Handling and storing cancer pills safely at home

In a hospital, cancer drugs are handled behind a set of rules that most patients never see. NIOSH, the federal workplace safety institute, describes protective equipment used with antineoplastic agents, noting that gloves are the type most often used and that protective gowns are another commonly used item.

At home, the same category of medicine sits in a cupboard. Nobody gowns up. That does not mean care stops mattering — it means the care becomes yours to organise.

MedlinePlus gives storage instructions for capecitabine that are worth copying for any cancer tablet unless your pharmacist says otherwise:

• Keep it in the container it came in, tightly closed.
• Keep it out of reach of children.
• Store it at room temperature.
• Keep it away from excess heat and moisture.

That last point rules out the two places people instinctively choose. A bathroom cabinet is humid. A windowsill or a car glovebox gets hot. A cool, dry, high shelf is duller and better.

If there are children or curious visitors in the house, treat placement as a safety decision, not a convenience decision.

MedlinePlus tells capecitabine users to swallow the tablets whole with water, and not to split, chew or crush them. The cabozantinib entry carries the equivalent instruction for its tablets and capsules.

People break this rule with good intentions — a tablet is large, swallowing has become uncomfortable, mixing it into food seems sensible. Crushing changes how the medicine is released and creates dust and residue that were never meant to escape the tablet.

If swallowing is genuinely difficult, that is a real problem with real solutions. Say so at the pharmacy counter rather than reaching for a pill cutter.

Whether family members need to take precautions when handling your tablets depends on the specific drug, and no general article can answer it responsibly. What is reasonable is to ask.

Useful things to establish before you start:

• Should anyone helping me handle these wear gloves?
• What should we do if a tablet is dropped on the floor or a capsule splits?
• Are there any precautions about laundry, toilet use or body fluids with this drug?
• Should the medicine be kept separate from the rest of the household's medicines?

A pharmacist will have clear answers, and asking takes two minutes.

Treatment plans change. Bottles get left half full, and the instinct is to flush the contents away.

MedlinePlus says not to. Do not flush this medication down the toilet, it states, advising a medicine take-back programme instead. Many pharmacies host collection points, and some police stations and local authorities run them too. Ask your pharmacy where the nearest one is while you still have the medicine, rather than discovering the answer months later.

Keeping unused cancer drugs "just in case" is not a good plan either. Doses change, drugs expire, and an old bottle in a drawer is a hazard to whoever finds it.

• Call 911 or go to an emergency department if someone who swallowed a tablet that was not prescribed to them collapses, has a seizure, cannot be woken, or is having trouble breathing.
• Call Poison Control on 1-800-222-1222 the same day if anyone in the house swallows one of these tablets by mistake, or takes more than the prescribed dose. MedlinePlus gives this number for accidental ingestion and overdose. Do not wait for symptoms before you ring it.
• Call your pharmacy or care team within a day or two if a tablet has been crushed, broken or spilled at home and you are unsure how to clear it up. MedlinePlus notes that exposure to crushed capecitabine tablets can cause eye irritation, rash, nausea, vomiting and diarrhoea. So this is worth a question rather than a guess.