Do not prepack list - American Society of Health System Pharmacists

Generic Name (Brand Name)
Oral Medications that Should Not be Packaged in the Prepackage Machine
and Oral Medications that Require Special Handling Precautions
Risk Category (or why the
medication cannot go in the prepack
machine)
Special handling
precautions required
NOTE: List may not be all-inclusive. New agents with similar pharmacologic activity may pose risks and should be packaged
appropriately. Consult specialized references for more information.
© 2013 Drug Information Service, University of Utah Hospitals and Clinics, Salt Lake City, UT
Warning to put on unit-dose
label
Abacavir (Epzicon, Trizivir, Highly allergenic agent None.
Ziagen)
Abiraterone (Zytiga) Chemotherapeutic agent; Teratogen Gloves, dedicated pill Chemotherapy, teratogen
cutter
Acitretin (Soriatane) Chemotherapeutic agent; Teratogen None. Teratogen
Altretamine (Hexalen) Chemotherapeutic agent None. Chemotherapy
Ambrisentan (Letairis) Pregnancy category X, Teratogen Gloves, dedicated pill Teratogen
cutter
Aminoglutethimide (Cytadren) Hormonal agent, possible teratogen None. Teratogen
Amoxicillin (Amoxil) Highly allergenic agent None.
Amoxicillin/clavulanate Highly allergenic agent None.
(Augmentin)
Amoxicillin/clavulanate (Sandoz
brand generic)
Highly allergenic agent None. Give blister packs no more
than 7 day expiration. Tablets
are moisture-sensitive.
Ampicillin Highly allergenic agent None.
Anastrozole (Arimidex) Hormonal agent, possible teratogen None. Teratogen
Aprepitant (Emend) Potential carcinogen None.
Atazanavir (Reyataz)
Moisture sensitive agent. May
prepackage small quantities (eg, a few
days) using the EXP tray. Do not
exceed 7 day expiration date; store
remaining product in the original
container.
None.

Generic Name (Brand Name)
Risk Category (or why the
medication cannot go in the prepack
machine)
Special handling
precautions required
NOTE: List may not be all-inclusive. New agents with similar pharmacologic activity may pose risks and should be packaged
appropriately. Consult specialized references for more information.
© 2013 Drug Information Service, University of Utah Hospitals and Clinics, Salt Lake City, UT
Warning to put on unit-dose
label
Axitinib (Inlyta) Chemotherapeutic agent None. Chemotherapy
Azathioprine (Imuran) Teratogen; Immunosuppressant agent Place unit dose oral
suspension in a separate
plastic bag for delivery
Teratogen,
Bexarotene (Targretin) Chemotherapeutic agent; Teratogen None. Chemotherapy, teratogen
Bicalutamide (Casodex) Hormonal agent, possible teratogen None.
Bosentan (Tracleer) Pregnancy category X, Teratogen Gloves, dedicated pill
cutter
Teratogen
Bosutinib (Bosulif) Chemotherapeutic agent None. Chemotherapy
Busulfan (Myleran) Chemotherapeutic agent None. Chemotherapy
Cabozantinib (Cometriq) Chemotherapeutic agent None. Chemotherapy
Capecitabine (Xeloda) Chemotherapeutic agent None. Chemotherapy
Cabergoline (Dostinex) Hormonal agent, possible teratogen None.
Carbamazepine (eg, Epitol,
Equetro, Tegretol, Tegretol
XR)
Carbidopa/levodopa orallydisintegrating
tablets (Parcopa)
Possible teratogen None. Teratogen
Highly-moisture sensitive agent
Cefaclor (Ceclor) Highly allergenic agent None.
Cefadroxil (Duricef) Highly allergenic agent None.
Cefdinir (Omnicef) Highly allergenic agent None.
Cefditorin (Spectracef) Highly allergenic agent None.
Cefprozil (Cefzil) Highly allergenic agent None.
Cefuroxime (Ceftin) Highly allergenic agent None.
Cephalexin (Keflex) Highly allergenic agent None.
Dry hands before
handling medication.
Open product package
just before use.

