Are exposure predictions, used for the prioritization of pharmaceuticals in the environment, fit for purpose?

What Approaches Should be Used to Prioritize Pharmaceuticals and Personal Care Products for Research on Environmental and Human Health Exposure and Effects?

Pharmaceuticals and personal care products (PPCPs) are released from multiple anthropogenic sources and thus have a ubiquitous presence in the environment. The environmental exposure and potential effects of PPCPs on biota and humans has aroused concern within the scientific community and the public. Risk assessments are commonly conducted to evaluate the likelihood of chemicals including PPCPs that pose health threats to organisms inhabiting various environmental compartments and humans. Because thousands of PPCPs are currently used, it is impractical to assess the environmental risk of all of them due to data limitations; in addition, new PPCPs are continually being produced. Prioritization approaches, based either on exposure, hazard, or risk, provide a possible means by which those PPCPs that are likely to pose the greatest risk to the environment are identified, thereby enabling more effective allocation of resources in environmental monitoring programs in specific geographical locations and ecotoxicological investigations. In the present review, the importance and current knowledge concerning PPCP occurrence and risk are discussed and priorities for future research are proposed, in terms of PPCP exposure (e.g., optimization of exposure modeling in freshwater ecosystems and more monitoring of PPCPs in the marine environment) or hazard (e.g., differential risk of PPCPs to lower vs. higher trophic level species and risks to human health). Recommended research questions for the next 10 years are also provided, which can be answered by future studies on prioritization of PPCPs. Environ Toxicol Chem 2024;43:488-501. © 2022 SETAC.

Defining the data gap: What do we know about environmental exposure, hazards and risks of pharmaceuticals in the European aquatic environment?

Active pharmaceutical ingredients (APIs) and their transformation products inevitably enter waterways where they might cause adverse effects to aquatic organisms. Identifying the potential risks of APIs in the environment is therefore a goal and current strategic direction of environmental management described in the EU Strategic Approach to Pharmaceuticals in the Environment and the Green Deal. This is challenged by a paucity of monitoring and ecotoxicity data to adequately describe risks. In this study we analyze measured environmental concentrations (MECs) of APIs from 5933 sites in 25 European countries as documented in the EMPODAT database or collected by the German Environment Agency for the time period between 1997 and 2020. These data were compared with empirical data on the ecotoxicity of APIs from the U.S. EPA ECOTOX database. Although 1763 uniquely identifiable APIs are registered with the European Medicines Agency (EMA) for sale in the European Economic Area (EEA), only 312 (17.7%) of these are included in publicly available monitoring data, 36 (1.8%) compounds have sufficient ecotoxicological data to derive a PNEC, and only 27 (1.5%) compounds meet both the hazard and exposure data requirements required to to perform an environmental risk assessment according to EMA guidelines. Four of these compounds (14.8%) had a median risk quotient (RQ) > 1. Endocrine disruptors had the highest median RQ, with 7.0 and 5.6 for 17α-ethinyl-estradiol and 17β-estradiol respectively. A comparison of in-silico and empirical exposure data for 72 APIs demonstrated the high protectiveness of the current EMA guidelines, with predicted environmental concentrations (PECs) exceeding median MECs in 98.6% of cases, with a 100-fold median increase. This study describes the data shortfalls hindering an accurate assessment of the risk posed to European waterways by APIs, and identifies 68 APIs for prioritized inclusion in monitoring programs, and 66 APIs requiring ecotoxicity testing to fill current data gaps.

Mechanistic evaluation in the removal of chlorpheniramine and ciprofloxacin on activated carbons

Chlorpheniramine (CPM) and Ciprofloxacin (CIP) adsorption onto a granular (GAC) and pelletized activated carbon (PAC) analyzing the physicochemical mechanisms involved using the carbon's characterization were studied. Adsorption isotherm studies were performed at temperatures of 25 °C at pH values of 4, 7 and 9 and at 45 °C at a pH of 7. The characterization demonstrated that GAC has a predominantly acid character due to its predominantly negative surface charge and acidic site concentration alongside the characteristic bands detected in the X-ray Photoemission Spectroscopy (XPS) study. On the other hand, PAC presented a mostly basic character due to its positive surface charge and basic site concentrations. The adsorption isotherm studies demonstrated that the Freundlich isotherm better described the equilibrium data with an average deviation percentage of 7.45 and 6.74 for GAC and PAC. The temperature and desorption studies demonstrated that the adsorption process occurs through a chemisorption mechanism, and the pH study alongside the GAC and PAC characterization demonstrated that the mechanisms involved are a combination of electrostatic interactions and pi-pi interactions between the CPM and CIP molecules and the carbon's surface. These results demonstrate that the adsorption process of these pharmaceutical compounds is done through a combination of physical and chemical interactions.

