Doxorubicine and doxorubicine hydrochloride – inhalable fraction. Documentation of proposed values of occupational exposure limits (OELs)

Abstract

Doxorubicin (CAS: 23214-92-8) and its hydrochloride (CAS: 25136 40 9) are organic chemicals soluble in water. It is a cytostatic drug from the group of anthracycline antibiotics, used in antimitotic antitumor chemotherapy, primarily by intravenous, intravesical, and also in the case of lung cancer in the form of an aerosol for inhalation. In Poland, according to data from the Central Data Register on Exposure to Chemicals, Mixtures Thereof, Factors or Technological Processes with Carcinogenic or Mutagenic Effect, conducted at the Institute of Occupational Medicine in Łódź, the number of people exposed to doxorubicin and its hydrochloride in 2016 totaled 587. Administration of doxorubicin or its hydrochloride to patients at therapeutic doses may lead to myelosuppression, cardiomyopathy and myocardial fibrosis as well as neurotoxicity. Adverse effects of doxorubicin administration included cough, shortness of breath, chest pain, wheezing, hoarseness, hemoptysis, and bronchospasm. Systemic toxicity was defined as mild and transient and included sore throat, anorexia, dysgeusia, fatigue, nausea, tongue pain, tachycardia. Doxorubicin manufacturers state in their safety data sheets that inhalation of dust or aerosol is hazardous to health, may cause discomfort and nuisance, nausea, vomiting, bone marrow suppression, stomatitis, hair loss, and cardiotoxicity. Animal carcinogenicity studies have shown that doxorubicin was carcinogenic to rats after intravenous and subcutaneous administration, mainly causing mammary gland tumors. Doxorubicin has been shown to have genotoxic effects on somatic and embryonic mouse cells. Doxorubicin is toxic for reproduction. It may damage fertility and the unborn child. In Poland and in other countries, the highest permissible concentrations of doxorubicin and its hydrochloride in the work environment have not yet been determined. Occupational exposure limits are recommended by its manufacturers: FormuMax Scientific, Inc. and Pfizer at 0.0005 mg/m3. It was proposed to set up the MAC value for doxorubicin and its hydrochloride at the equivalent concentration level up to 0.1% of the lowest inhalational therapeutic dose found in the literature Dw = 0.04 mg/kg, i.e., 0.0003 mg/m3 – inhalable fraction. There are no substantive grounds to determine the STEL value. It is recommended to label the substance with the notation “skin” – the absorption of the substance through the skin may be just as important as when inhaled. The letters “Ft” should also be used – toxic for reproduction, Carc. 1B – carcinogen category 1B and Muta. 1B – germ cell mutagen category 1B. This article discusses the problems of occupational safety and health, which are covered by health sciences and environmental engineering.