1.2 The NIOSH Hazardous Drug List (2024 Update)
Key Takeaways
- The NIOSH List of Hazardous Drugs in Healthcare Settings, 2024 (published December 17, 2024) replaced the 2016 list and added 25 drugs (12 with MSHI) while removing 7, including liraglutide and pertuzumab.
- The list now uses two tables: Table 1 (MSHI and/or NTP-known-carcinogen or IARC Group 1/2A) and Table 2 (other NIOSH hazard criteria without that carcinogen classification).
- PTCB Hazardous Drug Management Certificate exams delivered on or after March 24, 2025 are written against the 2024 list structure, not the older three-tier list.
- Facilities must actively update HD policies to reflect NIOSH list revisions; treating the list as a one-time reference is a real administrative-domain compliance gap.
The NIOSH Hazardous Drug List (2024 Update)
Quick Answer: The NIOSH List of Hazardous Drugs in Healthcare Settings, 2024 — published by CDC/NIOSH on December 17, 2024 — replaced the 2016 list. It added 25 drugs (12 with manufacturer's special handling information) and removed 7, and reorganized the list into two tables: Table 1 (drugs with MSHI and/or NTP/IARC carcinogen classification) and Table 2 (other drugs meeting a NIOSH hazard criterion, but not NTP/IARC carcinogens). PTCB Hazardous Drug Management exams delivered on or after March 24, 2025 test the 2024 list.
The NIOSH list is the reference document that tells USP <800> — and every facility's HD program — which drugs actually count as "hazardous." Without it, <800>'s requirements would have no defined trigger list. Knowing how the list is structured, and knowing that the 2024 version is now current, is a frequent exam checkpoint.
Why the List Exists
NIOSH (the National Institute for Occupational Safety and Health, part of the CDC) maintains and periodically updates a list of drugs identified as hazardous to healthcare workers based on defined criteria — carcinogenicity, teratogenicity or other developmental toxicity, reproductive toxicity, organ toxicity at low doses, genotoxicity, or a structure/toxicity profile similar to an existing hazardous drug. USP <800> incorporates the current NIOSH list by reference as its definition of which drugs trigger the chapter's containment, PPE, and administrative requirements.
The 2024 Update: What Changed
CDC/NIOSH published the List of Hazardous Drugs in Healthcare Settings, 2024 on December 17, 2024, superseding the 2016 list. Two changes matter most for the exam:
- Net drug changes — 25 drugs were added (12 of which carry manufacturer's special handling information, or MSHI, in their package insert), and 7 drugs were removed after reevaluation determined they no longer meet a NIOSH hazard criterion. Two named 2024 removals are liraglutide (a GLP-1 diabetes medication) and pertuzumab (a monoclonal-antibody antineoplastic) — both dropped after NIOSH's final reevaluation found their exposure risk did not warrant continued listing.
- Table restructuring — the list moved from a three-tier structure to two tables.
Table 1 vs. Table 2 — the Structural Change That Gets Tested
| Table 1 | Table 2 | |
|---|---|---|
| Core criterion | Manufacturer safe-handling information (MSHI) in the package insert, and/or NTP-classified known human carcinogen, or IARC Group 1/2A carcinogen | Meets a NIOSH hazard criterion (carcinogenicity, teratogenicity/developmental toxicity, reproductive toxicity, organ toxicity at low dose, genotoxicity, or structural/toxicity similarity to an existing HD) but is not an NTP/IARC-classified carcinogen |
| Typical drug type | Antineoplastics and other agents with the strongest carcinogen evidence or explicit manufacturer handling precautions | Broader group — includes drugs with reproductive/developmental risk or other hazard criteria, without carcinogen classification |
| Containment implication | Generally the strictest containment expectations; poor candidates for Assessment-of-Risk exceptions when compounding is involved | More likely candidates for a documented Assessment of Risk to determine alternative handling, especially for final dosage forms |
Exam trap: candidates often assume "Table 1 = chemo drugs, Table 2 = everything else, and that's it." The actual dividing line is the carcinogen classification and MSHI status, not simply "antineoplastic vs. non-antineoplastic." A drug can be non-antineoplastic and still land in Table 1 if it carries MSHI or a carcinogen classification; conversely, some antineoplastic-adjacent agents can fall into Table 2 if they don't meet the carcinogen/MSHI bar.
Why the Effective Date Matters for This Exam
PTCB confirmed that Hazardous Drug Management Certificate exams delivered on or after March 24, 2025 are written against the 2024 NIOSH list, not the 2016 list. If your training materials or a coworker's notes still describe a three-table structure or reference the 2016 list's specific counts, treat that as outdated — the exam tests the 2024 structure and the current, two-table framework described above.
Exam Scenario
A pharmacy's hazardous drug policy manual, last revised in 2018, references "the current NIOSH list" without naming a year, and staff have not cross-checked it since. A new drug added in the 2024 update is now stocked in the pharmacy, but because no one updated the reference list, staff handle it with standard PPE instead of HD precautions. This is exactly the kind of administrative-domain failure the exam probes: policies must name and track the current NIOSH list version, and facilities must review newly hazardous drugs against Table 1/Table 2 criteria as their formularies change — not rely on a static, undated internal list.
Key Takeaways
- The 2024 NIOSH list (published December 17, 2024) replaced the 2016 list; 25 drugs added (12 with MSHI), 7 removed, including liraglutide and pertuzumab.
- The list restructured from three tiers to two tables: Table 1 (MSHI and/or NTP/IARC carcinogen) and Table 2 (other NIOSH hazard criteria, non-carcinogen).
- PTCB HD Management exams delivered on/after March 24, 2025 test the 2024 list — assume the current exam uses this structure.
- Facilities must actively track NIOSH list updates in their HD policies; a stale reference list is a real compliance gap, not a technicality.
According to the NIOSH List of Hazardous Drugs in Healthcare Settings, 2024, what distinguishes a Table 1 drug from a Table 2 drug?
A facility's hazardous drug policy still references the 2016 NIOSH list and does not account for the 2024 update. Which of the following is most directly a consequence of this gap?
Which pair of drugs were removed from the NIOSH hazardous drug list in the 2024 update after reevaluation determined they no longer met a hazard criterion?