Gloves for handling misoprostol?

I work in abortion care where we are routinely handling 400-800 mcg of misoprostol, way more than the 25 mcg that is routine in labor & delivery, but I'm curious what L&D nurses have heard as well. I heard a rumor that we might be encouraged/mandated to wear gloves when handling miso because of potential effects on fertility, for those of us who have uteruses and may want to be pregnant someday. Now obviously I try not to touch any pills I'm dispensing with my bare hands anyway, but I heard that it might good to wear gloves just for handling the packaging and getting close to the med at all. Has anyone heard of this? Thoughts?

14 Answers

Specializes in Nurse Leader specializing in Labor & Delivery.

I found this document, that lists the medications that are considered potentially hazardous, and the recommendation for handling/administration. Cytotec IS mentioned. The recommendation for Cytotec, and other non-antineoplastic drugs that are in pill form, is that it does NOT require any special PPE, unless you are cutting or crushing (which you would not be doing with that dosage).

Ironically, administration of DMPA/Depo-Provera DOES recommend double-chemo gloves and a protective gown. How goofy is THAT?

https://www.CDC.gov/niosh/docs/2016-161/pdfs/2016-161.pdf

Specializes in OB.

I've definitely never heard that. It's technically a GI drug for ulcers, use in L&D is off-label although deemed safe, I can't imagine how it would affect one's fertility.

Hazardous agent / NIOSH 2016 - Group 3 (Source: UpToDate)

Considering the topic of occupational health,

"Group 3: Drugs that primarily pose a reproductive risk to men and women who are actively trying to conceive and women who are pregnant or breast feeding, because some of these drugs may be present in breast milk (Table 3)."

(Source: https://www.cdc.gov/niosh/docs/2016-161/pdfs/2016-161.pdf)

"Uncoated tablets may present a risk of exposure from dust by skin contact and/or inhalation when the tablets are counted [shahsavarani et al. 1993; Ahmad et al. 2014]."

(Source: https://www.cdc.gov/niosh/docs/2016-161/pdfs/2016-161.pdf, page 2)

It is recommended, per UpToDate, to utilize precautions for receiving, handling, admin, and disposal; furthermore, single gloves to be worn.

Similar topic came up in the general nursing forum, so I did a little digging. I found this document, that lists the medications that are considered potentially hazardous, and the recommendation for handling/administration. Cytotec IS mentioned. The recommendation for Cytotec, and other non-antineoplastic drugs that are in pill form, is that it does NOT require any special PPE, unless you are cutting or crushing (which you would not be doing with that dosage).

Ironically, administration of DMPA/Depo-Provera DOES recommend double-chemo gloves and a protective gown. How goofy is THAT?

https://www.cdc.gov/niosh/docs/2016-161/pdfs/2016-161.pdf

That is the same document I referenced in my post. It is recommended by NIOSH (Occupational Safety) to utilize single gloving for admin of intact tablets or capsules per the document you linked. The drug is classified as a Hazardous Agent and Grouped #3.

Specializes in Nurse Leader specializing in Labor & Delivery.
That is the same document I referenced in my post. It is recommended by NIOSH (Occupational Safety) to utilize single gloving for admin of intact tablets or capsules per the document you linked. The drug is classified as a Hazardous Agent and Grouped #3.

Right, as you would give ANY oral medication if you were going to be touching it. It does NOT say that it requires "chemo" gloves, gowning, or any special precautions in handling the packaging, as suggested in the OP. That's what she was asking about.

LibraSunCNM said:
I can't imagine how it would affect one's fertility.

Well there's the whole abortifacient property and how it comes with labels about NOT TO BE USED BY WOMEN WHO MAY BE PREGNANT. So maybe an overabundance of caution?

Specializes in OB.
boquiabierta said:
Well there's the whole abortifacient property and how it comes with labels about NOT TO BE USED BY WOMEN WHO MAY BE PREGNANT. So maybe an overabundance of caution?

Wait, are you seriously suggesting that simply touching a Cytotec or its packaging could cause someone to abort their baby? Or that the act of touching it could automatically cause them to become infertile? You can't be serious.

I've definitely never heard that. It's technically a GI drug for ulcers, use in L&D is off-label although deemed safe, I can't imagine how it would affect one's fertility.

Effective GI drug, yes. However, it has oxytocic actions.

Specializes in Nurse Leader specializing in Labor & Delivery.
Effective GI drug, yes. However, it has oxytocic actions.

Having "oxytocic" actions (and it really doesn't, its mechanism of action is that it's a prostaglandin analogue) doesn't affect a person's future fertility.

One would never touch the pills without gloves on, anyway, as you wouldn't with ANY medication that would be going directly into someone's mouth or other orifice. As it is not a chemotherapeutic drug, I see no reason why one would have to use such precautions with the packaging.

Specializes in OB.
Effective GI drug, yes. However, it has oxytocic actions.

I'm aware of how Cytotec works. That doesn't mean that handling the wrapper will abort your fetus.

Wait, are you seriously suggesting that simply touching a Cytotec or its packaging could cause someone to abort their baby? Or that the act of touching it could automatically cause them to become infertile? You can't be serious.

I agree it seems absurd. I'm asking in response to a rumor I heard at work about mandating glove usage for handling Cytotec and I was suggesting a reason why it might be warranted, since the drug certainly does have effects on pregnancy. I'm not saying I think it's likely or plausible that just touching the pill could have those effects.

It is recommended, per UpToDate, to utilize precautions for receiving, handling, admin, and disposal; furthermore, single gloves to be worn.

Thanks for this. Guess it's not so crazy after all?

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