Predicting Environmental Risks of Pharmaceuticals from Wholesale Data: An Example from Norway

Environmental risk assessment (ERA) of pharmaceuticals relies on available measured environmental concentrations, but often such data are sparse. Predicted environmental concentrations (PECs), calculated from sales weights, are an attractive alternative but often cover only prescription sales. We aimed to rank, by environmental risk in Norway, approximately 200 active pharmaceutical ingredients (APIs) over 2016-2019, based on sales PECs. To assess the added value of wholesale and veterinary data, we compared exposure and risk predictions with and without these additional sources. Finally, we aimed to characterize the persistence, mobility, and bioaccumulation of these APIs. We compared our PECs to available Norwegian measurements, then, using public predicted-no-effect concentrations, we calculated risk quotients (RQs) and appended experimental and predicted persistence and bioaccumulation. Our approach overestimated environmental concentrations compared with measurements for 18 of 20 APIs with comparable predictions and measurements. Seventeen APIs had mean RQs >1, indicating potential risk, while the mean RQ was 2.05 and the median 0.001, driven by sex hormones, antibiotics, the antineoplastic abiraterone, and common painkillers. Some high-risk APIs were also potentially persistent or bioaccumulative (e.g., levonorgestrel [RQ = 220] and ciprofloxacin [RQ = 56]), raising the possibility of impacts beyond their RQs. Exposure and risk were also calculated with and without over-the-counter sales, showing that prescriptions explained 70% of PEC magnitude. Likewise, human sales, compared with veterinary, explained 85%. Sales PECs provide an efficient option for ERA, designed to overestimate compared with analytical techniques and potentially held back by limited data availability and an inability to quantify uncertainty but, nevertheless, an ideal initial approach for identification and ranking of risks. Environ Toxicol Chem 2023;42:2253-2270. © 2023 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC.

In-situ multi-mode extraction (iMME) sampler for a wide-scope analysis of chemical and biological targets in water in urbanized and remote (off-the-grid) locations

Chemical pollution (including chemicals of emerging concern - CECs) continues to gain increasing attention as a global threat to human health and the environment, with numerous reports on the adverse and sometimes devastating effects upon ecosystems the presence of these chemicals can have. Whilst many studies have investigated presence of CECs in aquatic environments, these studies have been often focused on higher income countries, leaving significant knowledge gaps for many low-middle income countries. This study proposes a new integrated powerless, in-situ multi-mode extraction (iMME) sampler for the analysis of chemicals (105 CECs) and biological (5 genes) markers in water in contrasting settings: an urbanized Avon River in the UK and remote Olifants River in Kruger National Park in South Africa. The overarching goal was to develop a sampling device that maintains integrity of a diverse range of analytes via analyte immobilization using polymeric and glass fibre materials, without access to power supply or cold chain (continuous chilled storage) for sample transportation. Chemical analysis was achieved using ultra-performance liquid chromatography coupled with tandem mass spectrometry. Several mobile CECs showed low stability in river water, at room temperature and typical 24 h sampling/transport time. It is therefore recommended that, in the absence of cooling, environmental water samples are spiked with internal standards on site, immediately after collection and analyte immobilization option is considered, in order to allow fully quantitative analysis. iMME has proven effective in immobilization, concentration and increased stability of CECs at room temperature (and at least 7 days storage) allowing for sample collection at remote locations. The results from the River Avon and Olifants River sampling indicate that the pristine environment of Olifants catchment is largely unaffected by CECs common in the urbanized River Avon in the UK with a few exceptions: lifestyle chemicals (e.g., caffeine, nicotine and their metabolites), paracetamol and UV filters due to tourism and carbamazepine due to its persistent nature. iMME equipped with an additional gene extraction capability provides an exciting new opportunity of comprehensive biochemical profiling of aqueous samples with one powerless in-situ device. Further work is required to provide full integration of the device and comprehensive assessment of performance in both chemical and biological targets.

