Safe Handling Method for Splitting Azathioprine Tablets

• Published in: YAKUGAKU ZASSHI (Journal of the Pharmaceutical Society of Japan) Vol. 141; no. 1; pp. 125 - 133
• Main Authors: Aoki, Manahito, Oda, Satsuki, Kubota, Satoshi, Saito, Sakae, Yokota, Norio, Shibazaki, Atsushi, Shibuya, Kiyoshi, Sako, Magoichi, Otori, Katsuya
• Format: Journal Article
• Language: Japanese; English
• Published: Japan Pharmaceutical Society of Japan 01.01.2021
• Subjects: Azathioprine - adverse effects; Drug Compounding - methods; Drug Contamination - prevention & control; Drug Packaging - methods; Immunosuppressive Agents - adverse effects; Occupational Exposure - prevention & control; Tablets; cleaning; azathioprine; safe handling; tablet splitting; occupational exposure; hazardous drug
• ISSN: 0031-6903; 1347-5231
• DOI: 10.1248/yakushi.20-00106

The immunosuppressant azathioprine (AZA) is classified as a hazardous drug. AZA contamination during tablet-splitting increases exposure risk. However, there is no study on contamination and exposure during AZA tablet splitting and dispensing. AZA tablet splitting and dispensing methods were classified based on whether tweezers are used during splitting and packaging. In Dispensing Method (1), no tweezers were used in either step. In Dispensing Method (2), no tweezers were used during tablet splitting, but were used during packaging. In Dispensing Method (3), tweezers were used in both steps. After AZA half-tablet split-dispensing, we quantified the adherent AZA removed from the tools, packaging machines, and dispensing counters by three consecutive wipings with water-dampened polypropylene cloths. A large amount of AZA adhered to the gloves used in Dispensing Methods (1) and (2), wherein tablets were placed with gloved hands, compared with Dispensing Method (3), wherein tablets were held with tweezers. Thus, the gloves must be replaced before touching the packaging paper during the final step. After three consecutive wipings, AZA was not detected at most of the sites in the third round. Thus, we recommend that (1) AZA tablet splitting should be performed while wearing gloves, (2) the gloves should be changed before packaging the half tablets, and (3) the tools, packaging machines, and dispensing counters should be wiped twice or thrice with a water-dampened cloth after dispensing.