Monitoring the release of anti-inflammatory and analgesic pharmaceuticals in the receiving environment

The behavior of pharmaceutically active compounds and contrast agents during wastewater treatment - Combining sampling strategies and analytical techniques: A critical review

Increasing consumption of pharmaceuticals and the respective consequences for the aquatic environment have been the focus of many studies over the last thirty years. Various aspects in this field were investigated, considering diverse pharmaceutical groups and employing a wide range of research methodologies. Various questions from the perspectives of different research areas were devised and answered, resulting in a large mix of individual findings and conclusions. Collectively, the results of the studies offer a comprehensive overview. The large variety of methods and strategies, however, demands close attention when comparing and combining information from heterogeneous projects. This review critically examines the application of diverse sampling techniques as well as analytical methods in investigations concerning the behavior of pharmaceutically active compounds (PhACs) and contrast agents (CAs) in wastewater treatment plants (WWTPs). The combination of sampling and analysis is discussed with regard to its suitability for specific scientific problems. Different research focuses need different methods and answer different questions. An overview of studies dealing with the fate and degradation of PhACs and CAs in WWTPs is presented, discussing their strategic approaches and findings. This review includes surveys of anticancer drugs, antibiotics, analgesics and anti-inflammatory drugs, antidiabetics, beta blockers, hormonal contraceptives, lipid lowering agents, antidepressants as well as contrast agents for X-ray and magnetic resonance imaging.

The effect of tyrosol on diclofenac sodium-induced acute nephrotoxicity in rats

Although diclofenac (DCF) is a nonsteroidal anti-inflammatory drug that is considered safe, its chronic use and overdose may show some toxic effects. The protective effect of tyrosol (Tyr) pretreatment against DCF-induced renal damage was investigated in this study. The 32 rats used in the study were randomly divided into four groups of eight rats each. According to the data obtained, it was determined that creatinine, urea, and blood urea nitrogen (BUN) levels increased in serum samples of the DCF group. Besides, the levels of reduced glutathione (GSH) and glutathione peroxidase (GPx) activity decreased and the malondialdehyde (MDA) level increased in the kidney tissue. However, no change was observed in catalase (CAT) activity. Cyclooxygenase-2 (COX-2), nuclear factor kappa B (NF-κB), and tumor necrosis factor-alpha (Tnf-α) levels increased and nuclear factor erythroid 2-related factor 2 (Nrf-2) levels decreased. No change was detected in the level of interleukin 1 beta (IL-1β). When the DCF+Tyr group and the DCF group were compared, it was assessed that Tyr had a curative effect on all biochemical parameters. Also, kidney damages, such as degeneration and necrosis of tubular epithelium and congestion of veins, were obviated by treatment with tyrosol in histopathological examinations. It was determined that Tyr pretreatment provided a protective effect against nephrotoxicity induced by DCF with its anti-inflammatory and antioxidant properties.

Pharmaceuticals in hospital wastewaters: an analysis of the UBA's pharmaceutical database

The presence of pharmaceuticals in hospital wastewaters (HWW) has been a focus of interest for researchers in the last decades. Certain therapeutic classes, such as X-ray contrast media, broad-spectrum antimicrobials and cytotoxics among others, are mainly used in hospitals-health care facilities. This study is focused on available studies monitoring the presence of pharmaceuticals in HWW around the world. To that end, the last available version (v3. 2021) of the "Pharmaceuticals in the Environment" database published by the Federal German Environment Agency (Umweltbundesamt) has been used. Almost half of all studies included (107) have been conducted in Europe. Pharmaceuticals have been monitored in HWW in 38 different countries across all five continents. The country with the greatest number of studies is Brazil (11), followed by Spain (8), China (7), and France (6). Our analysis revealed that 271 different pharmaceuticals have been detected at least once in HWW. The five drugs with more studies showing a positive detection are ciprofloxacin (38), sulfamethoxazole (36), diclofenac (34), ibuprofen (29), and trimethoprim (27). A total of 47 out of 271 drugs are considered in the NIOSH "Hazardous drug" list. However, monitoring data for some widely used drugs in hospital settings such as muscle relaxants, anesthetics, and antidotes is lacking. In conclusion, this study provides the first large-scale metadata analysis for the pharmaceuticals in HWW worldwide.

