Collecting, storing and handling denosumab

You usually collect denosumab from the chemotherapy day unit. The medicine needs to be kept in the fridge and stored in a safe way. We give you all the equipment that you need to do the injections at home.

Denosumab needs to be handled safely. There are special procedures to follow if you accidentally spill any medicine.

Getting your supply of denosumab

We give you denosumab in a small bottle (vial). A nurse shows you how to draw it up into a syringe (small tube with a thin, hollow needle at the end) for injection. The bottles are stored in a sealed plastic bag from the pharmacy department.

We usually ask you to collect your denosumab bottles and equipment from the chemotherapy day unit. In exceptional circumstances, a courier service can deliver your medicines.

If you collect denosumab from the chemotherapy day unit

Please bring a leakproof, tight-fitting plastic storage container with a lid (for example, Tupperware® or something similar) to collect your medicine. This helps to protect the denosumab bottles from damage.

When transporting denosumab home, it is important to help reduce the effects of changes in temperature.

Denosumab needs to be kept in the fridge. You need to put your medicine supplies in the fridge straight away when you get home.

Storing denosumab at home

Here are some tips for how to store denosumab safely at home.

Damaged or unsafe supplies

If any denosumab bottles have been damaged, the date has expired or their container gets damaged, please contact the chemotherapy day unit as soon as possible. We can then give you advice and replace the prescribed amount (dose) of your medicine.

If your fridge does not work properly or you leave denosumab bottles out of the fridge, you can still use them provided that:

• you have kept the bottles in their original packaging
• the bottles have been out of the fridge for less than 30 days
• you have stored the bottles at room temperature between 8 and 30C

Contact the chemotherapy day unit if you have left the bottles out of the fridge for more than 30 days or outside these temperature limits. We can give you advice about what to do.

It is important to dispose safely of any denosumab bottles that have not been stored in the correct way. We give you a specially designed yellow box with a purple lid called a sharps bin. You can use another bottle if you have one and it has been stored properly in the fridge.

Returning unused medicine

Please return any unused denosumab bottles or syringes to the hospital in a suitable plastic container at your next appointment. This should be a leakproof, tight-fitting storage container with a lid (for example, Tupperware® or something similar).

If you give the unused medicine to a nurse in the chemotherapy day unit or your clinic, they will dispose of it safely.

Equipment needed for denosumab injections

The hospital gives you all the equipment that you need for injecting denosumab at home. If you need any more equipment supplies, please contact a nurse in the chemotherapy day unit.

The equipment that we give you includes:

• bottle(s) containing 120mg denosumab for your treatment
• syringes to inject the medicine
• needles (orange safety needles and red needles)
• sterile alcohol wipes
• alcohol swabs (cotton pads soaked in alcohol to clean a patch of skin before an injection)
• gauze swabs (cotton pads to soak up any spills and clean a patch of skin after an injection)
• gloves
• an apron (you only need this if a carer gives you the injections)
• a specially designed yellow box with a purple lid called a sharps bin to dispose of used bottles, syringes and needles

If we gave you any equipment to take your denosumab bottles home, please return it to the hospital at your next visit. This may include a cool box or ice packs.

Handling the medicine safely

There are some important safety rules for handling denosumab.

• It is not safe to handle denosumab if you are trying for a baby, already pregnant or breastfeeding.
• Denosumab bottles must always be kept out of the reach of children and pets.
• Only people who are trained to use denosumab bottles should handle them when they are out of the sealed plastic bag.
• A carer or member of your household can give you your injection if we have shown them how to do this correctly.
• If your carer or household member gets a needle stick injury (when a needle pierces or scratches their skin), they should wash the area thoroughly with water. They can then contact the chemotherapy day unit immediately for more advice.

Procedure if you spill any denosumab

You need to follow this procedure if you accidentally spill any denosumab.

1. Put on 2 pairs of gloves that you can throw away (disposable gloves).
2. If there is a small spill, soak it up using a kitchen towel. Start at the outside edge of the spill and work inwards towards the middle. Place the kitchen towel gently over the spill to avoid splashing.
3. Put the kitchen towel and any sharp material into a bag. Then put this bag into the yellow sharps bin with a purple lid.
4. Take off the top pair of gloves. Clean the floor or work surface with warm soapy water (for example, water and washing up liquid) and a kitchen towel.
5. After cleaning the area, put the kitchen towel and gloves into a bag. Then put this bag into the yellow sharps bin with a purple lid.
6. Wash your hands thoroughly.
7. Contact the nurse in charge at the chemotherapy day unit to tell them about the spill. They can arrange to replace your medicine if needed.

Procedure if you spill any denosumab on yourself

You need to follow this procedure immediately if you accidentally spill any denosumab onto your skin or at your nostrils, mouth, lips, eyelids or ears.

1. Wash the area thoroughly with soapy water as soon as possible. If there has been a large spill or splash, remove any clothes that have come into contact with denosumab. You need to wash these separately from your other clothes. Have a shower and put on a clean set of clothes.
2. If the medicine has splashed into your eye, rinse it thoroughly with tap water for about 20 minutes.
3. Immediately report what has happened to your clinical nurse specialist or the nurse in charge at the chemotherapy day unit.