judged to be 

hazardous, the various precautions outlined in 

the Alert should be applied when handling that 

drug. Also included is a list of drugs that should 

be handled as hazardous. This list is based on 

a compilation of lists from four health care facilities, one drug manufacturers’ organization, 

and NIOSH.

In addition to using the list of hazardous drugs 

presented here, each organization should create its own list of drugs considered to be hazardous. This document presents guidance for 

making such a facility-specific list (see section 

entitled How to Generate your own List of Hazardous Drugs). Once this list is made, newly 

purchased drugs should be evaluated against 

the organization’s hazardous drug criteria and 

added to the list if they are deemed hazardous. 

Some organizations may have inadequate resources for determining their own list of hazardous drugs. If so, the sample list of hazardous 

drugs in this document will help employers 

and workers to determine when precautions 

are needed. However, reliance on such a published list is a concern because it quickly becomes outdated as new drugs continually 

enter the market or listed drugs are removed 

when additional information becomes available. NIOSH will update a list periodically, 

adding new drugs considered to be hazardous 

and removing those that require reclassification. This hazardous drug list will be posted on 

the NIOSH Web site at www.cdc.gov/niosh/

topics/hazdrug/.

How to Generate You Own List of 

Hazardous Drugs

The OSHA hazard communication standard 

[29 CFR 1910.1200] requires employers to develop a hazard communication program appropriate for their unique workplace. An essential 

part of the program is the identification of all 

hazardous drugs a worker may encounter 

in the facility. Compliance with the OSHA 

hazard communication standard entails (1) 

evaluating whether these drugs meet one or 

more of the criteria for defining hazardous 

drugs and (2) posting a list of the hazardous 

drugs to ensure worker safety. Institutions may 

wish to compare their lists to the sample listing 

in this document or on the NIOSH Web site.

It is not likely that every health care provider 

or facility will use all drugs that have received 

U.S. Food and Drug Administration (FDA) approval, and the OSHA hazard communication 

standard does not mandate evaluation of every 

marketed drug. Instead, compliance requires 

practice-specific assessments for drugs used at 

any one time by a facility. However, hazardous 

drug evaluation is a continual process. Local 

hazard communication programs should provide for assessment of new drugs as they enter 

the marketplace, and when appropriate, reassessment of their presence on hazardous drug 

lists as toxicological data become available to 

support recategorization. Toxicological data 

are often incomplete or unavailable for investigational drugs. However, if the mechanism of 

action suggests that there may be a concern, it 

is prudent to handle them as hazardous drugs 

until adequate information becomes available 

to exclude them.

With the increased availability of oral antineoplastic and other hazardous drugs, additional 

precautions are required in order to prevent 

worker exposure to these formulations. Some 
4

drugs defined as hazardous may not pose a significant risk of direct occupational exposure 

because of their dosage formulation (for example, coated tablets or capsules—solid, intact 

medications that are administered to patients 

without modifying the formulation). Uncoated 

tablets may present a risk of exposure from dust 

by skin contact and/or inhalation when the 

tablets are counted [Shahsavarani et al. 1993]. 

However, they may pose a risk if solid drug 

formulations are altered, such as by crushing 

tablets or making solutions from them outside 

a ventilated cabinet.

All hazardous drugs, regardless of the formulation, should be labeled as such to prevent improper handling. Tablet and capsule forms of 

hazardous drugs should not be placed in automated counting machines, which subject them 

to stress and may introduce powdered contaminants into the work area. Counting and pouring of hazardous drugs should be done carefully, and clean equipment should be dedicated 

for use with these drugs. Crushing tablets or 

opening capsules should be avoided and liquid 

formulations should be used whenever possible. During the compounding of hazardous 

drugs (e.g., crushing, dissolving, or preparing 

a solution or an ointment), workers should 

wear non-permeable gowns and double gloves. 

Compounding should take place in a ventilated cabinet whenever possible [ASHP 2006].

