August 13, 2026 Author : Ana Pragana (pharmacy technician) Cytotoxic medicines are drugs that act on cells, preventing their multiplication or destroying them. Their name reflects this action: cyto (cells) + toxic (causing damage) = cytotoxic. These medicines are used primarily to treat various types of cancer through chemotherapy and are often administered intravenously , which means they must be sterile. As a rule, they are highly potent drugs, and their doses must be carefully adjusted for each l patient , taking into account factors such as weight, height, age, and specific characteristics of the disease. For this reason, they are generally prepared immediately before administration in the Hospital Pharmacy of the hospitals where these treatments are provided. The handling of cytotoxic medicines by healthcare professionals involves potential occupational risks from accidental exposure. Although these medicines target rapidly dividing cells, such as cancer cells, they cannot distinguish between tumor cells and healthy cells. As a result, exposure to these drugs may have mutagenic, carcinogenic, or teratogenic effects. For all these reasons, the preparation of cytotoxic medicines follows strict safety standards designed to: Ensure that patients receive sterile, effective, and safe medicines; Protect the health of the professionals who prepare and administer them. Particularities of cytotoxic medicine preparation The preparation environment In hospital pharmacies, cytotoxic medicines are prepared in dedicated areas reserved only for this activity. These areas typically have the following features: Vertical laminar airflow cabinets where the air is filtered through high-efficiency HEPA filters, creating an air curtain that maintains a sterile environment and protects operators from exposure to aerosols generated during the handling of cytotoxic medicines. Are negative-pressure rooms, where the air pressure is lower than that of surrounding areas, preventing air from escaping the room and contaminating adjacent spaces. Personal protective equipment (PPE) Protection against respiratory and skin exposure requires the use of specific personal protective equipment: Chemical-resistant gloves, worn as two overlapping pairs; Impermeable gowns with tight-fitting cuffs; FFP3 respiratory protection masks, which provide the highest level of protection among disposable filtering facepiece respirators; Chemical-resistant safety goggles with a full seal around the eyes and side protection. Training Pharmacists and pharmacy technicians involved in the preparation of cytotoxic medicines must receive specialized training , particularly in aseptic techniques, which ensure that preparations remain free from contamination. They must also be trained in the use of closed-system transfer devices (CSTD), which mechanically prevent the escape of drug aerosols into the environment and the entry of contaminants into the preparation. Cleaning, decontamination, and waste and spill management The surfaces and equipment used in cytotoxic preparation areas are disinfected and decontaminated before and after each work session using specific cleaning and deactivating agents. Anything that comes into contact with cytotoxic medicines is classified as group IV waste, meaning hazardous healthcare waste with biological and chemical risks. Such waste is placed in dedicated rigid, hermetically sealed, and clearly labelled containers until it is transported for high-temperature incineration. Areas where these medicines are prepared and administered must also have a dedicated spill kit available for immediate use in the event of an accidental cytotoxic spill, helping to protect both people and the environment. A commitment to excellence Strict adherence to guidelines and best practices in the preparation of cytotoxic medicines is essential to ensure the effectiveness and safety of patient treatments, protect the health of healthcare professionals, and promote a culture of quality, safety, and responsibility within healthcare institutions. Source: Ordem dos Farmacêuticos. Norma específica sobre manipulação de medicamentos . 2018. OSHA Technical Manual (OTM) Section VI, Chapter 2. Controlling occupational exposure to hazardous drugs. 2017 Portaria nº. 594/2004 de 2 de junho. prova as boas práticas a observar na preparação de medicamentos manipulados em farmácia de oficina e hospitalar. Sessink PJM, Connor TH, Tyler TG. Reduction in surface contamination with antineoplastic drugs in 22 hospital pharmacies in the US following implementation of a closed-system drug transfer device. J Oncol Pharm Pract 2011;17:39-48. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item. English translation generated with AI and reviewed by the editorial team