Generic Name (Brand Name)
Risk Category (or why the
medication cannot go in the prepack
machine)
Cephradine (Velosef) Highly allergenic agent None.
Cefpodoxime (Vantin) Highly allergenic agent None.
Ceftibuten (Cedax) Highly allergenic agent None.
Special handling
precautions required
Chloral Hydrate (Somnote) Requires black box disposal per
RCRA.
None.
Chlorambucil (Leukeran) Chemotherapeutic agent, Requires None.
black box disposal per RCRA.
Clonazepam (eg, Klonopin) Possible teratogen None. Teratogen
Cloxacillin (Cloxapen) Highly allergenic agent None.
Colchicine Carcinogen, or potential carcinogen None. Carcinogen
Cotrimoxazole (Bactrim,
Bactrim DS, Cotrim, Cotrim DS,
Septra, Septra DS)
Highly allergenic agent None.
Warning to put on unit-dose
label
Black box disposal / RCRA
Chemotherapy
Black box disposal / RCRA
Crizotinib (Xalkori) Chemotherapeutic agent None. Chemotherapy
Cyclophosphamide (Cytoxan) Chemotherapeutic agent, Requires
black box disposal per RCRA.
None.
Chemotherapy
Black box disposal / RCRA
Cyclosporine (Sandimmune,
Neoral, Gengraf)
Teratogen; Immunosuppressant agent Place unit dose oral
suspension in a separate
Teratogen
plastic bag for delivery
Danazol Possible teratogen None. Teratogen
Dasatinib (Sprycel) Chemotherapeutic agent None. Chemotherapy
Dicloxacillin (Dynapen) Highly allergenic agent None.
Divalproex sodium (eg, Teratogen None. Teratogen
Depakote, Depakote ER)
Dronedarone (Multaq) Teratogen, or potential teratogen None. Teratogen
Dutasteride (Avodart) Teratogen None. Teratogen
NOTE: List may not be all-inclusive. New agents with similar pharmacologic activity may pose risks and should be packaged
appropriately. Consult specialized references for more information.
© 2013 Drug Information Service, University of Utah Hospitals and Clinics, Salt Lake City, UT

Generic Name (Brand Name)
Efavirenz / Emtricitabine /
Tenofovir (Atripla)
Risk Category (or why the
medication cannot go in the prepack
machine)
Highly-moisture sensitive agent. May
prepackage small quantities (up to 7
tablets) in EXP tray. Do not exceed 1
month expiration date; store remaining
product in the original container.
Special handling
precautions required
Dry hands before
handling medication
Efavirenz Possible teratogen None Teratogen
Emtricitabine/Tenofovir
Dry hands before
(Truvada)
handling medication.
Highly-moisture sensitive agent. May
prepackage small quantities (up to 7
tablets) in EXP tray. Do not exceed 1
month expiration date; store remaining
product in the original container.
NOTE: List may not be all-inclusive. New agents with similar pharmacologic activity may pose risks and should be packaged
appropriately. Consult specialized references for more information.
© 2013 Drug Information Service, University of Utah Hospitals and Clinics, Salt Lake City, UT
Warning to put on unit-dose
label
Entecavir (Baraclude) Possible teratogen None Teratogen
Enzalutamide (Xtandi) Hormonal agent, possible teratogen None.
Erlotinib (Tarceva) Chemotherapeutic agent None. Chemotherapy
Estramustine (Emcyt) Chemotherapeutic agent None. Chemotherapy
Etoposide (VePesid) Chemotherapeutic agent None. Chemotherapy
Everolimus (Afinitor, Zortress) Chemotherapeutic agent;
Immunosuppressant agent
None.
Exemestane (Aromasin) Hormonal agent, possible teratogen None. Teratogen
Finasteride (Propecia, Proscar) Teratogen None. Teratogen
Fish oil capsules Capsules explode in prepack machine None.
Flucytosine (Ancobon) Teratogen or potential teratogen Place unit dose oral
suspension in a separate
plastic bag for delivery.
Chemotherapy
Teratogen
Fludarabine (Oforta) Chemotherapeutic agent None. Chemotherapy
Fluoxymesterone (Halotestin) Hormonal agent, possible teratogen None.
Flutamide (Eulexin) Hormonal agent, possible teratogen None.