Where to Find Information Related 

to Drug Toxicity

Practice-specific lists of hazardous drugs (usually developed by pharmacy or nursing departments) should be comprehensive, including all 

hazardous medications routinely used or very 

likely to be used by a local practice. Some of 

the resources that employers can use to evaluate the hazard potential of a drug include, but 

are not limited to, the following:

 MSDSs 

 Product labeling approved by the U.S. FDA 

(package inserts)

 Special health warnings from drug manufacturers, FDA, and other professional groups 

and organizations

 Reports and case studies published in medical and other health care profession journals

 Evidence-based recommendations from other facilities that meet the criteria defining 

hazardous drugs

Examples of Hazardous Drugs

The following list contains a sampling of major hazardous drugs. The list (Table 1) was 

compiled from information provided from 

(1) the NIOSH Alert [NIOSH 2004] that was 

based on lists from four institutions that have 

generated lists of hazardous drugs for their respective facilities and the American Hospital 

Formulary Service Drug Information (AHFS 

DI) monographs [ASHP/AHFS 2003], (2) the 

2010 NIOSH update to the 2004 list covering 

the period from 2004 to 2007 [NIOSH 2010], 

and (3) new drug approvals and new drug 

warnings from 2007 to 2009. The most recent 

review resulted in the addition of 26 new entries to the list.

In addition, 15 drugs were removed from the 

2010 list. Nine of these are no longer available in the U.S., two are radio-pharmaceuticals 

that are regulated by the Nuclear Regulatory 

Agency and require special handling, and four 

are determined to not meet the criteria for a 

hazardous drug as defined by NIOSH [NIOSH 

2004, 2010] (Table 2). The OSHA hazard communication standard requires hazardous drugs 

to be handled using special precautions. The 

mandate applies not only to health care professionals who provide direct patient care but 
5

also to others who support patient care by 

participating in product acquisition, storage, 

transportation, housekeeping, and waste disposal. Institutions may want to adopt this list 

or compare theirs with the list on the NIOSH 

Web site.

CAUTION: Drugs purchased and used by a 

facility may have entered the marketplace after 

the list below was assembled. Therefore, this 

list may not be all-inclusive.

If you use a drug that is not included in the list 

of examples, check the available literature to see 

whether the unlisted drug should be treated 

as hazardous. Check the MSDS or the proper 

handling section of the package insert; or check 

with other institutions that might be using the 

same drug. If any of the documents mention carcinogenicity, genotoxicity, teratogenicity, or reproductive or developmental toxicity, use the precautions stipulated in this Alert. If a drug meets 

one or more of the criteria for hazardous drugs 

listed in this Alert, handle it as hazardous.

The listing below will be updated periodically 

on this Web site [www.cdc.gov/niosh/topics/

hazdrug/].

The attached list of hazardous drugs supersedes the 2004 list [http://www.cdc.gov/niosh/

docs/2004-165/ and the 2010 list: http://www.

cdc.gov/niosh/docs/2010-167/].
6

Table 1. Sample List of Drugs that Should be Handled as Hazardous*

Drug Source AHFS Pharmacologic-therapeutic classification

Acitretin 7 88:04 Vitamin A

Aldesleukin 4,5 10:00 Antineoplastic agents

Ambrisentan 7 24:12.92 Vasodilating agents, miscellaneous

Alefacept 6 84:92 Skin and mucous membrane agents, 

miscellaneous

Alitretinoin 3,4,5 84:92 Skin and mucous membrane agents, 

miscellaneous

Altretamine 1,2,3,4,5 10:00 Antineoplastic agents

Amsacrine 3,5 Not in AHFS (antineoplastic agent)

