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<h3>Background and Importance</h3> The preparation of injectable cytotoxic drugs in hospital compounding units (HCU) generates greenhouse gas emissions linked to glass vial production, single-use consumables, and waste incineration. Industrial ready-to-use (RTU) polypropylene bags of gemcitabine may reduce this footprint while improving production efficiency. However, few studies have assessed both the environmental and organisational effects of this approach. <h3>Aim and Objectives</h3> To compare the carbon footprint of gemcitabine prepared in HCU versus industrial RTU formats and evaluate their impact on workflow efficiency. <h3>Material and Methods</h3> A life cycle assessment (LCA) compliant with ISO 14040 was conducted using Ecovamed 2025 (a private platform assessing the environmental footprint of pharmaceuticals) and Carebone v2.3 (a sustainability tool from the Paris public hospital network). Internal process data refined emission estimates. All marketed RTU doses (1200–2200 mg) were compared with equivalent compounded preparations, analysing active ingredient, packaging, transport, consumables, and end of life management. Packaging and consumables were weighed, and waste volumes were measured to quantify material savings. Workflow data were extracted from Chimio (software for chemotherapy compounding traceability and time monitoring) between January 2024 and March 2025. The production coverage rate—the share of treatments prepared with RTU formats—was calculated using Noxelia, a French AI-based tool optimising hospital pharmacy production workflows. <h3>Results</h3> Approximately 2,000 RTU gemcitabine bags were used, accounting for 82% of total production. Each RTU dose avoided 0.8–1.7 kg CO<sub>2</sub> eq., a 40–60% reduction versus vial preparation. Major contributors were the replacement of glass vials by polypropylene bags (≈42%), the elimination of single-use sterile devices (≈19%), and the reduction of incinerated waste (≈14%). Measured consumables showed a 120–160 g weight reduction per dose, corresponding to about 0.8 m<sup>3</sup> less waste per 1,000 bags. The total saving reached 3.6 tonnes CO<sub>2</sub> eq. and 0.9 tonnes of waste—equivalent to 20 inpatient hospital days—with €250 saved in disposal costs. Preparation time improved by 12% overall (p < 0.05) and 17% for RTU batches. <h3>Conclusion and Relevance</h3> Industrial RTU gemcitabine provides measurable environmental and organisational benefits without compromising safety or workflow integrity. Scaled to annual use, carbon savings approach 3 tonnes CO<sub>2</sub> eq. per site. Extending RTU adoption to other cytotoxics could strengthen decarbonisation and efficiency in hospital pharmacy practice. <h3>Conflict of Interest</h3> Corporate sponsored research or other substantive relationships: A. Plan and D. Protzenko promote the use of dose banding strategies in France through their start-up Noxelia and give lectures on the implementation of dose banding in hospital workflows for SunPharma.