Adriamycin
Full Profile
General Information
Adriamycin® is the trade name for the hydrochloride salt of a chemotherapeutic drug called doxorubicin, and it exists as a red, crystalline solid.[1] It may also be referred to simply as doxorubicin or as Adriblastin, which is another trade name for the drug.[2] See HSDB for more information on synonyms and product names.[2]
Adriamycin® has been classified by IARC as Group 2A, probably carcinogenic to humans.[1] In animal studies, exposure to Adriamycin® caused mammary gland cancers and localized injection site sarcomas, as well as non-malignant tumours of the mammary gland and bladder in rats and mice.[1] Patients receiving Adriamycin® as cancer treatment were found to have higher risks of leukemia and bone tumours.[1,3] However, the evidence was inconclusive because the patients were also exposed to other carcinogenic agents such as radiation and other chemotherapy drugs.[1,3] Other health effects experienced by patients taking Adriamycin® may include gastrointestinal problems and hematological changes such as anemia and low white blood cell count.[3]
Adriamycin® has been ranked by CAREX Canada as a Group A (immediate high priority) for occupational settings, targeting people who may be exposed to the drug at work (i.e. nurses and pharmacists), rather than those who are prescribed the drug for therapeutic use. Prioritization for pharmaceuticals was based on the carcinogenicity of the substance – only IARC Group 1 and 2A drugs were considered – and whether the drug is registered for use in Canada.
Regulations and Guidelines
Occupational Exposure Limits (OEL)
No occupational exposure limits for Canada or any other international bodies were located.
Canadian Agencies/Organizations
| Agency | Designation/Position | Year |
|---|---|---|
| Health Canada | DSL – high priority substance with lowest potential for exposure | 2006[4] |
Adriamycin® was not included in other Canadian government chemical listings reviewed.[5]
Main Uses
Adriamycin® is used as a chemotherapeutic drug to treat various cancers.[1]
Occupational Exposures
Occupational exposure to Adriamycin® may occur via inhalation, dermal exposure, or ingestion.[1]
Probable exposure scenarios in BC are in hospitals and limited to handling in wholesale pharmacies, patient handling, sanitary and similar services, research, and education.[7]
Nurses
In 2006, CIHI (the Canadian Institute for Health Information) estimated that 68 Licensed Practical Nurses (LPNs) and 2,975 Registered Nurses (RNs) worked in the oncology areas of Canadian hospitals[8] and thus may have been exposed to chemotherapeutic drugs (including Adriamycin®). The number of nurses potentially exposed to Adriamycin® by province is shown in the table below.
| Nursing Oncology Workforce by Province/Territory 2006[8] | ||
|---|---|---|
| RN | LPN | |
| Canada | 2,975 | 68 |
| NL | 63 | 0 |
| PE | ** | * |
| NS | 206 | ** |
| NB | 128 | 12 |
| QC | 1,345 | 0 |
| ON | 0 | 0 |
| MB | 139 | 0 |
| SK | 174 | 18 |
| AB | 511 | 8 |
| BC | 396 | 15 |
| YT | * | 0 |
| NT | 0 | 0 |
| NU | ^ | .. |
Pharmacists and Pharmacy Technicians
Pharmacists and pharmacy technicians are potentially exposed to chemotherapeutics when they prepare the drugs for patient use.
A report by Eli Lilly on hospital pharmacies in Canada (for 2005/06) reports the number of hospitals with in-house pharmacies performing hematology and oncology functions for the whole country.[9] This data is presented in the table below. There were 94 pharmacists working in outpatient pharmacies with hematology/oncology, and 91 in inpatient pharmacies.
Inpatients are patients who are admitted to hospital. Outpatients visit the hospital for treatment, but are not admitted. There could be minor differences in the types of drugs prepared by workers in these different pharmacies (i.e. IV drugs are likely used more for inpatients), therefore we differentiate this information in the table.
| Number of Hematology/Oncology Clinical Pharmacy Services 2005/6[9] | ||||||
|---|---|---|---|---|---|---|
| All | BC | Pr. | ON | QC | Atl. | |
| Hospitals (total n) | 142 | 20 | 20 | 45 | 42 | 15 |
| Outpatient pharmacy (n) | 118 | 17 | 14 | 32 | 40 | 15 |
| Inpatient pharmacy (n) | 116 | 16 | 15 | 34 | 39 | 12 |
Pharmacy technicians compose approximately 47% of the average hospital pharmacy staff (pharmacists compose 40%).[9] The number of pharmacy technicians exposed to chemotherapeutic drugs can therefore be estimated as being slightly higher than the number of pharmacists.
Sources
- Wikimedia Commons Photo for Doxorubicin (PDF)
- Hazardous Substances Databank entry for Adriamycin (Search term: 'adriamycin')
- IARC monograph summary, Volume 26 Supplement 7 (1987) (PDF)
- Health Canada's Prioritization of the DSL (2006)
- CEPA List of Toxic Substances (1999)
- Health Canada Drug Product Database (Search term: 'doxorubicin as active ingredient')
- Ward et al. 2007. Mortality and Cancer Incidence in a cohort of Registered Nurses From British Columbia, Canada. American Journal of Industrial Medicine. 50:892–900.
- CIHI, 2006. 2006 Workforce Trends Health Human Resources Database
- Eli Lilly Canada. 2007. 2005/06 Hospital Pharmacy in Canada Report. (PDF)
