Antineoplastics exposure levels

Yoshida J, Koda S, Nishida S, Yoshida Ti, Miyajima K, Kumagai S (2011) Association between occupational exposure levels of antineoplastic drugs and work environment in five hospitals in Japan. J Oncol Pharm Pract 17(l) 29-38... 

In a study in 8 patients, cimetidine 400 mg twice daily increased the AUC of epirubicin by 50%. At the same time the AUCs of two metabolites of epirubicin, epirubicinol and 7-deoxydoxorubicinol aglycone, increased by 41% and 357%, respectively. Liver blood flow also increased by 17%. The mechanism is unknown. More study of this interaction is needed but be aware of the possibility of cimetidine inereasing the exposure to epirubicin monitor the patient closely and adjust epirubicin dosage if needed. Cimetidine is available without a preseription in some countries so that patients may unwittingly increase the toxicity of epirubicin. Cimetidine has also increased the levels or toxicity of some other antineoplastics, see Nitrosoureas + Cimetidine , p.655, Cyclophosphamide + H2-receptor antagonists , p.626 and Fluorouracil + H2-reeeptor antagonists , p.633. 

Exposure from antineoplastics in hospital pharmacies and wards during reconstitution of parenteral medicines is monitored and evaluated by assessing contamination levels in air, on surfaces or personnel (blood, urine). Publications originate from all over the world, for example in the Netherlands [33-37, 54], in Sweden [55], Germany [56-58], UK [59], Italy [60, 61], France [62-64], US and Canada [65, 66] and Japan [67]. 

However, as long as such substances are indispensable (or put differently as long as Society accepts the use of such substances, e.g. many antineoplastics), the risk of exposure, and thus the risk of cancer, cannot be completely avoided. The same applies to limits for sensitising substances (see Sect. 26.3.3). Limiting the risk level is the general approach for these substances. Limits are set based on an accepted risk of 10 (the value of p being decided upon by Society). 

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