Anastrozole 1,5 10:00 Antineoplastic agents

Arsenic trioxide 1,2,3,4,5 10:00 Antineoplastic agents

Asparaginase 1,2,3,4,5 10:00 Antineoplastic agents

Azacitidine 3,5 10:00 Antineoplastic agents

Azathioprine 2,3,5 92:44 Immunosuppressant agents

Bacillus Calmette-Guerin 

(BCG)†

1,2,4 80:12 Vaccines

Bendamustine HCl 7 10:00 Antineoplastic agents

Bexarotene 2,3,4,5 10:00 Antineoplastic agents

Bicalutamide 1,5 10:00 Antineoplastic agents

Bleomycin 1,2,3,4,5 10:00 Antineoplastic agents

Bortezomib 6 10:00 Antineoplastic agents

Bosentan 6 24:12.92 Vasodilating agents, miscellaneous

Busulfan 1,2,3,4,5 10:00 Antineoplastic agents

Cabergoline 7 28:36.20.04 Ergot-derivative dopamine receptor 

agonists

Capecitabine 1,2,3,4,5 10:00 Antineoplastic agents

Carbamazepine 7 28:12.92 Anticonvulsants, miscellaneous

Carboplatin 1,2,3,4,5 10:00 Antineoplastic agents

Carmustine 1,2,3,4,5 10:00 Antineoplastic agents

Cetrorelix acetate 5 92:40 Gonadotropin-releasing hormone antagonists 

Chlorambucil 1,2,3,4,5 10:00 Antineoplastic agents

Chloramphenicol 1,5 8:12.08 Chloramphenicols

Choriogonadotropin alfa 5 68:18 Gonadotropins

See footnotes at end of table (Continued)
7

Table 1 (Continued). Sample List of Drugs that Should be Handled as Hazardous*

Drug Source AHFS Pharmacologic-therapeutic classification

Cidofovir 3,5 8:18.32 Nucleosides and nucleotides

Cisplatin 1,2,3,4,5 10:00 Antineoplastic agents

Cladribine 1,2,3,4,5 10:00 Antineoplastic agents

Clofarabine 6 10:00 Antineoplastic agents

Clonazepam 7 28:12.08 Benzodiazepines

Colchicine 5 92:16 Antigout agents

Cyclophosphamide 1,2,3,4,5 10:00 Antineoplastic agents

Cyclosporin 1 92:44 Immunosuppressive agents

Cytarabine 1,2,3,4,5 10:00 Antineoplastic agents

Dacarbazine 1,2,3,4,5 10:00 Antineoplastic agents

Dactinomycin 1,2,3,4,5 10:00 Antineoplastic agents

Dasatinib 6 10:00 Antineoplastic agents

Daunorubicin HCl 1,2,3,4,5 10:00 Antineoplastic agents

Decitibine 6 10:00 Antineoplastic agents

Degarelix 7 10:00 Antineoplastic agents

Denileukin 3,4,5 10:00 Antineoplastic agents

Diethylstilbestrol 5 Not in AHFS (nonsteroidal synthetic estrogen)