Ketoprofen as an emerging contaminant: occurrence, ecotoxicity and (bio)removal

Ketoprofen, a bicyclic non-steroidal anti-inflammatory drug commonly used in human and veterinary medicine, has recently been cited as an environmental contaminant that raises concerns for ecological well-being. It poses a growing threat due to its racemic mixture, enantiomers, and transformation products, which have ecotoxicological effects on various organisms, including invertebrates, vertebrates, plants, and microorganisms. Furthermore, ketoprofen is bioaccumulated and biomagnified throughout the food chain, threatening the ecosystem function. Surprisingly, despite these concerns, ketoprofen is not currently considered a priority substance. While targeted eco-pharmacovigilance for ketoprofen has been proposed, data on ketoprofen as a pharmaceutical contaminant are limited and incomplete. This review aims to provide a comprehensive summary of the most recent findings (from 2017 to March 2023) regarding the global distribution of ketoprofen in the environment, its ecotoxicity towards aquatic animals and plants, and available removal methods. Special emphasis is placed on understanding how ketoprofen affects microorganisms that play a pivotal role in Earth's ecosystems. The review broadly covers various approaches to ketoprofen biodegradation, including whole-cell fungal and bacterial systems as well as enzyme biocatalysts. Additionally, it explores the potential of adsorption by algae and phytoremediation for removing ketoprofen. This review will be of interest to a wide range of readers, including ecologists, microbiologists, policymakers, and those concerned about pharmaceutical pollution.

Photocatalytic Degradation of Acetaminophen in Aqueous Environments: A Mini Review

Over the past few decades, acetaminophen (ACT), a typical nonsteroidal anti-inflammatory drug (NSAID), has gained global usage, positioning itself as one of the most extensively consumed medications. However, the incomplete metabolism of ACT leads to a substantial discharge into the environment, classifying it as an environmental contaminant with detrimental effects on non-target organisms. Various wastewater treatment technologies have been developed for ACT removal to mitigate its potential environmental risk. Particularly, photocatalytic technology has garnered significant attention as it exhibits high efficiency in oxidizing and degrading a wide range of organic pollutants. This comprehensive review aims to systematically examine and discuss the application of photocatalytic technology for the removal of ACT from aqueous environments. Additionally, the study provides a detailed overview of the limitations associated with the photocatalytic degradation of ACT in practical applications, along with effective strategies to address these challenges.

Efficient Removal of Analgesic and Anti-Inflammatory Drugs from Sewage Treatment Plant Effluents Using Magnetite Nanoparticles Synthesized Red Mud

Due to the COVID-19 epidemic, the consumption of pharmaceuticals, especially paracetamol, has sharply increased on a global scale. The increasing concentration of analgesic and anti-inflammatory drugs (AAIDs) in the aquatic medium is a global problem for human and aquatic life. Therefore, simple and effective treatment options for removing AAIDs from wastewater after the COVID-19 pandemic are needed. The removal of AAIDs (acetaminophen, acetylsalicylic acid, codeine, diclofenac, ibuprofen, indomethacin, ketoprofen, mefenamic acid, naproxen, and phenylbutazone) from sewage treatment plant (STP) effluents by the prepared magnetite nanoparticles synthesized from red mud (mNPs-RM) is presented for the first time in this study. The removal efficiencies of AAIDs onto mNPs-RM were determined to be between 90% (diclofenac) and 100% (naproxen, codeine, and indomethacin). Acetaminophen (paracetamol) was used as a model compound in kinetic and isotherm model studies. The adsorption of acetaminophen was matched well with the pseudo second order kinetic model. Film diffusion governed its rate mechanism. The Freundlich isotherm model preferably fitted the adsorption data with an adsorption capacity of 370 mg/g at 120 min contact time at pH 7.0 at 25 °C. Furthermore, the regenerated mNPs-RM were used four times without affecting the adsorption capacity and the magnetic separability. mNPs-RM can be used as a simple, inexpensive and effective adsorbent for removing AAIDs from STP effluents. Also, low cost adsorbent obtained from industrial waste could be employed to replace the high cost activated carbons for the adsorption of other micro pollutants in STP effluents.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11270-023-06404-7.

