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Administration of methotrexate injections

June 15, 2016

We have received several questions about administering methotrexate injections in pharmacies. Although we do not have a specific policy about methotrexate, we have been working with the College of Physicians and Surgeons of Alberta and the College and Association of Registered Nurses of Alberta to develop guidelines regarding medication administration.

The draft guideline document includes directions for hazardous drugs. The complete document has not yet been finalized, but it has been approved in principle by ACP council. Therefore, we are providing the following section on administration of hazardous drugs as interim advice:

If hazardous drugs are administered in the practice setting,they are stored, handled and used safely.

  • A written procedure is in place for the management of hazardous drugs.
  • Hazardous drugs are stored separately from other medications if possible.
  • Employees and others at risk from handling hazardous drugs are identified and provided with adequate training and equipment.
  • Cytotoxic spill kits are available and staff are trained in spill management.
  • Adequate personal protective equipment including, but not limited to gloves, disposable gowns, and eye protection is worn for administration of hazardous drugs.
    • Additional personal protective equipment is used where there is potential for splash, spill or aerosolization.
    • Personal protective equipment is disposable where possible.
  • Hazardous drug waste and equipment is disposed at point-of-use into a cytotoxic waste container with minimal manipulation (e.g., needles and syringes are left intact).

Within the confines of the steps described above, single doses of methotrexate may be drawn up for immediate administration outside of a biological safety cabinet. However, pre-filling of methotrexate syringes should only occur in an appropriate sterile compounding environment. Employers may wish to consider implementing an acknowledgement of reproductive risk for pharmacist staff members who prepare and administer a hazardous product by injection.  

Finally, you are reminded that multi-dose vials must be discarded within 28 days of puncture.


*The above article was published on June 15, 2016, and may not be up-to-date with current standards and guidelines. If administering methotrexate injections in a pharmacy, please refer to ACP’s Guidelines for Medication and Vaccine Injection Safety. If compounding, please refer to the NAPRA Model Standards for Compounding Hazardous Sterile Preparations.