Permeability of latex and polyvinyl chloride gloves to fluorouracil and methotrexate

The permeability of latex surgical and polyvinyl chloride (PVC) examination gloves to fluorouracil and methotrexate was studied using a radiotracer method. Drug-tracer solutions for both drugs were prepared by combining tritiated fluorouracil or methotrexate with fluorouracil or methotrexate injection, respectively. Drug-free solutions were also prepared to be as similar as possible to the vehicles of the commercial injections. Each half of a total of 40 equilibrium-dialysis cells (20 for each glove type) was filled with either the drug-tracer solution or the drug-free solution. The cell halves were then sealed with glove membranes cut from each type of glove and fastened together so that the drug-tracer and drug-free solutions of each respective drug were opposite one another. Samples were collected after 5 to 45 minutes from each dialysis-cell well and analyzed for drug using liquid scintillation counting techniques. Microgram levels of both drugs were detected in the drug-free dialysis wells for both glove types at each sampling time. Except for the methotrexate drug-labeled well sealed with the PVC glove membrane, the amount of drug in the dialysis wells was significantly different at different sampling times. The variability in results using gloves from different lots was also significantly different for both types of gloves. Overall, latex gloves were significantly less permeable than PVC gloves to fluorouracil, and PVC gloves were significantly less permeable to methotrexate than latex gloves. The latex and PVC gloves used in this study both exhibit time-dependent permeability to fluorouracil and methotrexate.(ABSTRACT TRUNCATED AT 250 WORDS)     

Permeability of nitrile rubber, latex, polyurethane, and neoprene gloves to 18 antineoplastic drugs.

The permeability of four glove materials to various antineoplastic drugs was studied. Eighteen antineoplastic drugs posing potential health hazards to handlers were prepared at the highest concentrations normally encountered by hospital personnel. Four glove materials-nitrile rubber, latex, polyurethane, and neoprene-were exposed to the drugs for 30, 60, 90, and 120 minutes. Glove thickness was measured with an electronic digital caliper. Random samples of material were selected from the glove fingertips, and triplicate samples were tested for each drug at each interval. For a majority of the drugs, a bacterial mutagenicity assay was used to measure the amount of drug (if any) that permeated the material. High-performance liquid chromatography was used for drugs not tested with the bacterial assay. The nitrile gloves were the thinnest (0.12 mm), and the latex gloves were the thickest (0.18 mm). The four materials were generally impermeable to each drug. One sample of the nitrile gloves appeared to have a defect, allowing >5% of the drug solution to pass through at 30 minutes. One sample each of the latex, polyurethane, and neoprene gloves demonstrated minimal permeability (< or =1%): One latex glove sample was permeated by carmustine, and paclitaxel permeated one sample each of the polyurethane and neoprene materials. Nitrile rubber, latex, polyurethane, and neoprene gloves were impermeable to 18 antineoplastic drugs in most, but not all, cases.     

Permeability of four disposable protective-clothing materials to seven antineoplastic drugs

The permeability of four types of protective-clothing material to seven injectable antineoplastic drugs was studied. The protective materials tested were Saranex-laminated Tyvek, polyethylene-coated Tyvek, nonporous Tyvek, and Kaycel. Circles 6 cm in diameter were cut from a single garment of each material and exposed to each drug. Permeation of cisplatin, etoposide, mitomycin, cyclophosphamide, carmustine, and thiotepa was assessed by the Salmonella mutagenicity test after four hours of exposure. Doxorubicin permeation was assessed qualitatively over an eight-hour exposure period using a coloration assay. Saranex-laminated Tyvek was not permeable under the test conditions. Polyethylene-coated Tyvek was slightly permeable to thiotepa and carmustine. Nonporous Tyvek was permeable to all seven drugs, and the Kaycel garment was permeable to all of the drugs except etoposide. In no instance did permeation exceed 3.3% of the applied drug dose. Saranex-laminated Tyvek was the most protective of the barrier garments, followed closely in effectiveness by the polyethylene-coated Tyvek. Clothing made from these two Tyvek composites would allow less air flow and, therefore, would be less comfortable to wear for extended periods. Garments made of nonporous Tyvek or Kaycel would be more comfortable, but their use should be accompanied by an awareness of their potential permeability to certain antineoplastic drugs.     