Generic Name (Brand Name)
Ganciclovir (Cytovene)
Risk Category (or why the
medication cannot go in the prepack
machine)
Teratogen; Mutagen or potential
mutagen; Carcinogen or potential
carcinogen; Immunosuppressant agent
Special handling
precautions required
Place unit dose oral
suspension in a separate
plastic bag for delivery
Warning to put on unit-dose
label
Teratogen
Gefitinib (Iressa) Chemotherapeutic agent None. Chemotherapy
Hydroxyurea (eg, Hydrea, Chemotherapeutic agent None. Chemotherapy
Droxia)
Imatinib (Gleevec) Chemotherapeutic agent None. Chemotherapy
Isotretinoin (Accutane) Teratogen None. Do not repackage, Teratogen
keep in original package.
Lamivudine / Zidovudine Mutagen or potential mutagen; None.
Mutagen, Carcinogen
(Combivir)
Carcinogen or potential carcinogen
Lapatinib (Tykerb) Chemotherapeutic agent None. Chemotherapy
Leflunomide (Arava) Teratogen; Immunosuppressant agent None. Teratogen
Lenalidomide (Revlimid) Chemotherapeutic agent; Teratogen None. Do not repackage, Chemotherapy, teratogen
keep in original package.
Letrozole (Femara) Hormonal agent, possible teratogen None. Teratogen
Levodopa/carbidopa orallydisintegrating
tablets (Parcopa)
Highly-moisture sensitive agent
Dry hands before
handling medication.
Open product package
just before use.
Lomustine (CeeNu) Chemotherapeutic agent None. Chemotherapy
Lopinavir/ritonavir (Kaletra)
Highly-moisture sensitive agent. May
prepackage small quantities in EXP
tray. Do not exceed 2 week expiration
date; store remaining product in the
original container.
None.
NOTE: List may not be all-inclusive. New agents with similar pharmacologic activity may pose risks and should be packaged
appropriately. Consult specialized references for more information.
© 2013 Drug Information Service, University of Utah Hospitals and Clinics, Salt Lake City, UT

Generic Name (Brand Name)
Magnesium chloride entericcoated
tablets (Slow-Mag)
Risk Category (or why the
medication cannot go in the prepack
machine)
Highly-moisture sensitive agent. May
prepackage small quantities (eg, a few
days) using the EXP tray. Do not
exceed 7 day expiration date; store
remaining product in the original
container.
Special handling
precautions required
NOTE: List may not be all-inclusive. New agents with similar pharmacologic activity may pose risks and should be packaged
appropriately. Consult specialized references for more information.
None.
Medroxyprogesterone (Provera) Hormonal agent, possible teratogen None. Teratogen
Megestrol (Megace) Hormonal agent, possible teratogen Place unit dose oral
suspension in a separate
plastic bag for delivery
Teratogen
© 2013 Drug Information Service, University of Utah Hospitals and Clinics, Salt Lake City, UT
Warning to put on unit-dose
label
Melphalan (Alkeran)
Chemotherapeutic agent, Requires
black box disposal per RCRA.
None.
Mercaptopurine (Purinethol) Chemotherapeutic agent None. Chemotherapy
Methotrexate (Folex) Chemotherapeutic agent None. Chemotherapy
Methoxsalen (8-MOP,
Teratogen None. Teratogen
Oxsoralen, Oxsoralen Ultra)
Methyltestosterone (Android) Hormonal agent, possible teratogen None. Teratogen
Mifepristone (Korlyn, Mifeprex) Abortifacient None. Abortifacient
Misoprostol (Cytotec) Teratogen None. Teratogen
Mitotane (Lysodren) Chemotherapeutic agent None. Chemotherapy
Mycophenolate mofetil
(Cellcept)
Mycophenolate sodium
(Myfortic)
Mutagen or potential mutagen;
Teratogen or potential teratogen;
Immunosuppressant agent
Mutagen or potential mutagen;
Teratogen or potential teratogen;
Immunosuppressant agent
Place unit dose oral
suspension in a separate
plastic bag for delivery
None.
Chemotherapy
Black box disposal / RCRA
Mutagen
Teratogen
Mutagen
Teratogen
Nilotinib (Tasigna) Chemotherapeutic agent None. Chemotherapy