Effective removal of selected pharmaceuticals from sewerage treatment plant effluent using natural clay (Na-montmorillonite)

The consumption of pharmaceuticals has rapidly increased on a global scale due to the serious increase in Covid-19, influenza and respiratuar sinsityal virus, which is called "triple epidemic" in the world. The use of non-prescription analgesic and anti-inflammatory drugs (AAIDs), especially paracetamol, is higher compared to pre-pandemic. This increased the AAIDs load discharged to the aqueous media through sewerage treatment plant (STP). Therefore, simple and effective treatment options for removing AAIDs from STP effluents are needed. The aim of the study was to remove AAIDs (paracetamol, acetylsalicylic acid, codeine, diclofenac, ibuprofen, indomethacin, ketoprofen, mefenamic acid, naproxen, and phenylbutazone) from STP effluents by nearly pure natural clay Na-montmorillonite. The Na-montmorillonite taken from the Ordu region in the northern part of Turkey. Surface area of the Na-montmorillonite is 99.58 m2/g and CEC is 92.40 meq/100 g. The removal efficiencies of AAIDs using Na-montmorillonite were between 82 ± 5% (ibuprofen) and 94 ± 4% (naproxen). Paracetamol was used as a model compound in kinetic and isotherm model studies. Freundlich isotherm model and the pseudo second order kinetic model were the best-fit using the obtained experimental data. Film diffusion governed its rate mechanism. The paracetamol adsorption capacity was acquired as 244 mg/g at 120 min contact time at pH 6.5 at 25 °C. With this study, it could be shown that montmorillonite can be used effectively to eliminate paracetamol from STP effluent. Natural clay can be used as a simple, inexpensive and effective adsorbent for removing AAIDs from STP effluents.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13201-023-01930-5.

Acute and Transgenerational Effects of Non-Steroidal Anti-Inflammatory Drugs on Daphnia magna

Pharmaceuticals pose a great threat to organisms inhabiting the aquatic environment. Non-steroidal anti-inflammatory drugs (NSAIDs) are major pharmaceutical pollutants with a significant presence in freshwater ecosystems. In this study, the impact of indomethacin and ibuprofen, two of the most commonly prescribed NSAIDs, was assessed on Daphnia magna. Toxicity was assessed as the immobilization of animals and used to determine non-lethal exposure concentrations. Feeding was assessed as a phenotypic endpoint and key enzymes were used as molecular endpoints of physiology. Feeding was decreased in mixture exposures for five-day-old daphnids and neonates. Furthermore, animals were exposed to NSAIDs and their mixture in chronic and transgenerational scenarios revealing changes in key enzyme activities. Alkaline and acid phosphatases, lipase, peptidase, β-galactosidase, and glutathione-S-transferase were shown to have significant changes in the first generation at the first and third week of exposure, and these were enhanced in the second generation. On the other hand, the third recovery generation did not exhibit these changes, and animals were able to recover from the induced changes and revert back to the control levels. Overall, our study points towards transgenerational exposures as more impactful laboratory studies to understand pharmaceutical stressors with a combination of molecular and phenotypic markers of physiology.

Cocktails of NSAIDs and 17α Ethinylestradiol at Environmentally Relevant Doses in Drinking Water Alter Puberty Onset in Mice Intergenerationally

