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Metotreksat – frakcja wdychalna : dokumentacja proponowanych dopuszczalnych wielkości narażenia zawodowego

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Warianty tytułu
EN
Methotrexate – inhalable fraction : documentation of proposed values of occupational exposure limits (OELs)
Języki publikacji
PL
Abstrakty
PL
Metotreksat (MTX) jest strukturalnym analogiem kwasu foliowego. Związek jest w temperaturze pokojowej ciałem stałym występującym w formie jasnożółtopomarańczowego krystalicznego proszku o lekkim zapachu, charakterystycznym dla związków aromatycznych. Metotreksat jest stosowany jako lek cytostatyczny podawany w infuzjach lub doustnie, należący do antagonistów kwasu foliowego. O zawodowym narażeniu na cytostatyki można mówić na dwóch etapach ich zastosowania, tj. podczas procesów wytwarzania chemioterapetyków oraz podczas ich stosowania w codziennej praktyce leczniczej oddziałów szpitalnych, przede wszystkim tych, na których leczeni są pacjenci chorujący na choroby nowotworowe. W Polsce metotreksat nie jest produkowany i obecnie brak jest danych o liczbie osób narażonych na jego działanie w placówkach służby zdrowia, ponieważ nie zostały ustalone wartości najwyższych dopuszczalnych stężeń tej substancji w środowisku pracy. W NIOSH w 2004 r. oszacowano, że liczba osób narażonych zawodowo w USA na cytostatyki i inne leki niebezpieczne przekracza 5 mln. Główne skutki działania metotreksatu po podaniu: dożołądkowym, domięśniowym lub dożylnym, obejmują: zahamowanie czynności szpiku kostnego, działanie hepatotoksyczne oraz zaburzenia płodności. W warunkach narażenia inhalacyjnego metotreksat może podrażniać oczy i błony śluzowe nosa. Substancja została zaklasyfikowana jako drażniąca na skórę i oczy kategorii 2. Kontakt ze skórą uznano za najważniejszy czynnik ryzyka dla personelu medycznego narażonego na cytostatyki. Najczęściej zgłaszane objawy skórne dotyczyły kontaktu z rozlanym roztworem zawierającym metotreksat lub wysypanym z opakowania produktem, w czasie jego usuwania oraz kontaktu z ekskrementami pacjentów poddawanych chemioterapii. U pracowników, zatrudnionych w zakładzie produkującym metotreksat, związek powodował uszkodzenia genetyczne kwasu dezoksyrybonukleinowego (DNA) w testach: mikrojądrowym, kometowym i mutacji genowych hprt. Uszkodzenia chromosomów stwierdzono w szpiku kostnym pacjentów leczonych metotreksatem. Genotoksyczność wywoływaną przez metotreksat potwierdzono na podstawie wyników badań na zwierzętach. Na podstawie dostępnych danych w Międzynarodowej Agencji ds. Badań nad Rakiem (IARC) stwierdzono, że brak jest dowodów na działanie rakotwórcze metotreksatu u ludzi i zwierząt (grupa 3.). W grupie chorych leczonych metotreksatem nie uzyskano jednoznacznych dowodów potwierdzających zwiększone ryzyko nowotworów. Metotreksat nie wykazywał działania rakotwórczego w przewlekłych badaniach na zwierzętach po podaniu: dożołądkowym, dootrzewnowym oraz dożylnym. Metotreksat wpływa na rozrodczość u ludzi zarówno w okresie leczenia, jak i przez krótki czas po jego zakończeniu. Obecnie rekomenduje się zharmonizowaną klasyfikację metotreksatu pod kątem szkodliwego działania na rozrodczość i ze względu na funkcje rozrodcze oraz płodność do kategorii 2., tj. substancji, co do których podejrzewa się, że działają szkodliwie na rozrodczość ludzi i ze względu na rozwój potomstwa do kategorii 1.A, tj. substancji działających szkodliwie na rozrodczość ludzi. Podstawą ustalenia wartości NDS dla metotreksatu były następujące dane: 1. Metotreksat wykazuje bezprogowe działanie genotoksyczne, które może wystąpić na każdym poziomie narażenia. Na podstawie danych u ludzi ustalenie zależności dawka-odpowiedź nie jest możliwe, jak również nie jest to możliwe przez ekstrapolację wyników z badań na zwierzętach. 2. Producenci metotreksatu ustalili dopuszczalne poziomy narażenia zawodowego na poziomie 0,0003 ÷ 0,0025 mg/m3. 3. Na podstawie przedstawionych klasyfikacji (IPCS, NIOSH, ASHP, IACP) metotreksat powinien mieć wartość dopuszczalnego narażenia zawodowego na poziomie < 0,01 mg/m3. Wartość tę przyjęto za podstawę do ustalenia wartości najwyższego dopuszczalnego stężenia (NDS) i zastosowano arbitralnie współczynnik niepewności równy 10, uwzględniając skutki odległe, wynikające z działania metotreksatu, tj. działanie genotoksyczne i szkodliwe działanie na rozrodczość u ludzi, zarówno na płodność, jak i rozwój potomstwa. Zaproponowano przyjęcie wartości NDS dla frakcji wdychalnej metotreksatu na poziomie 0,001 mg/m3. Ustalenie wartości dopuszczalnej w środowisku pracy dla metotreksatu nałoży na pracodawców obowiązek monitorowania stężenia tego cytostatyku w środowisku pracy i pozwoli na ocenę rzeczywistego narażenia personelu medycznego na tę substancję. Nie ma podstaw merytorycznych do ustalenia wartości najwyższego dopuszczalnego stężenia chwilowego (NDSCh) i wartości dopuszczalnego stężenia w materiale biologicznym (DSB) metotreksatu. Należy zastosować także oznakowanie „skóra”, ponieważ wchłanianie substancji przez skórę może być podobnie istotne, jak przy narażeniu drogą oddechową, a także oznakowanie literami „Ft” – substancja działająca szkodliwie na płód.