Sorption of four drugs to polyvinyl chloride and polybutadiene intravenous administration sets

Sorption of nitroglycerin, isosorbide dinitrate, diazepam, and clomethiazole edisylate (chlormethiazole) to polyvinyl chloride (PVC) i.v. administration sets with and without cellulose propionate burettes and to polybutadiene (PBD) sets with and without methacrylate butadiene styrene (MBS) burettes was studied. All drugs (except chlormethiazole) were diluted with 0.9% sodium chloride injection (NS) in glass bottles or in the burette chambers. Initial samples of each solution were obtained from the bottle or from the burette, and effluent samples were collected at various times up to 240 minutes from the sets without burettes and up to 90 minutes from the sets with burettes. For nitroglycerin, flow rates of 0.5 and 1.0 mL/min were used without the burette. The effect of priming the tubing before adding drug to the burette was studied for diazepam. Triplicate samples were analyzed for nitroglycerin and isosorbide dinitrate by high-performance liquid chromatography and for diazepam and chlormethiazole by ultraviolet spectrophotometry. Up to 50% potency of chlormethiazole and nitroglycerin, 15-25% of isosorbide dinitrate, and 13-20% of diazepam was lost to PVC sets without burettes, and an additional 10-15% loss of each drug resulted when PVC sets with burettes were used. Less sorption of nitroglycerin to the PVC sets occurred at the higher flow rate, but flow rate through the PBD sets did not affect sorption. Priming the tubing before adding diazepam to the burette did not affect final drug delivery. No loss to PBD sets was observed for nitroglycerin, isosorbide dinitrate, and diazepam; loss of chlormethiazole to PBD was 7-13%. Drug potency in effluent from PBD sets was not affected by presence or absence of a burette.(ABSTRACT TRUNCATED AT 250 WORDS)     

Sorption of various drugs in polyvinyl chloride, glass, and polyethylene-lined infusion containers

The sorption of chloroquine sulfate, diazepam, isosorbide dinitrate, lorazepam, midazolam, nitroglycerin, promethazine hydrochloride, thiopental sodium, and warfarin sodium to three types of containers was studied. Appropriate amounts of the drugs were added to 500 mL of 0.9% sodium chloride injection in polyvinyl chloride (PVC) bags, glass bottles, and Clear-Flex bags composed of a laminate of polyethylene, nylon, and polypropylene. The containers were stored in the dark at room temperature for 24 hours. Samples were taken at various intervals and assayed for drug concentration by high-performance liquid chromatography. There were no appreciable changes in pH after 24 hours, and all the admixtures remained clear and colorless. The potency of chloroquine sulfate, lorazepam, midazolam, promethazine hydrochloride, and thiopental sodium remained unchanged in glass, PVC, and Clear-Flex containers. Diazepam, isosorbide dinitrate, nitroglycerin, and warfarin sodium did not show any sorption to glass bottles and Clear-Flex bags. In PVC bags, however, up to 55% of diazepam, 23% of isosorbide dinitrate, 51% of nitroglycerin, and 24% of warfarin sodium was lost during the 24-hour study period. Diazepam, isosorbide dinitrate, nitroglycerin, and warfarin sodium in 0.9% sodium chloride injection showed a loss of potency when stored in PVC containers for 24 hours at room temperature, but none of the drugs studied lost potency when stored in glass bottles and Clear-Flex bags.     

Safe handling of antineoplastic drugs

Managers should be aware of the hazardous properties of antineoplastic drugs and of the procedures and equipment commonly recommended to provide a safe working environment for employees, patients, and visitors. Compliance with the many published guidelines should help ensure passage of the inevitable Occupational Safety and Health Administration (OSHA) or Joint Commission inspection. Acute and chronic toxicities of the antineoplastic drugs, the potential for exposure in the workplace, and the basic guidelines for safe handling of these agents are reviewed.     

