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NIOSH Hazardous Drugs 2024 — Reference for Nurses
v1.0.0 · NIOSH 2024 · Built-in · Last reviewed Dec 2024
NIOSH Hazardous Drugs 2024
CDC NIOSH List of Hazardous Drugs in Healthcare Settings · Tables 1 & 2 · Essential for oncology, chemo, and reproductive health nurses
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Table 1 — Drugs with manufacturer special handling information (MSHI) in package insert AND/OR classified as carcinogens by NTP or IARC. Requires full USP <800> compliance.
Table 2 — All other hazardous drugs meeting NIOSH criteria. May include reproductive/developmental hazards. Eligible for Assessment of Risk under USP <800>.
84 drugs found
Arsenic trioxide
Table 1
AHFS Class: Antineoplastic
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Double chemotherapy gloves, gown, eye protection. Negative pressure required for manipulation.
Azacitidine
Table 1
AHFS Class: Antineoplastic
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Double chemotherapy gloves, gown, eye protection. Negative pressure required.
Bendamustine
Table 1
AHFS Class: Antineoplastic
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Double chemotherapy gloves, gown, eye protection.
Bleomycin
Table 1
AHFS Class: Antineoplastic
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Chemotherapy gloves, gown. Avoid skin contact.
Busulfan
Table 1
AHFS Class: Antineoplastic
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Double chemotherapy gloves, gown, eye protection. Negative pressure required.
Cabazitaxel
Table 1
AHFS Class: Antineoplastic
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Double gloves, gown, eye protection.
Capecitabine
Table 1
AHFS Class: Antineoplastic
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Double gloves, gown. Avoid crushing tablets.
Carboplatin
Table 1
AHFS Class: Antineoplastic
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Double chemotherapy gloves, gown, eye protection. Negative pressure required.
Carmustine (BCNU)
Table 1
AHFS Class: Antineoplastic
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Double chemotherapy gloves, gown, face shield. Negative pressure required.
Chlorambucil
Table 1
AHFS Class: Antineoplastic
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Double chemotherapy gloves, gown, eye protection.
Cisplatin
Table 1
AHFS Class: Antineoplastic
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Double chemotherapy gloves, gown, eye protection. Negative pressure required.
Cladribine
Table 1
AHFS Class: Antineoplastic
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Double gloves, gown, eye protection.
Cyclophosphamide
Table 1
AHFS Class: Antineoplastic/Immunosuppressant
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Double chemotherapy gloves, gown, eye protection. Negative pressure required. Avoid inhaling dust.
Cytarabine (Ara-C)
Table 1
AHFS Class: Antineoplastic
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Double chemotherapy gloves, gown, eye protection.
Dacarbazine (DTIC)
Table 1
AHFS Class: Antineoplastic
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Double chemotherapy gloves, gown, eye protection. Light-sensitive.
Dactinomycin
Table 1
AHFS Class: Antineoplastic
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Double chemotherapy gloves, gown, eye protection.
Daunorubicin
Table 1
AHFS Class: Antineoplastic
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Double chemotherapy gloves, gown, eye protection. Vesicant.
Docetaxel
Table 1
AHFS Class: Antineoplastic
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Double gloves, gown, eye protection. Avoid skin contact.
Doxorubicin
Table 1
AHFS Class: Antineoplastic
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Double chemotherapy gloves, gown, eye protection. Vesicant — extravasation causes tissue necrosis.
Epirubicin
Table 1
AHFS Class: Antineoplastic
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Double chemotherapy gloves, gown, eye protection. Vesicant.
Eribulin
Table 1
AHFS Class: Antineoplastic
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Double gloves, gown, eye protection.
Estradiol (injectable/topical)
Table 1
AHFS Class: Hormone
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Gloves and gown. Avoid skin contact — absorbed transdermally.
Estrogen combinations
Table 1
AHFS Class: Hormone
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Gloves and gown. Avoid skin contact.
Etoposide (VP-16)
Table 1
AHFS Class: Antineoplastic
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Double chemotherapy gloves, gown, eye protection.
Fludarabine
Table 1
AHFS Class: Antineoplastic
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Double gloves, gown, eye protection. Avoid crushing tablets.
Fluorouracil (5-FU)
Table 1
AHFS Class: Antineoplastic
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Double chemotherapy gloves, gown, eye protection. Negative pressure required.
Gemcitabine
Table 1
AHFS Class: Antineoplastic
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Double chemotherapy gloves, gown, eye protection.
Hydroxyurea
Table 1
AHFS Class: Antineoplastic
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Double gloves, gown. Do not crush capsules.
Idarubicin
Table 1
AHFS Class: Antineoplastic
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Double chemotherapy gloves, gown, eye protection. Vesicant.
Ifosfamide
Table 1
AHFS Class: Antineoplastic
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Double chemotherapy gloves, gown, eye protection. Negative pressure required.