High Concentrations of Pharmaceuticals in a Nigerian River Catchment

Pharmaceutical contamination of the environment is recognized as a global problem although most research has focused on Europe and North America to date, and there remains a dearth of information for developing countries, including those in Africa. To address this data gap, the occurrence of 37 pharmaceuticals belonging to 19 therapeutic classes was monitored in surface water and effluents in Lagos State, Southwest Nigeria. Samples were collected quarterly between April 2017 and March 2018 from 22 sites, and 26 compounds were detected at least once, many in the µg/L range. Maximum concentrations for those compounds detected ranged from 75 to 129 µg L^-1 , and even mean concentrations for 13 compounds were in the order of µg L^-1 . These values are among the highest ever measured globally. Sewage effluent was more important than drug manufacturing waste in polluting rivers, although there are likely to be numerous unregulated sources of effluent being discharged to rivers that require further study, including urban waste collection areas and vacuum trucks that collect effluent. Seasonal trends in the data were complex, with some compounds being found at higher concentrations in the dry season and, conversely, others being greater during the wet period; this variation potentially relates to the variety of pollution sources in the catchment. Pharmaceuticals are indispensable to human health, although their usage and discharge into the aquatic environment may lead to ecological problems and antibiotic resistance. The data we present indicate that pharmaceutical pollution of freshwaters is a serious issue in Nigeria, and management efforts are needed to improve this problem. Environ Toxicol Chem 2022;41:551-558. © 2020 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC.

Pharmaceutical pollution of the world's rivers

Environmental exposure to active pharmaceutical ingredients (APIs) can have negative effects on the health of ecosystems and humans. While numerous studies have monitored APIs in rivers, these employ different analytical methods, measure different APIs, and have ignored many of the countries of the world. This makes it difficult to quantify the scale of the problem from a global perspective. Furthermore, comparison of the existing data, generated for different studies/regions/continents, is challenging due to the vast differences between the analytical methodologies employed. Here, we present a global-scale study of API pollution in 258 of the world's rivers, representing the environmental influence of 471.4 million people across 137 geographic regions. Samples were obtained from 1,052 locations in 104 countries (representing all continents and 36 countries not previously studied for API contamination) and analyzed for 61 APIs. Highest cumulative API concentrations were observed in sub-Saharan Africa, south Asia, and South America. The most contaminated sites were in low- to middle-income countries and were associated with areas with poor wastewater and waste management infrastructure and pharmaceutical manufacturing. The most frequently detected APIs were carbamazepine, metformin, and caffeine (a compound also arising from lifestyle use), which were detected at over half of the sites monitored. Concentrations of at least one API at 25.7% of the sampling sites were greater than concentrations considered safe for aquatic organisms, or which are of concern in terms of selection for antimicrobial resistance. Therefore, pharmaceutical pollution poses a global threat to environmental and human health, as well as to delivery of the United Nations Sustainable Development Goals.

Environmental risk assessments of multiclass pharmaceutical active compounds: selection of high priority concern pharmaceuticals using entropy-utility functions

This research aimed to identify high-risk pharmaceutically active compounds (PhACs) by analyzing occurrence (O), persistence (P), bioaccumulation (B), and toxicity (T) of 62 drugs which are widely used in Iran. A comprehensive approach was taken in risk assessment of the selected PhACs and in their prioritization using multiple-criteria decision analysis (MCDA) such as utility functions and principal component analysis (PCA). In practice, assigning weight to each criterion (i.e., O, P, B, and T) for risk assessment of PhACs is a challenge. In this research, the impact of giving both equal and unequal weight to each criterion by using a quantitative entropy method was studied. For risk assessment, two exposure approaches (consumption rate and occurrence of PhACs) and three MCDA approaches (PCA and utility functions with and without equal weights for each criterion) were compared. The utility function using equal weights for all O, P, B, and T criteria showed that thioridazine, pimozide, chlorpromazine, sertraline, clomipramine, and aripiprazole were at the highest level of risk, with concern score of 0.75, 0.75, 0.67, 0.58, 0.58, and 0.58, respectively. Unequal weight approach included additional compounds such as fluoxetine, citalopram, and methadone as a priority. All three MCDA approaches showed that sedatives and antidepressants were prevalent PhACs in the risk-based priority lists. However, the exposure-based approaches showed antibiotics and analgesics as the pharmaceutical of the highest priority. Overall, selection of the high priority concern pharmaceuticals depends on the prioritization approach employed. However, the utility function using unequal weights is a more conservative and effective approach for prioritization.