Dinoprostone 5 76:00 Oxytocics

Docetaxel 1,2,3,4,5 10:00 Antineoplastic agents

Doxorubicin 1,2,3,4,5 10:00 Antineoplastic agents

Dronedarone HCl 7 24:04.04 Antiarrythmics 

Dutasteride 5 92:08 5-alpha reductase inhibitors

Entecavir 6 8:18.32 Nucleosides and nucleotides

Epirubicin 1,2,3,4,5 10:00 Antineoplastic agents

Ergonovine/

methylergonovine

5 76:00 Oxytocics

Estradiol 1,5 68:16.04 Estrogens

Estramustine phosphate 1,2,3,4,5 10:00 Antineoplastic agents

Estrogen-progestin 

combinations

5 68:12 Contraceptives

Estrogens, conjugated 5 68:16.04 Estrogens

Estrogens, esterified 5 68:16.04 Estrogens

See footnotes at end of table (Continued)
8

Drug Source AHFS Pharmacologic-therapeutic classification

Estrone 5 68:16.04 Estrogens

Estropipate 5 68:16.04 Estrogens

Etoposide 1,2,3,4,5 10:00 Antineoplastic agents

Everolimus 7 10:00 Antineoplastic agents

Exemestane 1,5 10:00 Antineoplastic agents

Finasteride 1,3,5 92:08 5-alpha reductase inhibitors

Floxuridine 1,2,3,4,5 10:00 Antineoplastic agents

Fludarabine 1,2,3,4,5 10:00 Antineoplastic agents

Fluorouracil 1,2,3,4,5 10:00 Antineoplastic agents

Fluoxymesterone 5 68:08 Androgens

Flutamide 1,2,5 10:00 Antineoplastic agents

Fulvestrant 5 10:00 Antineoplastic agents

Ganciclovir 1,2,3,4,5 8:18.32 Nucleosides and nucleotides

Ganirelix acetate 5 92:40 Gonadotropin-releasing hormone 

antagonists 

Gemcitabine 1,2,3,4,5 10:00 Antineoplastic agents

Gemtuzumab ozogamicin 1,3,4,5 10:00 Antineoplastic agents

Gonadotropin, chorionic 5 68:18 Gonadotropins

Goserelin 1,2,5 10:00 Antineoplastic agents

Hydroxyurea 1,2,3,4,5 10:00 Antineoplastic agents

Idarubicin 1,2,3,4,5 10:00 Antineoplastic agents

Ifosfamide 1,2,3,4,5 10:00 Antineoplastic agents

Imatinib mesylate 1,3,4,5 10:00 Antineoplastic agents

Irinotecan HCl 1,2,3,4,5 10:00 Antineoplastic agents

Ixabepilone 7 10:00 Antineoplastic agents

Leflunomide 3,5 92:36 Disease-modifying antirheumatic agents 

Lenalidomide 6 92:20 Biologic response modifiers

Letrozole 1,5 10:00 Antineoplastic agents

Leuprolide acetate 1,2,5 10:00 Antineoplastic agents

Lomustine 1,2,3,4,5 10:00 Antineoplastic agents

Mechlorethamine 1,2,3,4,5 10:00 Antineoplastic agents

Medroxyprogesterone 

acetate

6 68:32 Progestins

Megestrol 1,5 10:00 Antineoplastic agents

See footnotes at end of table (Continued)

Table 1 (Continued). Sample List of Drugs that Should be Handled as Hazardous*
9

Drug Source AHFS Pharmacologic-therapeutic classification

Melphalan 1,2,3,4,5 10:00 Antineoplastic agents

Menotropins 5 68:18 Gonadotropins

Mercaptopurine 1,2,3,4,5 10:00 Antineoplastic agents

Methotrexate 1,2,3,4,5 10:00 Antineoplastic agents

Methyltestosterone 5 68:08 Androgens

Mifepristone 5 76:00 Oxytocics

Mitomycin 1,2,3,4,5 10:00 Antineoplastic agents

Mitotane 1,4,5 10:00 Antineoplastic agents

Mitoxantrone HCl 1,2,3,4,5 10:00 Antineoplastic agents

Mycophenolate mofetil 1,3,5 92:44 Immunosuppressive agents

Mycophenolic acid 7 92:44 Immunosuppressive agents

Nafarelin 5 68:18 Gonadotropins

Nelarabine 6 10:00 Antineoplastic agents

Nilotinib 7 10:00 Antineoplastic agents

Nilutamide 1,5 10:00 Antineoplastic agents

Oxaliplatin 1,3,4,5 10:00 Antineoplastic agents

Oxcarbazepine 7 28:12.92 Anticonvulsants, miscellaneous

Oxytocin 5 76:00 Oxytocics

Paclitaxel 1,2,3,4,5 10:00 Antineoplastic agents

Palifermin 6 84:16 Cell stimulants and proliferants

Paroxetine** 6, 7 28:16.04.20 Selective serotonin uptake inhibitors

Pazopanib HCl 7 10:00 Antineoplastic agents

Pegaspargase 1,2,3,4,5 10:00 Antineoplastic agents

Pemetrexed 6 10:00 Antineoplastic agents

Pentamidine isethionate 1,2,3,5 8:30.92 Antiprotozoals, miscellaneous

Pentetate calcium 

trisodium††

6 Not in AHFS

Pentostatin 1,2,3,4,5 10:00 Antineoplastic agents

Phenoxybenzamine HCl 7 12:16.04.04 Non-selective alpha-adrenergic 

blocking agents

Pipobroman 3,5 Not in AHFS (antineoplastic agent)

Plerixafor 7 20:16 Hematopoietic agents

Podofilox 5 84:92 Miscellaneous skin and mucous membrane 

agents (mitotic inhibitor)

See footnotes at end of table (Continued)

Table 1 (Continued). Sample List of Drugs that Should be Handled as Hazardous*
10