Non-steroidal anti-inflammatory drugs (NSAIDs) and 17α-ethinyl-estradiol (EE2) are among the most relevant endocrine-disrupting pharmaceuticals found in the environment, particularly in surface and drinking water due to their incomplete removal via wastewater treatment plants. Exposure of pregnant mice to NSAID therapeutic doses during the sex determination period has a negative impact on gonadal development and fertility in adults; however, the effects of their chronic exposure at lower doses are unknown. In this study, we investigated the impact of chronic exposure to a mixture containing ibuprofen, 2hydroxy-ibuprofen, diclofenac, and EE2 at two environmentally relevant doses (added to the drinking water from fetal life until puberty) on the reproductive tract in F1 exposed mice and their F2 offspring. In F1 animals, exposure delayed male puberty and accelerated female puberty. In post-pubertal F1 testes and ovaries, differentiation/maturation of the different gonad cell types was altered, and some of these modifications were observed also in the non-exposed F2 generation. Transcriptomic analysis of post-pubertal testes and ovaries of F1 (exposed) and F2 animals revealed significant changes in gene expression profiles and enriched pathways, particularly the inflammasome, metabolism and extracellular matrix pathways, compared with controls (non-exposed). This suggested that exposure to these drug cocktails has an intergenerational impact. The identified Adverse Outcome Pathway (AOP) networks for NSAIDs and EE2, at doses that are relevant to everyday human exposure, will improve the AOP network of the human reproductive system development concerning endocrine disruptor chemicals. It may serve to identify other putative endocrine disruptors for mammalian species based on the expression of biomarkers.

Non-steroidal anti-inflammatory drugs caused an outbreak of inflammation and oxidative stress with changes in the gut microbiota in rainbow trout (Oncorhynchus mykiss)

One of the main contributors to pharmaceutical pollution of surface waters are non-steroidal anti-inflammatory drugs (NSAIDs) that contaminate the food chain and affect non-target water species. As there are not many studies focusing on toxic effects of NSAIDs on freshwater fish species and specially effects after dietary exposure, we selected rainbow trout (Oncorhynchus mykiss) as the ideal model to examine the impact of two NSAIDs - diclofenac (DCF) and ibuprofen (IBP). The aim of our study was to test toxicity of environmentally relevant concentrations of these drugs together with exposure doses of 100× higher, including their mixture; and to deepen knowledge about the mechanism of toxicity of these drugs. This study revealed kidneys as the most affected organ with hyalinosis, an increase in oxidative stress markers, and changes in gene expression of heat shock protein 70 to be signs of renal toxicity. Furthermore, hepatotoxicity was confirmed by histopathological analysis (i.e. dystrophy, congestion, and inflammatory cell increase), change in biochemical markers, increase in heat shock protein 70 mRNA, and by oxidative stress analysis. The gills were locally deformed and showed signs of inflammatory processes and necrotic areas. Given the increase in oxidative stress markers and heat shock protein 70 mRNA, severe impairment of oxygen transport may be one of the toxic pathways of NSAIDs. Regarding the microbiota, an overgrowth of Gram-positive species was detected; in particular, significant dysbiosis in the Fusobacteria/Firmicutes ratio was observed. In conclusion, the changes observed after dietary exposure to NSAIDs can influence the organism homeostasis, induce ROS production, potentiate inflammations, and cause gut dysbiosis. Even the environmentally relevant concentration of NSAIDs pose a risk to the aquatic ecosystem as it changed O. mykiss health parameters and we assume that the toxicity of NSAIDs manifests itself at the level of mitochondria and proteins.

Pharmaceutical pollution of hospital effluents and municipal wastewaters of Eastern Canada

Quantification of drugs residues in wastewaters of different sources could help better understand contamination pathways, eventually leading to effluent regulation. However, limited data are available for hospital-derived wastewaters. Here, an analytical method based on automated on-line solid-phase extraction liquid chromatography tandem mass spectrometry (on-line SPE - UPLC-MS/MS) was developed for the quantification of multi-class pharmaceuticals in wastewaters. Filtrate phase and suspended solids (SPM) were both considered to evaluate the distribution of targeted analytes. Experimental design optimization involved testing different chromatographic columns, on-line SPE columns, and loading conditions for the filtrate phase, and different organic solvents and cleanup strategies for suspended solids. The selected methods were validated with suitable limits of detection, recovery, accuracy, and precision. A total of 30 hospital effluents and 6 wastewater treatment plants were sampled to evaluate concentrations in real field-collected samples. Certain pharmaceuticals were quantified at high levels such as caffeine at 670,000 ng/L in hospital wastewaters and hydroxyibuprofen at 49,000 ng/L in WWTP influents. SPM samples also had high contaminant concentrations such as ibuprofen at 31,000 ng/g in hospital effluents, fluoxetine at 529 ng/g in WWTP influents or clarithromycin at 295 ng/g in WWTP effluents. Distribution coefficients (K_d) and particle-associated fractions (Φ) indicate that pharmaceuticals tend to have better affinity to suspended solids in hospital wastewater than in municipal wastewaters. The results also bring arguments for at source treatment of these specific effluents before their introduction into urban wastewater systems.

