Grandpa took thalidomide-familiy worried about environmental exposure to it

[boggle, ASN, RN]

A friend just came to me for advice. The Grandfather died recently from myeloma, CV disease and other causes. Now the family is tending to the house and his belongings. The grandfather took thalidomide, among many other meds, during his last few weeks of life. The family is afraid to use or keep some of his belongings and furniture, afraid that they are not safe because of the thalidomide.

It turns out they thought all women of childbearing age and the young great-grandchildren could not even go in the house. These people missed the last few weeks with this man because of this fear. It is so sad.

Now, I don't know what they were actually told, or what they understood(misunderstood) about the safety precautions when taking Thalidomide, but I can't believe that was part of it.

I told her I had never heard of a risk of exposure to friends and family of the person taking the med unless they were handling or ingesting the med. Also that women who take thalidomide can become pregnant later in life, just not ingest thalidomide while pregnant or becoming pregnant. I also explained to her that there was no contagion factor with the cancer, and that his "waste" chemo meds had long since flushed down the toilet.

I asked her to consider how meds were handled at that home. Were they worried that the kids might find pills that were spilled into the furniture? I told her I would do some research and talk to her again.

So what do you guys think? Could there possibly be any problem here?

[kids]

I checked the 4 resources below. None of the links below gave any indication that home, furnishings or belongings represent any risk (and I would think that if it did at least one of them would mention it in the patient information). I would encourage them to make a call to the doctor who prescribed (or the pharmacy that dispensed) and put the question to them (this could be done without breeching any confidentiality).

From what I found Thalomide is a heavily regulated drug, it appears not all doctors can prescribe it and not all pharmacies can dispense it (in the US). One source even stated to return the unused drug to the doctor. I am thinking it has been "re-allowed" for use to treat certain conditions in Europe longer than it has the US. Maybe someone else will have something to add.

http://www.fda.gov/cder/news/thalidomide.htm

http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a699032.html

http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202692.html

http://www.rxlist.com/cgi/generic2/thalidom_wcp.htm

[kids]

I also suggest a Google search, I just did one and found many patient info links and studies. The first half dozen I skimmed did not mention home/furnishing/belongings being a hazard after someone has taken thalomide (some for as long as >1year).

[jemb]

We have quite a few patients on Thalidomide. There is no reason to avoid contact with someone taking the drug, and their clothing and furniture is not contaminated from having the drug in the home.

The primary warning we give our patients is that if they are capable of becoming pregnant, use more than one birth control method or abstain while on the drug because of potential deformities of the fetus.

[caroladybelle, BSN, RN]

As long as the capsules were not broken/crushed, they need to returned to the physician/pharmacy. They should not be flushed/thrown out with regular trash/washed down the sink (which really is what we should do with all unused ABX, chemo meds -Tamoxofen/Busulfan/Methatrexate/etc- or drugs than cause mutation -Accutane/minoxidil/etc.). Too many of us get in the habit of just flushing old meds, which contaminates septic systems/water/soil.

In the home environment, the only worry that I have is with people breaking/crushing capsules, which could potential aerosolize the drug. But then a thorough area cleaning should be in order.

I have been told that it comes in a liquid form, but I have never given it that way. But it should never be crushed (per some pharmacies). If the patient is too ill to swallow the capsules, the MD should reconsider giving it. There is no "scoring" to open the capsule for that reason.

[boggle, ASN, RN]

Thanks for your replies, everyone. I also did not not find any resources describing cautions for the patient's environment.

I feel bad that the family avoided contact as they did.