Drug Source AHFS Pharmacologic-therapeutic classification

Podophyllum resin 5 84:92 Skin and mucous membrane agents, 

miscellaneous

Pralatrexate 7 10:00 Antineoplastic agents

Procarbazine 1,2,3,4,5 10:00 Antineoplastic agents

Progesterone 5 68:32 Progestins

Progestins 5 68:12 Contraceptives

Raloxifene 5 68:16.12 Estrogen agonists-antagonists

Rasagiline mesylate 6 28:36 Antiparkinsonian agents

Ribavirin 1,2,5 8:18.32 Nucleosides and nucleotides

Risperidone 6 28:16.08.04 Atypical antipsychotics

Romidepsin 7 10:00 Antineoplastic agents

Sirolimus 6 92:44 Immunosuppressive agents

Sorafenib 6 10:00 Antineoplastic agents

Streptozocin 1,2,3,4,5 10:00 Antineoplastic agents

Sunitinib malate 6 10:00 Antineoplastic agents

Tacrolimus 1,5 92:44 Immunosuppressive agents

Tamoxifen 1,2,5 10:00 Antineoplastic agents

Televancin 7 8:12.28.16 Glycopeptides

Temozolomide 3,4,5 10:00 Antineoplastic agents

Temsirolimus 7 10:00 Antineoplastic agents

Teniposide 1,2,3,4,5 10:00 Antineoplastic agents

Testolactone 5 10:00 Antineoplastic agents

Testosterone 5 68:08 Androgens

Tetracycline HCl 7 8:12.24 Tetracyclines

Thalidomide 1,3,5 92:20 Biologic response modifiers

Thioguanine 1,2,3,4,5 10:00 Antineoplastic agents

Thiotepa 1,2,3,4,5 10:00 Antineoplastic agents

Topotecan 1,2,3,4,5 10:00 Antineoplastic agents

Toremifene citrate 1,5 10:00 Antineoplastic agents

Tretinoin 1,2,3,5 84:16 Cell stimulants and proliferants

Trifluridine 1,2,5 52:04.20 Antivirals

Triptorelin 5 10:00 Antineoplastic agents

Uracil mustard 3,5 Not in AHFS (antineoplastic agent)

See footnotes at end of table (Continued)

Table 1 (Continued). Sample List of Drugs that Should be Handled as Hazardous*
11

Drug Source AHFS Pharmacologic-therapeutic classification

Valganciclovir 1,3,5 8:18.32 Nucleosides and nucleotides

Valproic acid/ 

divalproex Na 

7 28:12.92 Anticonvulsants, miscellaneous

Valrubicin 1,2,3,5 10:00 Antineoplastic agents

Vidarabine 1,2,5 Not in AHFS

Vigabatrin 7 28:12.92 Anticonvulsants, miscellaneous

Vinblastine sulfate 1,2,3,4,5 10:00 Antineoplastic agents

Vincristine sulfate 1,2,3,4,5 10:00 Antineoplastic agents

Vinorelbine tartrate 1,2,3,4,5 10:00 Antineoplastic agents

Vorinostat 6 10:00 Antineoplastic agents

Zidovudine 1,2,5 8:18:08 Antiretroviral agents

Ziprasidone HCl 7 28:16.08.04 Atypical antipsychotics

Zoledronic acid 7 92:24 Bone resorption inhibitors

Zonisamide 6 28:12.92 Anticonvulsants, miscellaneous

*These lists of hazardous drugs were used with the permission of the institutions that provided them and were adapted for 

use by NIOSH. The sample lists are intended to guide health care providers in diverse practice settings and should not 

be construed as complete representations of all of the hazardous drugs used at the referenced institutions. Some drugs 

defined as hazardous may not pose a significant risk of direct occupational exposure because of their dosage formulation 

(for example, intact medications such as coated tablets or capsules that are administered to patients without modifying 

the formulation). However, they may pose a risk if solid drug formulations are altered outside a ventilated cabinet (for 

example, if tablets are crushed or dissolved, or if capsules are pierced or opened). †

BCG preparation should be done using aseptic techniques. To avoid cross-contamination, parenteral drugs should not be 

prepared in areas where BCG has been prepared. A separate area for the preparation of BCG suspension is recommended. 

All equipment, supplies, and receptacles in contact with BCG should be handled and disposed of as biohazardous. If preparation cannot be performed in a containment device, then respiratory protection, gloves and a gown should be worn to 

avoid inhalation or contact with BCG organisms.