Generic Name (Brand Name)
Risk Category (or why the
medication cannot go in the prepack
machine)
Special handling
precautions required
Nilutamide (Nilandron) Hormonal agent, possible teratogen None. Teratogen
Omega-3 Fatty Acids Capsules explode in prepack machine None.
Oxacillin (Bactocill) Highly allergenic agent None.
Oxandrolone (Oxandrin) Teratogen; Hormonal agent, possible None.
Teratogen
teratogen
Oxcarbazepine (eg, Trileptal) Possible teratogen None. Teratogen
Pancreatic enzyme replacement
products (Creon, Pancreaze,
Pertzye, Ultresa, Viokace,
Zenpep)
Highly-moisture sensitive agent. Send
as 100-count bottle. Store in original
bottle with dessicant (if included).
None.
Warning to put on unit-dose
label
Paroxetine (Paxil) Teratogen or potential teratogen None. Teratogen
Pazopanib (Votrient) Chemotherapeutic agent None. Chemotherapy
Penicillin (Beepen VK, Betapen
VK, Bopen VK, Pen-Vee K,
Pfizerpen VK, Suspen, V-Cillin
K, Veetids)
Highly allergenic agent None.
Phenoxybenzamine (eg,
Dibenzyline)
Mutagen or potential mutagen;
Carcinogen or potential carcinogen
None.
Phentermine (Adipex-P, Requires black box disposal per None.
Phentercot, Suprenza)
RCRA.
Pomalidomide (Pomalyst) Chemotherapeutic agent None. Chemotherapy
Ponatinib (Iclusig) Chemotherapeutic agent None. Chemotherapy
Prasugrel (Effient) Highly moisture sensitive Do not repackage. Keep
in original unit-dose
packaging.
Procarbazine (Matulane) Chemotherapeutic agent None. Chemotherapy
Mutagen, Carcinogen
Black box disposal / RCRA
NOTE: List may not be all-inclusive. New agents with similar pharmacologic activity may pose risks and should be packaged
appropriately. Consult specialized references for more information.
© 2013 Drug Information Service, University of Utah Hospitals and Clinics, Salt Lake City, UT

Generic Name (Brand Name)
Pyridostigmine (eg, Mestinon,
Mestinon Timespan)
Risk Category (or why the
medication cannot go in the prepack
machine)
Highly-moisture sensitive agent. May
prepackage small quantities (eg, a few
days) using the EXP tray. Do not
exceed 7 day expiration date; store
remaining product in the original
container.
Special handling
precautions required
NOTE: List may not be all-inclusive. New agents with similar pharmacologic activity may pose risks and should be packaged
appropriately. Consult specialized references for more information.
None.
© 2013 Drug Information Service, University of Utah Hospitals and Clinics, Salt Lake City, UT
Warning to put on unit-dose
label
Raloxifene (Evista) Hormonal agent, possible teratogen None. Teratogen
Rasagiline (Azilect)
Mutagen or potential mutagen; None.
Mutagen, Carcinogen
Carcinogen or potential carcinogen
Regorafenib (Stivarga) Chemotherapeutic agent None. Chemotherapy
Ribavirin (Rebetol) Teratogen None. Teratogen
Risperidone (Risperdal) Carcinogen or potential carcinogen;
Teratogen or potential teratogen
Place unit dose oral
suspension in a separate
Carcinogen
Teratogen
plastic bag for delivery.
Ritonavir (Norvir)
Capsules are sensitive to heat. Capsules Store in refrigerator.
may explode in prepack machine
Ruxolitinib (Jakafi) Chemotherapeutic agent None. Chemotherapy
Selenium
Requires black box disposal per None.
Black box disposal / RCRA
RCRA.
Sirolimus (Rapamune) Immunosuppressant agent Place unit dose oral
suspension in a separate
plastic bag for delivery
Sorafenib (Nexavar) Chemotherapeutic agent None. Chemotherapy
Sulfadiazine Highly allergenic agent None.
Sulfapyridine Highly allergenic agent None.
Sulfasalazine Highly allergenic agent None
Sulfisoxazole (Gantrisin) Highly allergenic agent None.