Irinotecan
Table 1
AHFS Class: Antineoplastic
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Double chemotherapy gloves, gown, eye protection.
Lomustine (CCNU)
Table 1
AHFS Class: Antineoplastic
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Double chemotherapy gloves, gown, face shield.
Mechlorethamine (Nitrogen mustard)
Table 1
AHFS Class: Antineoplastic
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Double chemotherapy gloves, gown, face shield, respirator. Highly vesicant.
Melphalan
Table 1
AHFS Class: Antineoplastic
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Double chemotherapy gloves, gown, eye protection.
Mercaptopurine (6-MP)
Table 1
AHFS Class: Antineoplastic
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Double gloves, gown. Do not crush tablets.
Methotrexate
Table 1
AHFS Class: Antineoplastic/Disease-modifying
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Double chemotherapy gloves, gown. Avoid crushing. Handle ALL strengths with caution.
Mitomycin C
Table 1
AHFS Class: Antineoplastic
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Double chemotherapy gloves, gown, eye protection. Vesicant.
Mitoxantrone
Table 1
AHFS Class: Antineoplastic
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Double chemotherapy gloves, gown, eye protection. Turns urine blue-green.
Oxaliplatin
Table 1
AHFS Class: Antineoplastic
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Double chemotherapy gloves, gown, eye protection. Cold-induced neuropathy — avoid cold exposure.
Paclitaxel (Taxol)
Table 1
AHFS Class: Antineoplastic
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Double chemotherapy gloves, gown, eye protection. Premedicate for hypersensitivity.
Procarbazine
Table 1
AHFS Class: Antineoplastic
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Double chemotherapy gloves, gown, eye protection. MAO inhibitor — dietary restrictions.
Streptozocin
Table 1
AHFS Class: Antineoplastic
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Double chemotherapy gloves, gown, eye protection. Nephrotoxic.
Tamoxifen
Table 1
AHFS Class: Hormone antagonist
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Gloves and gown. Avoid crushing tablets. Handle with care in reproductive-age workers.
Temozolomide
Table 1
AHFS Class: Antineoplastic
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Double gloves, gown. Do not open capsules.
Thalidomide
Table 1
AHFS Class: Immunomodulatory
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Double gloves, gown. Extreme teratogen — REMS program required. Female nurses of childbearing age must use contraception.
Thioguanine (6-TG)
Table 1
AHFS Class: Antineoplastic
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Double gloves, gown. Do not crush tablets.
Thiotepa
Table 1
AHFS Class: Antineoplastic
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Double chemotherapy gloves, gown, eye protection. Absorbed through skin.
Topotecan
Table 1
AHFS Class: Antineoplastic
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Double gloves, gown, eye protection.
Treosulfan (Grafapex)
Table 1
AHFS Class: Antineoplastic
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Double chemotherapy gloves, gown, eye protection. Added 2024.
Vinblastine
Table 1
AHFS Class: Antineoplastic
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Double chemotherapy gloves, gown, eye protection. Vesicant — fatal if given intrathecally.
Vincristine
Table 1
AHFS Class: Antineoplastic
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Double chemotherapy gloves, gown. FATAL if given intrathecally — must be dispensed in minibag, NEVER in syringe.
Vinorelbine
Table 1
AHFS Class: Antineoplastic
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Double chemotherapy gloves, gown, eye protection. Vesicant.
Datopotamab deruxtecan (Datroway)
Table 1
AHFS Class: Antineoplastic (ADC)
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Double gloves, gown, eye protection. Added Dec 2024.
Telisotuzumab vedotin (Emrelis)
Table 1
AHFS Class: Antineoplastic (ADC)
⚠ Reproductive/Developmental HazardMSHI Required
PPE & Handling: Double gloves, gown, eye protection. Added Dec 2024.
Azathioprine
Table 2
AHFS Class: Immunosuppressant
⚠ Reproductive/Developmental Hazard
PPE & Handling: Gloves and gown. Do not crush tablets. Teratogenic.
Cidofovir
Table 2
AHFS Class: Antiviral
⚠ Reproductive/Developmental Hazard
PPE & Handling: Gloves, gown, eye protection. Nephrotoxic and reproductive hazard.
Colchicine (injectable)
Table 2
AHFS Class: Anti-gout
⚠ Reproductive/Developmental Hazard
PPE & Handling: Gloves and gown for injectable form.
Cyclosporine
Table 2
AHFS Class: Immunosuppressant
⚠ Reproductive/Developmental Hazard
PPE & Handling: Gloves and gown. Reproductive hazard.
Degarelix
Table 2
AHFS Class: Hormone antagonist
⚠ Reproductive/Developmental Hazard
PPE & Handling: Gloves and gown. Reproductive/developmental hazard.
Diethylstilbestrol (DES)
Table 2
AHFS Class: Hormone
⚠ Reproductive/Developmental Hazard
PPE & Handling: Gloves and gown. Potent reproductive hazard.