Identifying unknown antibiotics with persistent and bioaccumulative properties and ecological risk in river water in Beijing, China

The goal of this study was to identify antibiotics with potential risk in river water of the megacity Beijing, China. This was accomplished by using a tiered approach that combined hazard (phase I) and monitoring-based risk (phase II) assessment. Ninety-five candidate antibiotics were screened and 31 was identified as hazardous during phase I assessment. Of these hazardous antibiotics, 29 were identified as persistent and 7 were identified as bioaccumulative antibiotics. Fluoroquinolones, macrolides, sulfonamides, and aminoglycosides account for over 80% of these hazardous antibiotics. During phase II, four antibiotics (erythromycylamine, cefotaxime, ampicillin, and fusidic acid) that were not previously reported were detected in the surface water sampled from four major rivers in Beijing, with concentrations ranging from not detected to approximately 300 ng/L. The ecological risk assessment showed that erythromycylamine, cefotaxime, and ampicillin posed low to high levels of risk to the aquatic organisms. To summarize, erythromycylamine, cefotaxime, and ampicillin were identified as priority antibiotics in rivers in Beijing, China. Our results demonstrated the necessity of conducting monitoring-based verification process in identification of priority antibiotics in a specific region.

The importance of over-the-counter-sales and product format in the environmental exposure assessment of active pharmaceutical ingredients

When assessing the environmental exposure of active pharmaceutical ingredients (APIs), the mass contributed from over the counter (OTC) sales are often not included due to difficulty obtaining this data and topical formats are overlooked completely. This study presents a comprehensive approach, investigating the significance of OTC and topical applications as sources of API releases to wastewater, in addition to temporal and subnational variations in use in the UK. The study provides methods to obtain and make use of OTC sales data which can be applied widely. The calculated releases to wastewater compared well with influent concentrations measured at several UK wastewater treatment plants (WWTPs). Consistent overestimation was observed, attributed to a number of factors, including in-sewer removal. OTC sales were found to make up a large proportion of the mass of ibuprofen (76%) and diclofenac (35%) consumed and topical formats were also found to be vital, contributing disproportionately to wastewater loadings per unit mass of ibuprofen and diclofenac used (43% and 99% of the total mass released, respectively). Releases of the APIs investigated did not vary temporally, but regional variation was significant and where possible should be considered for the most accurate exposure assessment of pharmaceuticals.

Prioritizing pharmaceuticals based on environmental risks in the aquatic environment in China

In last two decades, the number of detected activated pharmaceutical ingredients (APIs) in the natural environment worldwide has increased due to their widespread use in daily life. However, given the large number of APIs that are currently in use (approximate 850 are on the market in China), it is impractical to investigate the occurrence, ecotoxicological effects, and perform environmental risk assessment for all drugs. Therefore, it is crucial to rank and prioritize APIs in the environment to identify the compounds of high concern. In China, since information on API usage is not available, an attempt was made to use the number of products per API (the number of pharmaceutical commodities that contain a particular API) on the market multiplied by its daily dose (average daily dose of medication for adults used for the primary therapeutic purpose) to replace the usage in the exposure modeling. Coupled with the hazard assessment, including acute and chronic toxicity of aquatic ecological effects and potential effects related to the therapeutic mode of action, risk scores were estimated and used for ranking. Application of the approach was illustrated for 259 APIs with product number no less than 4. A list of 20 APIs was finally identified as a potential priority, including drugs of cardiovascular, nervous system, respiratory system, musculoskeletal system and antibiotics. In the future, this approach could be applied to prioritize APIs in other countries/regions where information on API usage are limited or non-existent.

Environmental prioritization of pesticide in the Upper Citarum River Basin, Indonesia, using predicted and measured concentrations

A novel screening method was developed to prioritize aquatic and human health risks of pesticides based on usage data, runoff modelling and effect prediction. An important asset of this new method is that it does not require measured concentration data, which are often unavailable or difficult to obtain in low- and middle-income countries like Indonesia. The method was applied to prioritize 31 agricultural pesticides used in the Upper Citarum River Basin in West Java, Indonesia. Ranking of pesticides based on predicted concentrations generally showed good agreement with ranking based on concentrations measured by passive sampling. The individual pesticide intake through the consumption of river water was predicted to cause negligible human health risks, but substantial aquatic risks (i.e. PEC/PNEC >1) were predicted for profenofos (5.2.E+01), propineb (3.6.E+01), chlorpyrifos (2.6.E+01), carbofuran (1.7.E+01), imidacloprid (9.4.E+00), methomyl (7.6.E+00) and chlorantraniliprole (3.6.E+00). In order to protect the aquatic environment, water managers are advised to take measures to reduce the use and runoff of these pesticides in the UCRB. The screening assessment can be further refined by performing additional effect studies for some pesticides, pesticide mixtures and validation of the predicted water concentrations by targeted measurements.

