Safe handling of hazardous medicines at home: Cutting and preparing tablets as a liquid

If your child cannot swallow tablets, you can dissolve them as a liquid. It is important that you do not crush hazardous medicine tablets. Follow these instructions to dissolve the medicine as a liquid using an oral syringe.

What is hazardous medicine?

Hazardous medicines are used to treat a variety of medical conditions. For example, chemotherapy is used to treat cancer, and immunosuppressants are used to prevent organ rejection after a transplant.

Hazardous medicine can damage healthy cells. Anyone handling hazardous medicine should keep themselves protected.

Although the risk of harm from handling hazardous medicine is small, it is a good idea to avoid exposure. This includes not tasting your child’s medicine. If you are pregnant or breastfeeding, it is best to avoid contact with hazardous medicine. If possible, have someone else prepare and give your child their medicine.

Preparing the space

You will need to gather certain supplies and take careful steps when setting up your work area. Your child’s healthcare provider will help you make a list of the supplies you will need. You can buy some of these materials at a grocery or drug store.

To handle your child’s hazardous medicine at home, choose an uncluttered counter or table away from windows, fans, vents, areas where you prepare food, and where children and pets play.

If you are cutting your child’s tablets and dissolving them as a liquid, a gown, mask and gloves offer protection. Other supplies will include:

• paper towels or a disposable, absorbent plastic-backed mat — to contain any spills
a plastic bag — for waste disposal
• a medicine cup — to hold the water used to dissolve the tablets
• tweezers — to pick up the medicine
• an oral syringe — to mix and give the medicine
• a tablet cutter, also called a pill splitter
• room-temperature water — to dissolve the medicine
• a suitable drink such as water. Your child’s health-care provider will tell you which drinks are suitable
• your child’s medicine

Giving your child the disolved tablets

Always prepare the medicine right before your child will take it. Never prepare and store the dose ahead of time.

Before cutting a tablet and dissolving it as a liquid:

• Wash your hands with soap and water.
• Put on your gloves, gown and mask.
• Place paper towels or a disposable, absorbent plastic-backed mat over your work surface.

You are now ready to handle your child’s medicine.

Giving the medicine

1. Pour some of the room-temperature water into the medicine cup. Do not use other drinks such as juice or cola.
2. Open the tablet cutter.
3. Open the medicine bottle and use the tweezers to remove the required number of tablets. Place the tablets into the medicine cup and put the lid back on the medicine bottle as soon as possible.



4. Using the tweezers place a tablet in the tablet cutter. If the tablet has a score mark, line this up with the blade of the tablet cutter. Close the tablet cutter and press down firmly. Use the tweezers to place the portion of the tablet to be taken into the medicine cup.
5. When you are done, use the tweezers to return the remaining piece of the tablet to the original medicine bottle. You can use this piece for your child’s next dose. Only cut as many tablets as you need at one time. If any tablet pieces are not intact, place them in a container or plastic bag clearly marked for disposal of hazardous medicines.
6. You will use the oral syringe to dissolve the tablets and give your child the liquid medicine as follows:
1. To prepare the syringe, remove the cap. Then remove the plunger from the syringe.
2. Use the tweezers to place the required number of tablets or partial tablet into the barrel of the oral syringe.
3. Place the plunger back into the syringe.



4. Place the tip of the syringe into the medicine cup with the room-temperature water. Pull up on the plunger to draw up 5 to 7.5 mL of water into the syringe.
5. Put the cap back onto the oral syringe.
6. Gently rock the syringe back and forth until you no longer see any big pieces of the tablet. This may take several minutes. The tablet does not dissolve completely — you may see small white particles floating in the water. It is fine to give the medicine like this, as long as there are no large chunks that will clog the syringe.
7. Give the dose to your child. To give the medicine to your child, remove the cap and place the oral syringe into their mouth. Slowly push the plunger to release the medicine.
8. If any medicine is left in the syringe, draw up more water, gently rock the syringe back and forth and give the medicine to your child.
7. Your child may drink more water after taking their medicine. Your child’s health-care provider will tell you if your child may take any other drinks or food.

Speak to your health-care provider if your child is having trouble taking the medicine.

While preparing your child’s medicine, please remember:

• Use the tweezers, tablet cutter and oral syringe to give the hazardous medicine only. Do not use them for other medicines.

Clean-up and storage of hazardous medicines

Hazardous medicines should be handled safely. It is important to carefully handle the clean-up of the supplies and work area, and to dispose of wastes properly.

Remember these key tips for safe handling of hazardous medicines at home.

• If possible, avoid contact with hazardous medicines if you are pregnant or breastfeeding.
• You and your child should wash your hands before and after handling hazardous medicines.
• Wear gloves when handling hazardous medicine tablets, capsules, or liquids.
• Properly clean, dispose or store the equipment and hazardous medicine.

All disposable items that have been in contact with hazardous medicines, such as used paper towels and gloves, must go into a designated plastic waste bag or container. Contact the Household Hazardous Waste Depot in your neighbourhood to see if they will accept the waste bags or containers. If such a service does not exist in your area, ask a member of your child's healthcare team about other options.

You may wash and reuse some of your supplies, but do not rinse them in the kitchen sink over other dishes or utensils.

If you are reusing an item, such as the medicine cup, rinse it with warm soapy water and allow it to air dry. Clean the sink after washing your supplies.

Always store hazardous medicines away from children and pets. If stored at room temperature, place them in a locked box, away from moisture and direct sunlight, and in a cool, dry place. If the medicine needs refrigeration, place it in a separate container at the back of the fridge. Return the medicine to the locked box or fridge after each use. Do not keep any medicine in your purse, knapsack or diaper bag.

Take special precautions with your child's waste (vomit, urine and stool) while they are taking hazardous medicine

While your child is taking hazardous medicine, some of the drug is broken down and removed from the body through urine and stool. It may also appear in vomit. It is important that you protect yourself and others from hazardous medicine in your child's urine, stool or vomit by following these guidelines:

• When changing your child’s diaper, wear disposable gloves and place diapers in a sealed plastic bag before disposal.
• If your child is toilet trained, have your child close the lid, to avoid splashes, and flush twice after using the toilet. Always make sure they wash their hands afterwards.
• Have supplies ready in case you need to quickly clean up any accident. You need a paper towel, soap and water, disposable gloves, and a disposable container, such as an empty ice cream container.
• Use a plastic mattress cover to protect the mattress from accidents.
• Keep a plastic container close by in case of vomiting. If you use the container, empty the contents into the toilet and wash with warm soapy water.
• Wear disposable gloves when you are handling any bodily wastes, such as changing soiled sheets or cleaning up vomit.
• Wash soiled clothes or sheets separately from other laundry. If they cannot be washed right away, place them in a sealed plastic bag and set it aside.
• Once you are all finished, wash your hands.