Estrogen (oral tablets)
Table 2
AHFS Class: Hormone
⚠ Reproductive/Developmental Hazard
PPE & Handling: Gloves when handling crushed or split tablets.
Finasteride
Table 2
AHFS Class: 5-alpha reductase inhibitor
⚠ Reproductive/Developmental Hazard
PPE & Handling: Gloves. Women who are or may be pregnant must not handle crushed or broken tablets — absorbed through skin.
Flutamide
Table 2
AHFS Class: Antiandrogen
⚠ Reproductive/Developmental Hazard
PPE & Handling: Gloves and gown. Reproductive hazard.
Ganciclovir
Table 2
AHFS Class: Antiviral
⚠ Reproductive/Developmental Hazard
PPE & Handling: Gloves, gown, eye protection. Reproductive hazard — teratogenic in animals.
Goserelin
Table 2
AHFS Class: Hormone agonist
⚠ Reproductive/Developmental Hazard
PPE & Handling: Gloves. Reproductive hazard.
Leflunomide
Table 2
AHFS Class: DMARD
⚠ Reproductive/Developmental Hazard
PPE & Handling: Gloves and gown. Teratogenic — long half-life (active metabolite persists).
Lenalidomide
Table 2
AHFS Class: Immunomodulatory
⚠ Reproductive/Developmental Hazard
PPE & Handling: Gloves and gown. Severe teratogen — REMS program. Female workers of childbearing age must use contraception.
Leuprolide
Table 2
AHFS Class: Hormone agonist
⚠ Reproductive/Developmental Hazard
PPE & Handling: Gloves. Reproductive/developmental hazard.
Megestrol
Table 2
AHFS Class: Progestin
⚠ Reproductive/Developmental Hazard
PPE & Handling: Gloves and gown for liquid form. Reproductive hazard.
Metotrexate (oral low-dose)
Table 2
AHFS Class: DMARD/Antineoplastic
⚠ Reproductive/Developmental Hazard
PPE & Handling: Gloves when handling. Do not crush. Teratogenic at any dose.
Mycophenolate mofetil
Table 2
AHFS Class: Immunosuppressant
⚠ Reproductive/Developmental Hazard
PPE & Handling: Gloves and gown. Do not crush or open capsules. Teratogenic.
Nafarelin
Table 2
AHFS Class: Hormone agonist
⚠ Reproductive/Developmental Hazard
PPE & Handling: Gloves. Reproductive hazard.
Nicotine (patch/gum)
Table 2
AHFS Class: Smoking cessation
⚠ Reproductive/Developmental Hazard
PPE & Handling: Gloves when applying patches to patients. Avoid skin contact.
Oxytocin (injectable)
Table 2
AHFS Class: Oxytocic
⚠ Reproductive/Developmental Hazard
PPE & Handling: Gloves for handling concentrated forms. Reproductive hazard.
Podophyllin
Table 2
AHFS Class: Antimitotic
⚠ Reproductive/Developmental Hazard
PPE & Handling: Gloves and gown. Teratogenic. Avoid all skin contact.
Pomalidomide
Table 2
AHFS Class: Immunomodulatory
⚠ Reproductive/Developmental Hazard
PPE & Handling: Gloves and gown. Severe teratogen — REMS program required.
Progesterone (injectable)
Table 2
AHFS Class: Hormone
⚠ Reproductive/Developmental Hazard
PPE & Handling: Gloves and gown. Reproductive hazard.
Raloxifene
Table 2
AHFS Class: Hormone antagonist
⚠ Reproductive/Developmental Hazard
PPE & Handling: Gloves. Reproductive hazard.
Ribavirin
Table 2
AHFS Class: Antiviral
⚠ Reproductive/Developmental Hazard
PPE & Handling: Gloves, gown, N95 mask if aerosolized. Teratogenic — female healthcare workers of childbearing age should avoid exposure.
Tacrolimus
Table 2
AHFS Class: Immunosuppressant
⚠ Reproductive/Developmental Hazard
PPE & Handling: Gloves and gown. Reproductive hazard.
Testosterone
Table 2
AHFS Class: Androgen
⚠ Reproductive/Developmental Hazard
PPE & Handling: Gloves when applying topical forms. Absorbed through skin. Reproductive hazard.
Tretinoin (all-trans retinoic acid)
Table 2
AHFS Class: Retinoid/Antineoplastic
⚠ Reproductive/Developmental Hazard
PPE & Handling: Gloves. Highly teratogenic — avoid all exposure in pregnancy.
Valganciclovir
Table 2
AHFS Class: Antiviral
⚠ Reproductive/Developmental Hazard
PPE & Handling: Gloves and gown. Do not crush tablets. Reproductive hazard.
Zidovudine (AZT)
Table 2
AHFS Class: Antiretroviral
⚠ Reproductive/Developmental Hazard
PPE & Handling: Gloves. Reproductive hazard.