Dados do Resumo

Título

Optimizing Antineoplastic Drug Utilization: Strategies to Minimize Waste from Stability Loss

Introdução

When handling injectable medications, such as antineoplastic therapies, vials are divided to create individualized doses. Often, remaining aliquots are discarded due to loss of pharmaceutical stability, affecting the drug's chemical, physical, and microbiological properties.¹ Given the high cost of antineoplastic drugs, these discarded aliquots can lead to significant financial waste, besides environmental harm and disposal costs, due to its cytotoxicity.

Objetivo

Develop and implement strategies to reduce medication waste caused by stability loss in opened multidose container, through the analysis of research on extended drug stability.

Métodos

A survey was conducted to assess the disposal of antineoplastic medications due to stability issues at two branches of the institution where these drugs are prepared. This survey identified 12 key medications that are major contributors to stability-related waste. Based on this data, a comprehensive literature review was performed to explore potential for extending the pharmaceutical stability of these drugs beyond that specified by manufacturers, with the goal of enabling increased reuse of remaining aliquots. Additionally, efforts were made to centralize the preparation of some drugs at a single branch to concentrate leftover medications and optimize their usage, improving efficiency and reducing waste. For drugs with limited stability, where there is no supporting research for extending their shelf life, schedules was adjusted, consolidating appointments for patients using these medications to specific week´s days, thereby optimizing the use of these drugs and minimizing waste.

Resultados

Data supported extending the stability, or utilization period, of several drugs—atezolizumab, carfilzomib, liposomal doxorubicin, ipilimumab, pembrolizumab, pertuzumab, and ramucirumab—when prepared in a controlled clean area with certified microbiological controls. However, for other medications—brentuximab, paclitaxel protein-bound particles, sacituzumab govitecan, trastuzumab deruxtecan, and trastuzumab emtansine—no stability extension could be achieved. Consequently, strategies for these drugs were limited to adjusting patient scheduling and centralizing preparation at one branch. Following the implementation of these strategies, over approximately 4 years, from April 2020 to July 2024, there was a significant reduction in medication disposal amounting to R$5,893,440.07.

Conclusões

The implemented strategies proved highly effective in significantly reducing medication disposal. By extending stability where possible and optimizing resource utilization, these measures have not only minimized waste but also improved the overall efficiency of medication management. Ongoing evaluation of these strategies continually enhances the program's effectiveness, underscoring a commitment to sustainable and resource-efficient pharmaceutical management practices.

Palavras Chave

antineoplastic disposal; pharmaceutical stability; medication waste