1. The NIH Clinical Center, Bethesda, MD (Revised 8/2002). The NIH Health Clinical Center Hazardous Drug (HD) 

List is part of the NIH Clinical Center’s hazard communication program. It was developed in compliance with the 

OSHA hazard communication standard [29 CFR 1910.1200] as it applies to hazardous drugs used in the workplace. 

The list is continually revised and represents the diversity of medical practice at the NIH Clinical Center; however, its 

content does not reflect an exhaustive review of all FDA-approved medications that may be considered hazardous, and 

it is not intended for use outside the NIH.

2. The Johns Hopkins Hospital, Baltimore, MD (Revised 9/2002).

3. The Northside Hospital, Atlanta, GA (Revised 8/2002).

4. The University of Michigan Hospitals and Health Centers, Ann Arbor, MI (Revised 2/2003)

5. This sample listing of hazardous drugs was compiled by the Pharmaceutical Research and Manufacturers of America 

(PhRMA) using information from the AHFS DI monographs published by ASHP in selected AHFS PharmacologicTherapeutic Classification categories [ASHP/AHFS DI 2003] and applying the definition for hazardous drugs. The list 

also includes drugs from other sources that satisfy the definition for hazardous drugs [PDR 2004; Sweetman 2002; 

Shepard 2001; Schardein 2000; REPROTOX 2003]. Newly approved drugs that have structures or toxicological profiles that mimic the drugs on this list should also be included. This list was revised in June 2004.

6. NIOSH addition 2010 updated using ASHP/AHFS DI 2010.

7. NIOSH addition 2012 updated using ASHP/AHFS DI 2011. **2010, Paroxetine HCl; 2012, Paroxetine mesylate

††Refers to non-radio-labeled formulation only.

Table 1 (Continued). Sample List of Drugs that Should be Handled as Hazardous*
12

Drugs reclassified as not meeting criteria for a hazardous drug*

Drug AHFS Pharmacologic-therapeutic classification

alemtuzumab 10:00 Antineoplastic agents

interferon alfa 2a 10:00 Antineoplastic agents

interferon alfa 2b 10:00 Antineoplastic agents

interferon alfa n3 10:00 Antineoplastic agents

 Radio-pharmaceuticals that are regulated by Nuclear Regulatory Commission,

which directs how they are handled†

Drug AHFS Pharmacologic-therapeutic classification

ibritumomab tiuxetan 10:00 Antineoplastic agents

tositumomab 10:00 Antineoplastic agents

Drugs that are currently not available in the United States‡

Drug AHFS Pharmacologic-therapeutic classification

dienestrol 68:16.04 Estrogens

interferon alfa n1 10:00 Antineoplastic agents

perphosphamide Not in AHFS (antineoplastic agent)

piritrexim isethionate Not in AHFS (antineoplastic agent)

plicamycin Not in AHFS (antineoplastic agent)

prednumustine Not in AHFS (antineoplastic agent)

raltitrexed Not in AHFS (antineoplastic agent)

trimetrexate glucuronate 8:30.92 Miscellaneous antiprotozoals

vindesine Not in AHFS (antineoplastic agent)

Table 2. Drugs Deleted from 2010 Appendix A 

*

The 2004 NIOSH list of hazardous drugs was a compilation of hazardous drug lists provided by other organizations. 

These four drugs were reviewed using the NIOSH criteria and found not to meet the criteria for listing as hazardous. †

Regulations for handling radiopharmaceuticals can be found at: U.S. NRC: Medical Uses of Nuclear Materials, [http://

www.nrc.gov/materials/miau/med-use.html]. ‡

The NIOSH hazardous drug list is based on approvals by the U.S. FDA. These drugs are not approved by the U.S. FDA 

and are no longer available in the U.S. However, some may be available in other countries.
13

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Acknowledgments

This document was written by Thomas H. Connor, 

PhD; Barbara A. MacKenzie, BS; D. Gayle DeBord, 

PhD; Douglas B. Trout, MD, MHS; and James P. 

O’Callaghan, PhD. (NIOSH).

Vanessa Williams and Tom Ziegler provided 

graphic design and production services.

1–800–CDC–INFO

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