In healthcare, hazardous drugs are essential for treatment, but they also pose risks to the people who handle them. These drugs are classified as “hazardous” because they can cause harm to humans through direct contact, inhalation, or accidental exposure. The National Institute for Occupational Safety and Health (NIOSH) defines hazardous drugs as those that show one or more dangerous properties, such as carcinogenicity (cancer-causing potential), reproductive toxicity, organ damage, or genetic mutations.

For patients, these medications can be life-saving, especially in cancer care. For healthcare workers, pharmacists, and caregivers, knowing the different categories of hazardous drugs is vital for maintaining safety. Let’s break down the main types you should know about.

1. Antineoplastic Drugs (Chemotherapy Agents)

Perhaps the most well-known type of hazardous drug, antineoplastics are used to treat cancer. These medications work by stopping or slowing the growth of rapidly dividing cancer cells. Unfortunately, they don’t distinguish between cancerous and healthy cells, which is why they are toxic.

Examples include:

• Cyclophosphamide
  
• Methotrexate
  
• Cisplatin
  

Risks:

For patients, side effects often include nausea, hair loss, and fatigue. For healthcare workers, even small accidental exposures can cause skin irritation, fertility issues, or long-term health effects. Because of this, strict protocols for handling, storing, and disposing of chemotherapy drugs are in place.

2. Immunosuppressant Drugs

Immunosuppressants are medications that reduce or prevent the activity of the immune system. They’re commonly prescribed to patients who have undergone organ transplants or who suffer from autoimmune diseases such as rheumatoid arthritis or lupus.

Examples include:

• Azathioprine
  
• Cyclosporine
  
• Mycophenolate mofetil
  

Risks:

While effective, these drugs leave patients vulnerable to infections. For workers, exposure can cause nausea, liver damage, or lowered immunity. Long-term contact may even increase the risk of certain cancers.

3. Hormonal Agents

Another category of hazardous drugs includes hormonal therapies, often used to treat cancers of the breast, prostate, or reproductive organs. These drugs work by either blocking or mimicking natural hormones in the body.

Examples include:

• Tamoxifen
  
• Estrogen and progesterone products
  
• Testosterone therapies
  

Risks:

For patients, these drugs may cause side effects such as blood clots, weight gain, or mood swings. For healthcare workers, accidental exposure can disrupt natural hormone levels, potentially affecting fertility, reproductive health, and long-term well-being.

4. Antiviral Drugs

Some antiviral medications are also classified as hazardous due to their toxic effects. These are often used to treat infections such as HIV or herpes.

Examples include:

• Zidovudine (AZT)
  
• Ganciclovir
  

Risks:

Handling these drugs without protection can lead to headaches, skin rashes, or even genetic mutations. Over time, repeated exposure may affect bone marrow function, increasing the risk of anemia or immune suppression.

5. Bioengineered and Miscellaneous Drugs

Beyond the main categories, some bioengineered drugs and other specialized treatments fall under the hazardous label. These may include certain biologics, investigational drugs, or newer therapies with limited safety data.

Examples include:

• Monoclonal antibodies with cytotoxic effects
  
• Certain investigational cancer drugs
  
• Experimental treatments under clinical trials
  

Risks:

Because some of these drugs are relatively new, the full scope of risks isn’t always known. Healthcare facilities typically treat them as hazardous out of precaution, ensuring protective measures are in place.

Why Classification Matters

Recognizing the different categories of hazardous drugs goes beyond scientific knowledge—it’s a matter of safety. By identifying the type of drug in use, healthcare professionals can implement proper protective measures, such as utilizing closed-system transfer devices, double gloves, and protective gowns. Compounding pharmacy consultants also play a vital role in guiding safe handling practices, ensuring that both pharmacies and healthcare facilities maintain compliance with established safety standards.

Precautions extend beyond clinical settings as well. Patients taking hazardous drugs may release active drug particles through urine, vomit, or sweat. Caregivers and family members assisting with daily needs—like laundry or bathroom cleaning—should wear gloves and practice thorough handwashing to reduce the risk of exposure.

Final Thoughts

Hazardous drugs save lives, but they also carry risks for those who administer, prepare, or come into contact with them. By breaking them down into categories—antineoplastic drugs, immunosuppressants, hormonal agents, antivirals, and bioengineered drugs—we gain a clearer picture of where dangers lie.

Whether you’re a healthcare worker, a caregiver, or simply someone interested in medical safety, knowing these types empowers you to handle them responsibly. Respecting the risks while appreciating their benefits ensures both effective treatment and safety for everyone involved.