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SafeMedicationUse Newsletter

Oral Chemotherapy: Not Just an Ordinary Pill


Oral chemotherapy is cancer medicine that is taken by mouth. These medicines come as tablets, capsules, or liquids that can be swallowed. As a result, oral chemotherapy can be taken at home. For people with cancer, taking a medicine by mouth is easier than intravenous chemotherapy because they don't have to go to the hospital or a clinic to have the medicine administered. However, even though these medicines can be taken by mouth, they aren't necessarily safer than injectable chemotherapy. In fact, chemotherapy pills can be just as strong as the chemotherapy given by injections and infusions. Mistakes with oral chemotherapy medicine can lead to serious side effects and even death.

What's so special about oral chemotherapy?

Oral chemotherapy medicines are similar to chemotherapy medicines given by injection. Both types have some special characteristics. Below are a few examples:

  • Cancer chemotherapy medicines can kill healthy cells as well as cancer cells. Mistakes with these drugs are more likely to cause harm than mistakes with many other medicines.
  • Instead of being taken every day like many other medicines, oral chemotherapy is often taken in cycles. For example, the patient might take the medicine for 2 weeks and then go for 1 week without taking any doses before starting the next 2 weeks of the medicine. It's important to keep track of the cycles to avoid taking too much medicine or missing a dose.
  • Some chemotherapy medicines are used to treat more than one type of cancer. The prescribed dose can be very different, depending on the type of cancer being treated.
  • Chemotherapy medicines may be harmful to people who do not have cancer. To prevent unnecessary exposure and mistakes, oral chemotherapy pills require special handling and disposal.

The incident received a report about a consumer who was taking the oral chemotherapy medicine capecitabine. The capecitabine was supposed to be given on a cycle that included a drug-free period. While the consumer was in hospital, the capecitabine was given once a day. When the consumer was discharged, the capecitabine was again prescribed to be taken daily, so the drug-free or "off" time in the cycle was missed. This problem was discovered by the oncologist 1 week after the consumer's discharge.

What can I do to prevent this problem? has the following suggestions for consumers to help prevent errors with oral chemotherapy medicines:

  • Be ready to give the pharmacist information that may be needed to check the prescription, such as your cancer diagnosis, your height and weight, and what you understand about your chemotherapy schedule.
  • Be familiar with your oral chemotherapy dosing schedule. Keep a calendar if necessary.
  • Keep a list of all your medicines. Bring the list with you any time you see a healthcare provider (e.g., clinic/office visits, emergency/urgent care visits, and hospital admissions). You should also bring all your medicines with you and tell your healthcare providers that you're taking oral chemotherapy.
  • Check the name, dose, directions, and contents of your prescription. Tell the pharmacist if anything looks different from what you were expecting.
  • When handling oral chemotherapy medicines, you and your family caregivers should avoid skin contact with the medicines (e.g., by wearing gloves).
  • Return unused, discontinued, or expired medications to the pharmacist for proper disposal.1

Tips for Practitioners:

  • Always check the patient's diagnosis, height, weight, and chemotherapy schedule when processing a prescription for oral chemotherapy.
  • Verify the medication and dosing schedule with the patient.
  • For complex schedules, provide dosing information in writing, e.g., with a dosing calendar.

Important Information from Health Canada about Acetaminophen Safety

Health Canada has announced new action to improve acetaminophen safety and minimize the risk of liver damage. This action stems from a Health Canada review that assessed acetaminophen and liver injury in Canada.

Acetaminophen is a medicine used to treat pain and reduce fever. It is most commonly known by the brand name Tylenol, but it is also found in many nonprescription and prescription products with other names. Acetaminophen is safe and effective when it is used correctly. However, taking too much acetaminophen can harm your liver, possibly leading to liver failure or even death.

Health Canada and ISMP Canada are co-chairing a steering committee that will lead efforts to educate and remind consumers about the safe use of acetaminophen. Additional steps to improve acetaminophen safety will be taken in the coming months. For complete information, including Health Canada's Information Update, a summary of the acetaminophen safety review, and an information page on acetaminophen, visit the Health Canada website.

Additional information on acetaminophen safety is available at ISMP Canada's consumer website, under "Spotlight on Acetaminophen".

1 Goodin S, Griffith N, Chen B, Chuk K, Daouphars M, Doreau C, Patel RA, Schwartz R, Tam├ęs MJ, Terkola R, Vadnais B, Wright D, Meier K. Safe handling of oral chemotherapeutic agents in clinical practice: recommendations from an international pharmacy panel. J Oncol Pract. 2011 Jan;7(1):7-12.

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