Legacy and Contaminants of Emerging Concern in Tree Swallows Along an Agricultural to Industrial Gradient: Maumee River, Ohio

Exposure to multiple classes of contaminants, both legacy and contaminants of emerging concern (CECs), were assessed in tree swallow (Tachycineta bicolor) tissue and diet samples from 6 sites along the Maumee River, Ohio, USA, to understand both exposure and possible effects of exposure to those CECs for which there are little avian data. The 6 sites represented a gradient from intensive agriculture upstream to highly urbanized and industrial landscapes downstream; 1 or 2 remote Wisconsin lakes were assessed for comparative purposes. Cytochrome P450 induction, DNA damage, and thyroid function were also assessed relative to contaminant exposure. Bioaccumulative CECs, such as polybrominated diphenyl ethers (PBDEs) and perfluorinated substances, did not follow any upstream to downstream gradient; but both had significantly greater concentrations along the Maumee River than at the remote lake sites. Greater exposure to PBDEs was apparent in swallows at or near wastewater-treatment facilities than at other sites. Total polychlorinated biphenyl and total polycyclic aromatic hydrocarbon concentrations were greater in swallows at downstream locations compared to upstream sites and were associated with higher ethoxyresorufin-O-dealkylase activity. Few herbicides or nonorganochlorine insecticides were detected in swallow tissues or their food, except for atrazine and its metabolite desethylatrazine. Few pharmaceuticals and personal care products were detected except for DEET and iopamidol. Both were detected in most liver samples but not in eggs, as well as detected at the remote lake sites. This is one of the most comprehensive assessments to date of exposure and effects of a wide variety of CECs in birds. Environ Toxicol Chem 2020;39:1936-1952. © 2020 SETAC. This article has been contributed to by US Government employees and their work is in the public domain in the USA.

Identifying targets of potential concern by a screening level ecological risk assessment of human use pharmaceuticals in China

The pollution of pharmaceuticals has attracted a lot of concerns during recent years. The goal of this study was to identify targets of ecological concern considering human use pharmaceuticals marketed in China. We constructed a database for 593 active pharmaceutical ingredients (APIs) by collecting their information on use and emission (e.g. production, human excretion, and removal by wastewater treatment) to calculated predicted environmental concentrations (PECs) by using an adapted European Medicines Agency method. PECs were comparable to the reported measurements for most APIs, demonstrating that the adapted method is reliable for the prioritization practice. Then PECs were compared to toxicity thresholds of three aquatic taxa (algae, daphnia, and fish). As a result, a total of 31 APIs, which were potentially risky and should be taken into consideration in future studies, were identified. Three APIs would pose a high risk with risk quotient (RQ) greater than 10. Six APIs were identified with moderate risks (1 < RQ < 10), and four of them were not reported before: rifaximin, griseofulvin, amikacin, and niclosamide. Of the 22 APIs with low risks (0.1 < RQ < 1), 17 have never been monitored previously in China and even worldwide. This study has yielded some probable antibiotics that should be considered as monitoring targets in China in the future.

Prioritization of pharmaceuticals in water environment in China based on environmental criteria and risk analysis of top-priority pharmaceuticals

Numerous studies have shown that a wide range of pharmaceuticals are present in the environment and many of their adverse biological effects on the aquatic ecosystem and human health are unknown. Due to the high population density and large number of pharmaceuticals produced and consumed in China, a systematic approach is needed to identify pharmaceuticals that require greater attention. The present study provides a ranking of pharmaceuticals in China in terms of their occurrence (O), persistence, bioaccumulation, and toxicity (PBT) based on the predicted environmental concentration (PEC). The total and partial ranking method implemented in the decision analysis by ranking techniques (DART) tool was used, which is an easy-to-use tool for the analysis of datasets. Using the DART approach, 10 pharmaceuticals were selected as priority compounds. These pharmaceuticals included antibiotics, anti-inflammatory and antilipidemic. In order to identify the characteristics of the priority pharmaceuticals, ecotoxicological endpoints were considered. The results of this study and the priority list facilitate the selection of candidate pollutants in future monitoring studies.