A Comprehensive Review for Removal of Non-Steroidal Anti-Inflammatory Drugs Attained from Wastewater Observations Using Carbon-Based Anodic Oxidation Process

Non-steroidal anti-inflammatory drugs (NSAIDs) (concentration <µg/L) are globally acknowledged as hazardous emerging pollutants that pass via various routes in the environment and ultimately enter aquatic food chains. In this context, the article reviews the occurrence, transport, fate, and electrochemical removal of some selected NSAIDs (diclofenac (DIC), ketoprofen (KTP), ibuprofen (IBU), and naproxen (NPX)) using carbon-based anodes in the aquatic environment. However, no specific protocol has been developed to date, and various approaches have been adopted for the sampling and elimination processes of NSAIDs from wastewater samples. The mean concentration of selected NSAIDs from different countries varies considerably, ranging between 3992−27,061 µg/L (influent wastewater) and 1208−7943 µg/L (effluent wastewater). An assessment of NSAIDs removal efficiency across different treatment stages in various wastewater treatment plants (WWTPs) has been performed. Overall, NSAIDs removal efficiency in wastewater treatment plants has been reported to be around 4−89%, 8−100%, 16−100%, and 17−98% for DIC, KTP, NPX, and IBU, respectively. A microbiological reactor (MBR) has been proclaimed to be the most reliable treatment technique for NSAIDs removal (complete removal). Chlorination (81−95%) followed by conventional mechanical biological treatment (CMBT) (94−98%) treatment has been demonstrated to be the most efficient in removing NSAIDs. Further, the present review explains that the electrochemical oxidation process is an alternative process for the treatment of NSAIDs using a carbon-based anode. Different carbon-based carbon anodes have been searched for electrochemical removal of selected NSAIDs. However, boron-doped diamond and graphite have presented reliable applications for the complete removal of NSAIDs from wastewater samples or their aqueous solution.

Fate of selected pharmaceuticals in hospital and municipal wastewater effluent: occurrence, removal, and environmental risk assessment

The concentrations and distribution of β-blockers, lipid regulators, and psychiatric and cancer drugs in the influent and effluent of the municipal wastewater treatment plant (WWTP) and the effluent of 16 hospitals that discharge into the wastewater treatment plant mentioned in this study at two sampling dates in summer and winter were examined. The pharmaceutical contribution of hospitals to municipal wastewater was determined. The removal of target pharmaceuticals was evaluated in a WWTP consisting of conventional biological treatment using activated sludge. Additionally, the potential environmental risk for the aquatic receiving environments (salt lake) was assessed. Beta-blockers and psychiatric drugs were detected in high concentrations in the wastewater samples. Atenolol (919 ng/L) from β-blockers and carbamazepine (7008 ng/L) from psychiatric pharmaceuticals were detected at the highest concentrations in hospital wastewater. The total pharmaceutical concentration determined at the WWTP influent and effluent was between 335 and 737 ng/L in summer and between 174 and 226 ng/L in winter. The concentrations detected in hospital effluents are higher than the concentrations detected in WWTP. The total pharmaceutical contributions from hospitals to the WWTP in summer and winter were determined to be 2% and 4%, respectively. Total pharmaceutical removal in the WWTP ranged from 23 to 54%. According to the risk ratios, atenolol could pose a high risk (risk quotient > 10) for fish in summer and winter. There are different reasons for the increase in pharmaceutical consumption in recent years. One of these reasons is the COVID-19 pandemic, which has been going on for 2 years. In particular, hospitals were operated at full capacity during the pandemic, and the occurrence and concentration of pharmaceuticals used for the therapy of COVID-19 patients has increased in hospital effluent. Pandemic conditions have increased the tendency of people to use psychiatric drugs. It is thought that beta-blocker consumption has increased due to cardiovascular diseases caused by COVID-19. Therefore, the environmental risk of pharmaceuticals for aquatic organisms in hospital effluent should be monitored and evaluated.