Generic Name (Brand Name)
Risk Category (or why the
medication cannot go in the prepack
machine)
Special handling
precautions required
Warning to put on unit-dose
label
Sunitinib (Sutent) Chemotherapeutic agent None. Chemotherapy
Tacrolimus (eg, Hecoria, Carcinogen or potential carcinogen; Place unit dose oral Carcinogen
Prograf)
Immunosuppressant agent
suspension in a separate
Tamoxifen (Nolvadex,
Soltamox)
Hormonal agent, possible teratogen
plastic bag for delivery.
Place unit dose oral
suspension in a separate
plastic bag for delivery
Teratogen
Temozolomide (Temodar) Chemotherapeutic agent None. Chemotherapy
Tenofovir (Viread)
Highly-moisture sensitive agent. May
prepackage small quantities (up to 7
tablets) in EXP tray. Do not exceed 1
month expiration date; store remaining
product in the original container.
Dry hands before
handling medication.
Testolactone (Teslac) Hormonal agent, possible teratogen None. Teratogen
Tetracycline (eg, Sumycin) Mutagen or potential mutagen; Possible None.
Mutagen
teratogen
Thalidomide (Thalomid) Chemotherapeutic agent; Teratogen None. Do not repackage, Chemotherapy, teratogen
keep in original package.
Thioguanine (Thioguanine Chemotherapeutic agent None. Chemotherapy
Tabloid)
Topotecan (Hycamtin) Chemotherapeutic agent None. Chemotherapy
Toremifene (Fareston) Hormonal agent, possible teratogen None. Teratogen
Tretinoin (Vesanoid) Chemotherapeutic agent; Teratogen None. Chemotherapy, teratogen
Trientine (Syprine) Potential teratogen, irritant None Possible teratogen, do not
open capsule
NOTE: List may not be all-inclusive. New agents with similar pharmacologic activity may pose risks and should be packaged
appropriately. Consult specialized references for more information.
© 2013 Drug Information Service, University of Utah Hospitals and Clinics, Salt Lake City, UT

Generic Name (Brand Name)
Valganciclovir (Valcyte)
Risk Category (or why the
medication cannot go in the prepack
machine)
Teratogen; Mutagen or potential
mutagen ; Immunosuppressant agent
Special handling
precautions required
Place unit dose oral
suspension in a separate
plastic bag for delivery
NOTE: List may not be all-inclusive. New agents with similar pharmacologic activity may pose risks and should be packaged
appropriately. Consult specialized references for more information.
© 2013 Drug Information Service, University of Utah Hospitals and Clinics, Salt Lake City, UT
Warning to put on unit-dose
label
Teratogen
Valproic acid (eg, Depacon, Teratogen None. Teratogen
Depakene, Stavzor)
Vandetanib (Caprelsa) Chemotherapeutic agent None. Chemotherapy
Vemurafenib (Zelboraf) Chemotherapeutic agent None. Chemotherapy
Vigabatrin (Sabril) Teratogen None. Teratogen
Vismodegib (Erivedge) Chemotherapeutic agent None. Chemotherapy
Vorinostat (Zolinza)
Warfarin sodium (Coumadin,
Jantoven)
Zidovudine (Retrovir)
Chemotherapeutic agent; Mutagen or
potential mutagen
Requires black box disposal per
RCRA.
Mutagen or potential mutagen,
Carcinogen or potential carcinogen
None.
None.
Ziprasidone (Geodon) Possible teratogen None.
Zonisamide (Zonegran) Mutagen or potential mutagen; None.
Teratogen or potential teratogen
Agents Used to Clean the Prepackage Machine
Refer to the user manual for general cleaning instructions.
Place unit dose oral
suspension in a separate
plastic bag for delivery
Chemotherapy, mutagen
Black box disposal / RCRA
Mutagen, Carcinogen
Mutagen
Teratogen
In the event that one of the drugs listed above is accidentally placed in the prepackage machine, either of the following agents may be
used to clean the machine depending on the type of drug that was accidently placed in the machine.
1. Clorox – any chemotherapeutic drug