Effect of low-dose, repeated exposure of contaminants of emerging concern on plant development and hormone homeostasis

Treated wastewater is increasingly used to meet agriculture's water needs; however, treated wastewater contains numerous contaminants of emerging concern (CECs). With exposure and uptake of CECs, phytotoxicity and health of crop plants is of concern, but is poorly understood. This study evaluated the effect of low-dose, chronic exposure to a mixture of 10 CECs, including 4 antibiotics, 3 anti-inflammatory drugs, 1 antiepileptic, 1 beta-blocker, and 1 antimicrobial, on lettuce (Lactuca sativa) and cucumber (Cucumis sativa L.) plants. The CEC mixture was added in nutrient media at 1 to 20X of their typical levels in treated wastewater effluents. Biological endpoints including germination, growth, phytohormone homeostasis, and CEC bioaccumulation were determined. Exposure to the CEC mixture did not affect the germination rate of lettuce seeds, but stimulated root elongation and increased the root-to-shoot biomass ratio during a 7 d cultivation. A dose-dependent decrease in biomass was observed in cucumber seedling after a 30 d exposure, with the highest rate CEC treatment resulting in decreases of 51.2 ± 20.9, 26.3 ± 34.1, and 33.2 ± 41.7% in the below-ground, above-ground, and total biomass, respectively. Levels of abscisic acid were significantly elevated (p < 0.05) in the leaves, but decreased (p < 0.05) in the roots. The dose-response of auxin was characterized by a hormesis effect. A significant 6-fold increase in the stem auxin level was observed at the 1X CEC rate, followed by a decrease to 2-fold the control at the 20X rate. Leaf auxin concentrations also significantly increased at the 1X CEC rate to 16-fold, followed by a decrease at the highest CEC rate. The results of this study suggeste that chronic exposure to low levels of CEC mixtures may compromise the fitness of plants, and the impairments are underlined by alterations in hormone balances.

Spatial and temporal occurrence of pharmaceuticals in UK estuaries

There is a lack of data on the occurrence of pharmaceuticals in estuaries worldwide, with little understanding of their temporal and spatial variations globally. Ibuprofen, paracetamol, diclofenac, trimethoprim and citalopram were measured in twelve estuaries in the UK. Initially, these compounds were monitored in the Humber Estuary, where samples were taken every two months over a twelve month period in order to assess their spatial and temporal variations. Ibuprofen was found at some of the highest concentrations ever measured in an estuary globally (18-6297 ng l^-1), with paracetamol also measured at relatively high concentrations (4-917 ng l^-1) in comparison to the other compounds. In terms of spatial distribution, a pattern was observed where the highest concentrations were found at a site at which wastewater is discharged, whilst compound concentrations were often lower upstream and downstream of this site. The downstream profile of pharmaceuticals differed temporally with concentrations highest downstream when input from wastewater effluent was highest. Eleven further estuaries were sampled around the UK in order to put the occurrence of pharmaceuticals in the Humber Estuary into a wider context. Pharmaceutical concentrations in the other estuaries sampled were <210 ng l^-1 but, again, ibuprofen and paracetamol were found at concentrations higher than other compounds, whereas diclofenac and citalopram were absent in many estuaries. The Humber, which is the receiving environment for the sewage effluent of approximately 20% (13.6 million people) of the population of England, was observed to have the highest overall concentration of pharmaceuticals in contrast to the other estuaries sampled, thereby representing a worst case scenario for pharmaceutical pollution.

Environmental pharmacology: source, impact and solution

Environmental pharmacology is the knowledge, study and the methods implemented for amalgamating the presence of pharmaceutical products and their metabolites in the environment. Pharmaceutical and house care products and their metabolites gain access to the environment through various means and affect the flora and fauna and modulate the ecosystem. The effect on wildlife, biofilms and human are being studied to gain knowledge of sources and causations. Potential risks of development of acute and chronic toxicity, carcinogenicity, interference with hormone and immune systems and drug resistance are of major concern. They may alter the genome and can affect future generations leaving them vulnerable to disease. There are regulations in good manufacturing practices and disposal which take into account the environmental risks but the knowledge for stakeholders and their implementation is very restricted. Ecopharmacology and ecopharmacovigilance are propagators of green healthcare. A strategy towards human health risk assessment and ecotoxicological hazard evaluation must be developed and risk minimization measures to be sought for and applied.