抗癌药物不良反应的职业防护

作者简要介绍了抗癌药物对制药人员和医务人员健康的危害，以及如何对暴露于该类药物的人群进行监测的方法。目前国外研究认为，防护的最佳途径是加强操作中的保护措施和对有关人员进行相关知识的教育。     

Carcinogenicity and epidemiological profile analysis of vinyl chloride and polyvinyl chloride

The carcinogenicity of vinyl chloride and polyvinyl chloride ($\text{VC}\text{PVC}$) is reviewed with specific attention to the gaps in knowledge for risk estimation and epidemiological presentation of the available data. Although experimental studies have demonstrated the carcinogenicity and mutagenicity of $\text{VC}\text{PVC}$ in general, the epidemiologic studies available for review do not include an assessment of carcinogenic risk among humans exposed to these chemicals. This conclusion is based on the observation that the majority of cohort studies reviewed lacked sufficient statistical power because of small sample sizes. Further, in epidemiological studies, individuals were not followed over an adequate period of time during which cancer could become clinically manifest.     

Sorption of amiodarone to polyvinyl chloride infusion bags and administration sets

The loss of amiodarone from i.v. admixtures to flexible polyvinyl chloride (PVC) infusion bags and i.v. administration sets was studied. Admixtures containing amiodarone hydrochloride 600 micrograms/mL and either 5% dextrose injection or 0.9% sodium chloride injection were stored at room temperature in glass bottles (both with and without contact of the drug solution with the rubber bottle closure), in flexible PVC bags, or in rigid PVC bottles. After 120 hours, the contents of each flexible PVC bag were emptied and replaced by methanol, which was allowed to remain in the bag for an additional 120 hours and was then analyzed for amiodarone content. To determine availability of amiodarone after infusion through a 1.8-m PVC i.v. administration set, solutions stored in glass containers were run through the set at 0.5 mL/min for 90 minutes. Samples of drug solutions were collected at appropriate intervals and analyzed by a stability-indicating high-performance liquid chromatography (HPLC) assay. Admixtures containing 0.9% sodium chloride injection were not stable; visual incompatibility was evident after 24 hours of storage in glass bottles, and no further testing was performed. In admixtures containing 5% dextrose injection that were stored in 50-mL flexible PVC bags, 60% of the initial amiodarone concentration remained after 120 hours; approximately half of the lost drug was recovered with the methanol. In effluent collected from the PVC administration set, 82% of the initial amiodarone concentration remained. Amiodarone concentrations did not decrease appreciably, after storage in glass or rigid PVC bottles, indicating that drug loss was probably affected by the plasticizer, di-2-ethylhexyl phthalate.(ABSTRACT TRUNCATED AT 250 WORDS)     

Degradation and disposal of some antineoplastic drugs

Bulk quantities and pharmaceutical preparations of the antineoplastic drugs carmustine (BCNU), lomustine (CCNU), chlorozotocin, N-[2-chloroethyl]-N'-[2,6-dioxo-3-piperidinyl]-N-nitrosourea (PCNU), methyl CCNU, mechlorethamine, melphalan, chlorambucil, cyclophosphamide, ifosfamide, uracil mustard, and spiromustine may be degraded using nickel-aluminum alloy in KOH solution. The drugs are completely destroyed and only nonmutagenic reaction mixtures are produced. Destruction of cyclophosphamide in tablets requires refluxing in HCl before the nickel-aluminum alloy reduction. Streptozotocin, chlorambucil, and mechlorethamine may be degraded using an excess of saturated sodium bicarbonate solution. The nitrosourea drugs BCNU, CCNU, chlorozotocin, PCNU, methyl CCNU, and streptozotocin were also degraded using hydrogen bromide in glacial acetic acid. The drugs were completely destroyed but some of the reaction mixtures were mutagenic and the products were found to be, in some instances, the corresponding mutagenic, denitrosated compounds.     

Oxidation of 2-mercaptobenzothiazole in latex gloves and its possible haptenation pathway

