Fluorouracil. Documentation of proposed values of occupational exposure limits (OELs)

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Fluorouracil. Documentation of proposed values of occupational exposure limits (OELs)

Journal Title: Podstawy i Metody Oceny Środowiska Pracy - Year 2019, Vol 35, Issue 2

Abstract

Fluorouracil is a cytostatic drug. Occupational exposure to fluorouracil occurs during its manufacture, packaging and use in hospital wards in a daily treatment practice. The maximum concentration of fluorouracil in workplace air of pharmacy technicians and nurses was 82.26 × 10-6 mg/m3. Exposure tests of employees of pharmaceutical plants dealing in packaging and production of fluorouracil in 1986-1988, showed the presence of fluorouracil in the air in concentrations up to 75 μg/m3 during product weighing operations. The main effects of fluorouracil toxicity have been described in treated patients and they include bone marrow suppression and gastrointestinal toxicity. Topical application of solutions or creams containing 1–5% fluorouracil resulted in skin irritation, dermatitis and allergic skin reactions. During the use of fluorouracil in the form of an aerosol, a patient at the therapeutic dose of 2.5 mg/kg/day showed oral mucositis and glottis. Fluorouracil manufacturers indicate in safety data sheets the possibility of health effects in workers including systemic effects after prolonged exposure through the respiratory system and through the skin, manifested by bone marrow suppression and cardiotoxicity. Long-term effects of fluorouracil include mainly genotoxic effects found in oncological nurses and occurrence of birth defects in children of patients treated with this drug. In 1987 IARC experts estimated that there was no evidence of carcinogenicity of fluorouracil in humans and animals, and ranked it in group 3. In the case of animals, the dog was the most sensitive to fluorouracil. The minimum toxic dose for a dog after oral administration of fluorouracil was 5 mg/kg. In a study on Syrian hamsters, which were exposed to a fluorouracil aerosol at a dose of 1.45 mg/kg and 2.08 mg/kg, no changes related to exposure were observed. The reprotoxic effect is the critical effect of fluorouracil in animals. It was proposed to adopt the MAC value of fluorouracil at the concentration equivalent to 0.1% of the lowest therapeutic dose in the literature found in humans of 5 mg/kg. An uncertainty factor at level 10 associated with long-term effects of exposure, i.e., genotoxic and reprotoxic effects, was also adopted. A MAC value of fluorouracil has been proposed – inhalable fraction of 0.0035 mg/m3. There are no data to determine the short-term value. There are no grounds to establish the concentration limit value in biological material. According to the criteria adopted by the Expert Group for Chemical Agents , the term “skin” should be used – the absorption of substances through the skin may be as important as in the case of inhalation and “Ft” – substance harmful to reproduction. This article discusses the problems of occupational safety and health, which are covered by health sciences and environmental engineering.<br/><br/>

Authors and Affiliations

Małgorzata Kupczewska-Dobecka

Keywords

fluorouracil OEL occupational exposure toxicity health sciences environmental engineering

EP ID EP599832
DOI 10.5604/01.3001.0013.2533
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