Where It Comes From
Prescription use, pharmaceutical manufacturing, hospital and household waste, and improper disposal; traces occur in wastewater and surface waters [4].
How You Are Exposed
Taking the medicine; handling or compounding tablets/capsules; inhaling dust during manufacturing or healthcare work; drinking water with trace residues [2][4].
Why It Matters
Use during pregnancy is linked to birth defects and developmental problems; workers may be exposed to hazardous drug levels; IARC classifies phenytoin as possibly carcinogenic to humans (Group 2B) [1][2][3].
Who Is at Risk
People who are pregnant or planning pregnancy and their fetuses; newborns; pharmacy/healthcare staff and manufacturing workers; people on high doses or long-term therapy [1][2].
How to Lower Your Exposure
Use only as prescribed and do not stop suddenly; if pregnant or planning, discuss treatment options; workers should follow NIOSH hazardous-drug handling (gloves, protective equipment, closed systems); return unused meds at take-back programs—don’t flush [2][4].
References
- [1]CDC. Epilepsy and Pregnancy. https://www.cdc.gov/epilepsy/pregnancy/index.htm
- [2]CDC/NIOSH. NIOSH List of Hazardous Drugs in Healthcare Settings, 2023. https://www.cdc.gov/niosh/docs/2023-130/
- [3]IARC/WHO. IARC Monographs: Phenytoin (Group 2B). https://monographs.iarc.who.int/list-of-classifications?search=phenytoin
- [4]EPA. Pharmaceuticals and Personal Care Products (PPCPs) in Water. https://www.epa.gov/wqc/pharmaceuticals-and-personal-care-products-ppcps-water