Pharmaceuticals in freshwater aquatic environments: A comparison of the African and European challenge

Hundreds of tons of pharmaceutical compounds are annually dispensed and consumed worldwide. Pharmaceuticals are an important class of emerging environmental micropollutants: their presence in water bodies is an increasing environmental concern. The aim of this review paper is to provide a comprehensive review of the occurrence of pharmaceuticals in freshwater aquatic environments in the African and European context. A literature survey has been performed, resulting in 3024 data points related to environmental occurrence. The concentration levels of 71 pharmaceuticals were assessed. The top ten most frequently detected and quantified compounds in both continents were sulfamethoxazole, carbamazepine, diclofenac, trimethoprim, ibuprofen, naproxen, paracetamol (acetaminophen), ketoprofen, venlafaxine and clarithromycin. The maximum concentrations of 17β-estradiol, estriol, ciprofloxacin, sulfamethoxazole, paracetamol, naproxen reported in African aquatic environments were ~3140, ~20,000, ~125, ~100, ~215 and ~171 times higher, respectively, than the concentrations reported in European based studies. The variation in pharmaceutical consumption, partial removal of pharmaceuticals in wastewater treatment processes, and the direct discharge of livestock animal farm wastewater were identified among the major reasons for the observed differences. Several pharmaceuticals were found in aquatic environments of both continents in concentration levels higher than their ecotoxicity endpoints. In Europe, compounds such as diclofenac, ibuprofen, triclosan, sulfadimidine, carbamazepine and fluoxetine were reported in a concentration higher than the available ecotoxicity endpoints. In Africa, much more compounds reached concentrations more than the ecotoxicity endpoints, including diclofenac, ibuprofen, paracetamol, naproxen, ciprofloxacin, triclosan, trimethoprim, sulfamethoxazole, carbamazepine and fluoxetine, estriol and 17β-estradiol. Details for each therapeutic group are presented in this review.

Comparison of Prioritisation Schemes for Human Pharmaceuticals in the Aquatic Environment

Only a small proportion of pharmaceuticals available for commercial use have been monitored in the aquatic environment, and even less is known about the effects on organisms. With thousands of pharmaceuticals in use, it is not feasible to monitor or assess the effects of all of these compounds. Prioritisation schemes allow the ranking of pharmaceuticals based on their potential as environmental contaminants, allowing resources to be appropriately used on those which are most likely to enter the environment and cause greatest harm. Many different types of prioritisation schemes exist in the literature and those utilising predicted environmental concentrations (PECs), the fish plasma model (FPM), critical environmental concentrations (CECs) and acute ecotoxicological data were assessed in the current study using the 50 most prescribed drugs in the UK. PECs were found to be overestimates of mean measured environmental concentrations but mainly underestimations of maximum concentrations. Acute ecological data identified different compounds of concern to the other effects assessments although the FPM and CECs methods were more conservative. These schemes highlighted antidepressants, lipid regulators, antibiotics, antihypertensive compounds and ibuprofen as priority compounds for further study and regulation.

A High-Resolution Spatial Model to Predict Exposure to Pharmaceuticals in European Surface Waters: ePiE

Environmental risk assessment of pharmaceuticals requires the determination of their environmental exposure concentrations. Existing exposure modeling approaches are often computationally demanding, require extensive data collection and processing efforts, have a limited spatial resolution, and have undergone limited evaluation against monitoring data. Here, we present ePiE (exposure to Pharmaceuticals in the Environment), a spatially explicit model calculating concentrations of active pharmaceutical ingredients (APIs) in surface waters across Europe at ∼1 km resolution. ePiE strikes a balance between generating data on exposure at high spatial resolution while having limited computational and data requirements. Comparison of model predictions with measured concentrations of a diverse set of 35 APIs in the river Ouse (UK) and Rhine basins (North West Europe), showed around 95% were within an order of magnitude. Improved predictions were obtained for the river Ouse basin (95% within a factor of 6; 55% within a factor of 2), where reliable consumption data were available and the monitoring study design was coherent with the model outputs. Application of ePiE in a prioritisation exercise for the Ouse basin identified metformin, gabapentin, and acetaminophen as priority when based on predicted exposure concentrations. After incorporation of toxic potency, this changed to desvenlafaxine, loratadine, and hydrocodone.

Suspect Screening and Regulatory Databases: A Powerful Combination To Identify Emerging Micropollutants

This study demonstrates that regulatory databases combined with the latest advances in high resolution mass spectrometry (HRMS) can be efficiently used to prioritize and identify new, potentially hazardous pollutants being discharged into the aquatic environment. Of the approximately 23000 chemicals registered in the database of the National Swedish Product Register, 160 potential organic micropollutants were prioritized through quantitative knowledge of market availability, quantity used, extent of use on the market, and predicted compartment-specific environmental exposure during usage. Advanced liquid chromatography (LC)-HRMS-based suspect screening strategies were used to search for the selected compounds in 24 h composite samples collected from the effluent of three major wastewater treatment plants (WWTPs) in Sweden. In total, 36 tentative identifications were successfully achieved, mostly for substances not previously considered by environmental scientists. Of these substances, 23 were further confirmed with reference standards, showing the efficiency of combining a systematic prioritization strategy based on a regulatory database and a suspect-screening approach. These findings show that close collaboration between scientists and regulatory authorities is a promising way forward for enhancing identification rates of emerging pollutants and expanding knowledge on the occurrence of potentially hazardous substances in the environment.

