Cytotoxic drugs (also sometimes known as antineoplastics) describe a group of medicines that contain chemicals which are toxic to cells.

Cytotoxic drugs are used widely in healthcare settings as well as in the community in the treatment of conditions such as rheumatoid arthritis, multiple sclerosis, lupus and vasculitis.

A pharmacy or service user's GP practice will be able to inform whether a medication is a Cytotoxic drug. A list of these drugs, treatments and side effects can also be found on:

Cytotoxic drugs | British National Formulary | NICE

They include drugs such as:

  • azathioprine (Imuran)
  • cyclophosphamide (Cytoxan)
  • methotrexate (Rheumatrex or Trexall)

However, due to their anti-inflammatory effects as opposed to their ability to kill cells, low dosage of methotrexate is anti-inflammatory and not cytotoxic.

The toxicity of Cytotoxic drugs means that they can present significant risks to those who handle them, and they are under the Control of Substances Hazardous to Health Regulations 2002.

Exposure may be through skin contact, skin absorption, inhalation of aerosols and drug particles, ingestion and needle stick injuries.

Once inside the body, Cytotoxic drugs can produce side effects both to the service user and others who become exposed to them.

Providers must assess the risks of their staff before handling Cytotoxic drugs (and containers) and take suitable precautions to protect them.

Provider risk assessments must include control measures to protect their staff, otherwise it could result in one or more of the following:

  • Abdominal pain, hair loss, nasal sores, vomiting, and liver damage.
  • Contact dermatitis and local allergic reactions.
  • Foetal loss in pregnant women and malformations in the children of pregnant women.
  • Alterations to normal blood cell count.

It is vital for staff to use Personal Protective Equipment (PPE) when handling Cytotoxic drugs and/or containers, ensuring the safe disposal of gloves and aprons.

Staff must always wash their hands after handling Cytotoxic drugs.

Providers must ensure they have relevant policies and procedures for dealing with Cytotoxic drugs and that staff involved in the risk assessing and supporting of Cytotoxic drugs are given appropriate information, instructions and training relevant to their role and associated risks.

Further guidance

Safe handling of cytotoxic drugs in the workplace | HSE (

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