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Annual for Hospital Pharmacy

Analysis of the centralized preparation of medicines for systemic treatment of malignant diseases in nine European countries

Velina Grigorova, Evgeni Grigorov



Back in the 1980s many analyses indicated that the centralized preparation of cytotoxics gave the opportunity to shorten the time for their preparation, to decrease the staff exposure to their toxic impact, to minimize the unavoidable residues (to be destroyed) after their preparation; therefore, this strategy has been getting implemented in different European countries.


The aim of this article is to make a comparison between the requirements and activities on central preparation of drugs for systemic treatment of malignant disease in a couple of chosen European countries and Bulgaria.  


The research has been carried out via online communication with hospital pharmacists directly involved in the centralized preparation of cytotoxics in their countries. The period of making the detailed interviews with the target respondents was June–August 2022.


In the 9 countries that participated in the research, patients with malignant diseases are treated only in hospitals where the centralized solution of cytotoxics are performed predominantly at hospital pharmacies. Rarely though, one can still encounter the practice of preparation of those drugs in the departments as this process has been practiced mainly in countries that have started with the centralized preparation in recent years (Bulgaria, Croatia, Romania, Lithuania).

Typically for Ireland and Sweden, the treatment can be performed in places out of the hospital, too, (e.g., at medical institutions for outpatient services or at patient’s home). The solution of the drugs for systemic treatment of malignant diseases in Ireland can be achieved both at hospital pharmacies and by independent contractors upon the hospital’s order; whereas in Sweden, it is done in the so-called centralized hospital pharmacies where solutions for a couple of hospitals are prepared. In Ireland and the Netherlands, only pharmacy technicians dissolve cytotoxics; it refers to Lithuania, too, as all that is performed at the pharmacy. Mostly pharmacy technicians deal with this activity in Portugal and Estonia, while in the other countries involved in the research, the preparation is done by Masters of pharmacy and by technicians/assistant pharmacists; in Sweden there are Masters of Pharmacy and Bachelors of Pharmacy.  

Predominantly, safety cabinets or isolators are used and usually their choice depends on the hospital. Standards related to the centralized preparation of cytotoxics are usually at national level, they are of advisable nature as it is in Bulgaria, Estonia, Lithuania, and are based on QUAPOS.

The Netherlands, Bulgaria, and Sweden have mandatory standards.  


cytotoxics; centralized preparation/solution; systemic treatment; malignant disease; hospital pharmacies

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