NIOSH 2014 List of Antineoplastic & Other Hazardous Drugs in Healthcare Settings

This is an updated version of  the National Institute of Occupational Safety and Health (NIOSH) hazardous drugs list. So what’s new in this current update?

The text for the update to the 2014 list was updated and expanded to reflect the complexity of safe handling issues that have arisen over the past few years.  This was driven, in part, by the growing number of oral antineoplastic drugs and the addition of oral non-antineoplastic drugs.  The list was reformatted and some drugs have been deleted.

(a) Based on feedback from multiple sources, it was determined that the universal approach as described in the 2004 Alert on Hazardous Drugs for handling hazardous drugs was no longer feasible.

 (b) The list of hazardous drugs was separated into three categories: (Table 1) Antineoplastic drugs; (Table 2) Non-antineoplastic drugs; (Table 3) Drugs with adverse reproductive effects only; and (Table 4) Deleted drugs.

  (c)  It was noted that the majority of the antineoplastic drugs may have adverse reproductive effects and the drugs in the non-antineoplastic category that had adverse reproductive effects as a secondary reason for their listing was noted.

  (d) New drug listings for 2014 are indicated by red font and drugs in the non-antineoplastic category that also have adverse reproductive effects are indicated by blue font.

 (e) Also added is a matrix of common activities related to hazardous drug handling and recommendations for the use of personal protective equipment and ventilated engineering controls for each activity (Table 5).


Hazardous drugs include those used for cancer chemotherapy, antiviral drugs, hormones, some bioengineered drugs, and other miscellaneous drugs.  The NIOSH cautions that the list may not be all inclusive and recommend that each organization should create its own list of drugs considered to be hazardous. This perhaps explains why sometimes I notice a drug not on the hazardous list is considered hazardous by one organization but not by another.  In my experience, many oncology infusion centers follow the precautions recommended for hazardous drugs for all drugs they administer regardless of classification in a effort to standardize handling practices.

When a  drug is hazardous, various precautions should be applied when handling the drug.  Click here for the full publication of the 2014 NIOSH Hazardous Drug List.

NIOSH 2014


Many thanks to Barbara MacKenzie and Thomas H. Connor for the  information and updates.