Temporal and spatial variation in pharmaceutical concentrations in an urban river system

Many studies have quantified pharmaceuticals in the environment, few however, have incorporated detailed temporal and spatial variability due to associated costs in terms of time and materials. Here, we target 33 physico-chemically diverse pharmaceuticals in a spatiotemporal exposure study into the occurrence of pharmaceuticals in the wastewater system and the Rivers Ouse and Foss (two diverse river systems) in the city of York, UK. Removal rates in two of the WWTPs sampled (a conventional activated sludge (CAS) and trickling filter plant) ranged from not eliminated (carbamazepine) to >99% (paracetamol). Data comparisons indicate that pharmaceutical exposures in river systems are highly variable regionally, in part due to variability in prescribing practices, hydrology, wastewater management, and urbanisation and that select annual median pharmaceutical concentrations observed in this study were higher than those previously observed in the European Union and Asia thus far. Significant spatial variability was found between all sites in both river systems, while seasonal variability was significant for 86% and 50% of compounds in the River Foss and Ouse, respectively. Seasonal variations in flow, in-stream attenuation, usage and septic effluent releases are suspected drivers behind some of the observed temporal exposure variability. When the data were used to evaluate a simple environmental exposure model for pharmaceuticals, mean ratios of predicted environmental concentrations (PECs), obtained using the model, to measured environmental concentrations (MECs) were 0.51 and 0.04 for the River Foss and River Ouse, respectively. Such PEC/MEC ratios indicate that the model underestimates actual concentrations in both river systems, but to a much greater extent in the larger River Ouse.

Active pharmaceutical ingredients entering the aquatic environment from wastewater treatment works: A cause for concern?

This work reports on the variation in wastewater treatment works (WwTW) influent concentrations of a wide variety of active pharmaceutical ingredients (APIs), their removal efficiency, effluent concentrations and potential risks to the aquatic environment. The research is based on data generated from two large UK-wide WwTW monitoring programmes. Taking account of removal of parent compound from the aqueous phase during treatment in combination with estimates of dilution available it is possible to prioritise the APIs of greatest risk of exceeding estimates of predicted no effect concentrations (PNEC) in receiving waters for all WwTW in the UK. The majority of substances studied were removed to a high degree, although with significant variation, both within and between WwTW. Poorer removal (between influent and effluent) was observed for ethinyloestradiol, diclofenac, propranolol, the macrolide antibiotics, fluoxetine, tamoxifen and carbamazepine. All except the last two of these substances were present in effluents at concentrations higher than their respective estimated PNEC (based on measurement of effluents from 45 WwTW on 20 occasions). Based on available dilution data as many as 890 WwTW in the UK (approximately 13% of all WwTW) may cause exceedances of estimated riverine PNECs after mixing of their effluents with receiving waters. The overall degree of risk is driven by the toxicity value selected, which in itself is controlled by the availability of reliable and relevant ecotoxicological data and consequently the safety factors applied. The dataset and discussion, provides information to assist in the future management of these types of chemicals.

Application of prioritization approaches to optimize environmental monitoring and testing of pharmaceuticals

Pharmaceuticals are ubiquitous in the natural environment with concentrations expected to rise as human population increases. Environmental risk assessments are available for a small portion of pharmaceuticals in use, raising concerns over the potential risks posed by other drugs that have little or no data. With >1900 active pharmaceutical ingredients in use, it would be a major task to test all of the compounds with little or no data. Desk-based prioritization studies provide a potential solution by identifying those substances that are likely to pose the greatest risk to the environment and which, therefore, need to be considered a priority for further study. The aim of this review was to (1) provide an overview of different prioritization exercises performed for pharmaceuticals in the environment and the results obtained; and (2) propose a new holistic risk-based prioritization framework for drugs in the environment. The suggested models to underpin this framework are discussed in terms of validity and applicability. The availability of data required to run the models was assessed and data gaps identified. The implementation of this framework may harmonize pharmaceutical prioritization efforts and ensure that, in the future, experimental resources are focused on molecules, endpoints, and environmental compartments that are biologically relevant.