2. Alcohol – any other drug
NOTE: List may not be all-inclusive. New agents with similar pharmacologic activity may pose risks and should be packaged
appropriately. Consult specialized references for more information.
© 2013 Drug Information Service, University of Utah Hospitals and Clinics, Salt Lake City, UT

References
University Health Care Policy Manual: Safe Handling of Hazardous Drugs.
http://intranet.uuhsc.utah.edu/standards/org_wide/med_mgmt/Safe-Handling-of-Hazardous-Drugs.pdf. Updated November 2012.
Accessed December 10, 2012.
ASHP Technical assistance bulletin on handling cytoxic and hazardous drugs. Am J Hosp Pharm. 1990;47(5):1033-1049.
Department of Health and Human Services. Centers for Disease Control and Prevention. National Institute for Occupational Safety
and Health. Preventing occupational exposure to antineoplastic and other hazardous drugs in health care settings. NIOSH Publication
No. 2004-165. http://www.cdc.gov/niosh/docs/2004-165/2004-165d.html. Published 2004. Accessed May 4, 2006.
Department of Health and Human Services. Centers for Disease Control and Prevention. National Institute for Occupational Safety
and Health. NIOSH list of antineoplastic and other hazardous drugs in healthcare settings 2010. NIOSH Publication No. 2010-167.
http://www.cdc.gov/niosh/docs/2010-167/pdfs/2010-167.pdf. Published September 2010. Accessed September 15, 2010.
Department of Health and Human Services. Centers for Disease Control and Prevention. National Institute for Occupational Safety
and Health. NIOSH list of antineoplastic and other hazardous drugs in healthcare settings 2012. NIOSH Publication No. 2012-150.
http://www.cdc.gov/niosh/docs/2012-150/pdfs/2012-150.pdf. Published June 2012. Accessed July 20, 2012.
McEvoy GK, Litvak K, Welsh OH, et al, eds. AHFS 2013 Drug Information. Bethesda, MD: American Society of Health-System
Pharmacists; 2013.
National Institute for Occupational Safety and Health. Process for updating the list of hazardous drugs (Appendix A) for the NIOSH
Alert on hazardous drugs. NIOSH Docket #105. http://www.cdc.gov/niosh/review/public/105/default.html. Published 2004. Accessed
July 9, 2007.
United States Department of Labor. Occupational Safety & Health Administration. Occupational Safety & Health Administration.
OSHA Technical Manual. Section VI. Chapter 2. Controlling occupational exposure to hazardous drugs. Available at:
http://www.osha.gov/dts/osta/otm/otm_vi/otm_vi_2_html. Published 1995. Accessed October 9, 2007.
NOTE: List may not be all-inclusive. New agents with similar pharmacologic activity may pose risks and should be packaged
appropriately. Consult specialized references for more information.
© 2013 Drug Information Service, University of Utah Hospitals and Clinics, Salt Lake City, UT

Wickersham RM, Novak KK, eds. Drug Facts and Comparisons. St. Louis, MO: Wolters Kluwer Health, Inc.; 2013.
NOTE: List may not be all-inclusive. New agents with similar pharmacologic activity may pose risks and should be packaged
appropriately. Consult specialized references for more information.
© 2013 Drug Information Service, University of Utah Hospitals and Clinics, Salt Lake City, UT