EN
Methotrexate (MTX) is a structural analogue of folic acid. This compound is solid at room temperature; it is a yellowish-orange, crystalline powder with a slight odor characteristic of aromatic compounds. Methotrexate is a cytostatic drug administered in infusion or orally; it is a folic acid antagonist. Occupational exposure to cytotoxic drugs takes place at two stages of their application, i.e., during manufacturing processes and during their use in daily practice of medical wards, especially those which treat cancer patients. In Poland, methotrexate is not produced, and there are currently no data on the number of people exposed to its action in health care, because the value of the maximum concentration of the substance in the workplace has not been set. NIOSH in 2004 estimated that the number of persons occupationally exposed to cytotoxic drugs and other dangerous drugs in the USA exceeded 5 million. The main effects of methotrexate after intragastric, intramuscular or intravenous administration include myelosuppression, hepatotoxicity and impaired fertility. In terms of exposure by inhalation, methotrexate can irritate the eyes and mucous membranes of the nose. This substance is classified as irritating to the skin and eyes, category 2. Contact with the skin was found to be the most important risk factor for medical personnel exposed to cytotoxic drugs. The most frequently reported skin symptoms were associated with removal of methotrexate powder or solutions and in contact with the excrement of patients undergoing chemotherapy. Methotrexate induced genetic damage of deoxyribonucleic acid (DNA) in micronucleus, comet and hprt gene mutation tests among workers employed in a plant manufacturing methotrexate. Chromosomal damage was found in the bone marrow of patients treated with methotrexate. Animal studies confirmed methotrexate-induced genotoxicity. On the basis of available data, the International Agency Research on Cancer (IARC) concluded that there was no evidence of a carcinogenic effect of methotrexate in humans and animals (group 3). In a group of patients treated with methotrexate, there was no conclusive evidence of an increased risk of cancer. Methotrexate was not carcinogenic in chronic animal studies after intragastric, intraperitoneal or intravenous administration. Methotrexate affects fertility in humans, both during treatment and for a short time afterwards. With respect to the sexual function and fertility, category 2 is the present recommended methotrexate harmonized classification for reproductive toxicity; however, with respect to the development of the offspring, it is category 1A. The MAC-TWA value for methotrexate was set on the basis of the following: 1. Methotrexate is genotoxic without a threshold, which may occur at any level of exposure. Based on the data in humans, it is not possible to determine the dose-response; this is not possible by extrapolation of results from animal studies, either. It is not possible to propose the MAC value on the basis of the smallest oral therapy dose because in 10% to 37% of patients methotrexate results in adverse effects after low therapeutic doses. Myelosuppression and toxic effects on mucous membranes depend on the dose of methotrexate and the time of exposure; the critical dose is > 2 - 10- 8 mol/L plasma. 2. Manufacturers of methotrexate established occupational exposure levels at 0.0003 – 0.0025 mg/m3. In 1988, OSHA arbitrarily established a target concentration level of 0.04 mg/m3 (40 μg/m3) for the purposes of air monitoring. 3. On the basis of the classification (IPCS, NIOSH, ASHP, IACP), methotrexate should have a permissible occupational exposure value of < 0.01 mg/m3. This value was taken as a basis for determining the maximum admissible concentration (MAC ); the arbitrary uncertainty factor of 10 was used, taking into account long-term consequences, resulting from the action of methotrexate, i.e., genotoxicity and reproductive toxicity in humans: the effect on both the fertility and development of the offspring in humans. It is proposed to determine the MAC values for the inhalable fraction of methotrexate at the level of 0.001 mg/m3. Determination of the limit value in the working environment for methotrexate imposes on employers an obligation to monitor the concentration of this chemotherapeutic agent in the working environment. It will also make it possible to assess actual exposure of medical personnel to this substance. The authors found basis for determining short-term ( STEL ) and permissible concentrations in biological material (DSB) of methotrexate. It is also proposed to use the "skin" label in the list of occupational exposure limit because absorption through the skin may be as important as inhalation. Using the letters " Ft " – toxic to the fetus – is also proposed.
Rocznik
Tom
Strony
73--118
Opis fizyczny
Bibliogr. 216 poz., tab.
Twórcy
  • Instytut Medycyny Pracy im. prof. dr. med. Jerzego Nofera 91-348 Łódź ul. św. Teresy od Dzieciątka Jezus 8 90-151 Łódź, ul. J. Muszyńskiego 1
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Typ dokumentu
Bibliografia
Identyfikator YADDA
bwmeta1.element.baztech-e076f1ee-c3eb-4a59-b551-666f205f37a3
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