Classification of non-antineoplastic intravenously administered drugs according to their toxicity risk: the path towards safe drug administration

Objective

Extravasation is a potential complication resulting from parenteral administration of drugs. The purpose of this study was to characterise the physicochemical properties of non-antineoplastic parenterally administered drugs and determine their potential to cause a toxic effect on tissue.

Methods

A list of drugs administered by intermittent or continuous intravenous (IV) infusion was prepared. A database was also established to collect information from the literature. Each active substance was classified according to its risk to cause tissue damage using the following criteria: (1) High risk: active substances presenting with any of the following characteristics: osmolarity of the IV solution form >500 mOsm/L; vasoconstriction; vesication; cellular toxicity; very common, common or uncommon adverse events such as phlebitis, necrosis or pain at the site of administration according to the Summary of Product Characteristics. (2) Moderate risk: active substances where the pH range was <3 or >11 or where adverse events at the site of administration occurred rarely, very rarely or with unknown frequency. (3) Low risk: active substances where the osmolarity of the IV solution was <500 mOsm/L and the pH ranged between 3 and 11. These active substances did not cause vasoconstriction, neither were they classified as vesicant or cytotoxic or presented with adverse events at the site of administration.

Results

The risk classification list included 138 active substances, of which 86 were classified as ‘high risk’, 18 as ‘moderate risk’ and 34 as ‘low risk’.

Conclusion

The classification of intravenously administered drugs according to their risk profile is useful to ensure their safe use, as it can be used to implement the necessary safety measures to prevent adverse events.