The rubber accelerator, 2-mercaptobenzothiazole (MBT), has been reported to cause allergic contact dermatitis from gloves and other rubber products, but its chemical fate when exposed to occupational oxidants and the mechanism of its pathogenesis are not known. It was hypothesized that the thiol group is critical to MBT's (its oxidation products or metabolites) covalent binding and/or haptenation to nucleophilic protein residues. Oxidative transformation of MBT to the disulfide 2,2'-dithiobis(benzothiazole) (MBTS) was observed within the glove matrix when hypochlorous acid, iodine, and hydrogen peroxide were used as oxidants. Cysteine reduced MBTS to MBT with subsequent formation of the mixed disulfide 2-amino-3-(benzothiazol-2-yl disulfanyl)propionic acid which was identified and characterized. Spectrophotometry and mass spectrometry experiments demonstrated the simultaneous reduction of MBTS and disulfide formation with Cys34 on bovine serum albumin, suggesting a potential route of protein haptenation through covalent bonding between protein cysteinyl residues and the MBT/MBTS thiol moiety. Metabolism of MBT using isoniazid and dexamethasone-induced rat liver microsomes, to give a protein reactive epoxide intermediate and provide an alternative protein haptenation mechanism, was not observed. The data suggest that the critical functional group on MBT is the thiol, and haptenation is via the formation of mixed disulfides between the thiol group on MBT and a protein sulfhydryl group.     

Permeability of 13 different gloves to 13 cytotoxic agents under controlled dynamic conditions.

PURPOSE: The permeability of 13 different gloves to 13 cytotoxic agents under controlled dynamic conditions is described. METHODS: Thirteen cytotoxic agents were prepared at the highest concentrations normally encountered by pharmacy personnel. Four glove types--neoprene, natural rubber latex, nitrile, and vinyl--were exposed to the cytotoxic agents for 15, 30, and 60 minutes. Tests were conducted using the middle finger of each glove. Linearity, reproducibility, and sensitivity were evaluated for each drug tested. Assays were run using liquid chromatographic tandem mass spectrometry (LC/MS/MS) and high-performance liquid chromatography with ultraviolet light (HPLC-UV). Permeability testing was conducted using an original system designed to evaluate dynamic constraints, such as rubbing, stretching, and tension. RESULTS: Linearity by LC/MS/MS and HPLC-UV was confirmed at concentrations up to 1000 ng/mL for all drugs. Most glove materials were permeable at rates below ASTM recommendations over the one-hour testing period. Vinyl was the most permeable material. Carmustine permeated the widest variety of materials. Due to the high sensitivity of the analytic methods, all materials displayed low but significant permeability for at least one drug after one hour. Higher resistance to permeation was recorded for all neoprene, some natural rubber latex, and one nitrile glove. CONCLUSION: Neoprene, natural rubber latex, and nitrile gloves displayed the highest resistance to permeation of the 13 cytotoxic agents studied. Additional factors, such as duration of exposure, glove thickness, and drug liposolubility and molecular weight, also affected permeability.     

Stability of infliximab in polyvinyl chloride bags

Purpose The stability of prepared infusions of the tumor necrosis factor (TNF)-α agent infliximab after storage for up to two weeks was investigated. Methods To determine the feasibility of liberalized expiration dating of infliximab (current recommendations call for the infusion of prepared doses within three hours), the stability of diluted infliximab stored in polyvinyl chloride (PVC) bags at 4 °C for up to 14 days was evaluated. A known quantity of TNF-α was combined with infliximab test samples in PVC bags for one hour; immediately after the reaction period and after 7 and 14 days of storage, the residual amount of TNF-α (an indirect measure of the drug's biological activity) was analyzed via a validated enzyme-linked immunosorbent assay (ELISA). Results The mean ± S.D. amount of TNF-α consumed by infliximab was calculated to be 24.5 ± 5.6 pg/mL at baseline, 29.0 ± 4.4 pg/mL at 7 days, and 24.8 ± 17.3 pg/mL at 14 days. At all evaluated time points, ELISA results indicated that 19-24% of the original TNF-α had been consumed by infliximab (mean ± S.D. consumption: 19.6% ± 4.5% at baseline, 23.2% ± 3.5% at 7 days, and 19.8% ± 13.8% at 14 days). Conclusion Infliximab, when prepared at a concentration of 400 μg/mL in 0.9% sodium chloride injection, incurred no loss of biological activity when stored for up to 14 days at 4 °C in PVC bags. Changing infliximab preparation practices may improve clinic efficiency by reducing patient dissatisfaction with long wait times for infusions and avoiding costly waste.     

Monitoring of oxidative stress in nurses occupationally exposed to antineoplastic drugs

Antineoplastic drugs (ANDs) have been in clinical usage for more than five decades. The nonselective mechanism of action of ANDs between cancerous and noncancerous cells had well documented side effects such as acute symptoms, reproductive health issues, and potential cancer development in healthcare workers as a result of occupational exposure. The anticancer mechanism of ANDs is the generation of reactive oxygen species (ROS) which are responsible for various side effects in patients undergoing chemotherapy and the healthcare personnel occupationally exposed to them. ROS have potential to damage lipids, DNA, proteins, and so on leading to oxidative stress condition. The aim of this study was to evaluate the possible oxidative stress effect of antineoplastic drugs in nurses who routinely handle ANDs in an oncology hospital in south India. Malondialdehyde levels, reduced glutathione content, and glutathione S-transferase activity were analyzed in serum collected from 60 female nurses handling ANDs and compared with equal number of healthy volunteers matched by age and sex except AND exposure. The results showed statistically significant (P < 0.05) increase in malondialdehyde levels in the serum of exposed nurses. However, glutathione content and glutathione S-transferase activity was significantly decreased in these nurses. Our study suggests that the nurses occupationally exposed to ANDs were susceptible to the oxidative stress and emphasizes the need for a harmonized safe handling approach that assures minimal risk to the working nurses.     

抗肿瘤药物职业暴露中尿液残留量测定方法的建立及应用

目的对山西省内抗肿瘤药物调配人员职业暴露情况进行评估。方法采用高效液相色谱串联质谱的方法对全省10家医疗机构分层抽取的104名相关工作人员进行尿液环磷酰胺和顺铂的浓度测定,其中暴露组52例,非暴露组52例。结果暴露组2例对象检出,非暴露组研究对象未检出。结论工作人员在调配抗肿瘤药物过程中存在职业暴露,需加强防范并采取有效的措施避免。     

Adsorption of antineoplastic drugs to polyalkylcyanoacrylate nanoparticles and their release in calf serum

Conditions are described for attaching anticancer drugs to polyalkylcyanoacrylate nanoparticles, a new drug delivery system for cells that exhibit endocytic uptake. They are ultrafine, metabolizable, and able to associate with various drugs in a nonspecific manner. Data are given for the in vitro degradation and for drug release from this new drug carrier system.     

Ambroxol and pulmonary toxicity induced by antineoplastic drugs

The authors describe the potential effects of ambroxol on the pulmonary disorders induced by antineoplastic agents (in particular, bleomycin and the nitrosureas). An experimental stage focussed attention on the early modifications occurring in the alveolar surfactant and in the afflux of inflammatory and immune-effector cells following bleomycin-induced lung fibrosis in the rat (by intratracheal instillation). The ambroxol-protected rats showed a slower drop of alveolar lecithins in the first few hours after bleomycin administration and a lower afflux of neutrophils, macrophages and lymphocytes. In the clinical stage, respiratory function was studied in two groups of cancer patients treated with nitrosureas or bleomycin. Preliminary findings indicate a rapid worsening of some functional parameters--maximal expiratory flow at 25% vital capacity, diffusing capacity for carbon monoxide and diffusing capacity/ventilation--in controls, while no such changes occurred in the ambroxol-protected subjects. The possible pathogenetic implications of these results and perspective for future investigations are discussed.     

职业暴露抗肿瘤药和其他危险药物对医务人员的危害及防护

危险药物是指具有致癌性、致畸性、生殖毒性、遗传毒性及低剂量致器官毒性的药物,包括抗肿瘤药、抗病毒药、激素、免疫抑制剂等。大量研究表明,配制和使用危险药物的医务人员面临职业暴露风险。危险药物暴露可发生于呼吸道吸入、皮肤接触吸收、消化道摄入等。吸入和皮肤接触吸收可能是危险药物暴露的主要途径。职业暴露危险药物可导致机体免疫力降低、发生肿瘤的危险性增加和潜在的生殖损害,常见的不良反应有头晕、乏力、脱发、咳嗽、恶心、呕吐、月经异常及皮疹等,长期接触还可能引起慢性肝损害。为了减少危险药物暴露对医务人员的风险,应采取以下安全防护措施：制定安全操作规程;对可能接触危险药物的医务人员加强安全教育和培训;设置专用配药场所;使用生物安全柜;穿戴个人防护装备包括手套、隔离衣、护目镜、面罩和呼吸罩;加强对废弃物处理的管理;急性危险药物暴露应及时处理。