Biological removal processes in aerobic granular sludge exposed to diclofenac

Diclofenac is a worldwide consumed drug included in the watch list of substances to be monitored according to the European Union Water Framework Directive (Directive 2013/39/EU). Aerobic granular sludge sequencing batch reactors (AGS-SBR) are increasingly used for wastewater treatment but there is scant information on the fate and effect of micropollutants to nutrient removal processes. An AGS-SBR fed with synthetic wastewater containing diclofenac was bioaugmented with a diclofenac degrading bacterial strain and performance and microbial community dynamics was analysed. Chemical oxygen demand, phosphate and ammonia removal were not affected by the micropollutant at 0.03 mM (9.54 mg L^-1). The AGS was able to retain the degrading strain, which was detected in the sludge throughout after augmentation. Nevertheless, besides some adsorption to the biomass, diclofenac was not degraded by the augmented sludge given the short operating cycles and even if batch degradation assays confirmed that the bioaugmented AGS was able to biodegrade the compound. The exposure to the pharmaceutical affected the microbial community of the sludge, separating the two first phases of reactor operation (acclimatization and granulation) from subsequent phases. The AGS was able to keep the bioaugmented strain and to maintain the main functions of nutrient removal even through the long exposure to the pharmaceutical, but combined strategies are needed to reduce the spread of micropollutants in the environment.

Pharmaceutical residues in digested sewage sludge: Occurrence, seasonal variation and risk assessment for soil

The occurrences, temporal variations and ecotoxicological risks of 38 selected pharmaceuticals from 7 therapeutic classes (i.e. antibiotics, analgesics, anti-inflammatories, beta-blockers, lipid regulators, anticancer agents, and psychiatric drugs) have been observed in the anaerobically treated sludge of the urban wastewater treatment plant (WWTP) in Konya, Turkey. Sampling was carried out to assess the seasonal variations in one year. The total daily wastewater flow rate of the WWTP was approximately 200,000 m³/day, and 140 tons/day of treated sludge were produced. The total concentrations of all pharmaceutical compounds ranged from 280 to 4898 μg/kg of dry matter (dm). The dominant therapeutic class was analgesics and anti-inflammatories (49%), which was followed by antibiotics (31%). Clarithromycin and azithromycin were the most abundant compounds, with concentrations of 1496 μg/kg dm. The total daily pharmaceutical load in the treated sludge was as high as 1.002 kg/day in the winter season, while the annual pharmaceutical mass load that was discharged into the environment was estimated to be approximately 71.6 kg. The use of treated sludge as fertilizer in agricultural lands causes continuous contamination of the terrestrial environment by pharmaceuticals. Five antibiotics (i.e., azithromycin, clarithromycin, erythromycin, sulfamethoxazole, and doxycycline), one analgesic (acetylsalicylic acid) and one beta-blocker (atenolol) in the digested sludge pose acute and short chronic high risks to environment. The highest short chronic risk in the digested sludge-amended soils was determined for azithromycin (RQ: 54.9). To reduce the potential environmental impact of pharmaceuticals, digested sludge should be monitored in terms of the pharmaceutical contents before being applied to soil.

Monitoring and ecological risk of illegal drugs before and after sewage treatment in an area

In this study, the occurrence of illicit drugs and their metabolites in the sewerage systems and in the influent and effluent of wastewater treatment plant (WWTP) in Konya, Turkey, was presented. The drug removal efficiencies of the central WWTP were investigated. Potential ecotoxicological risks for algae, fish, and Daphnia magna in the receiving environments were also evaluated. The highest estimated mean illicit drug use was obtained for cannabis (marijuana) at 280 ± 12 mg/day/1000 inhabitants and 430 ± 20 g/day/1000 inhabitants (15-64 years). Amphetamine was found to be the second most consumed drug of abuse. While cannabis and ecstasy consumption values were higher during the weekend, cocaine use dominated on weekdays. The removal efficiencies for THC-COOH and THC-OH were 100% in the WWTP. The average removal of cocaine, amphetamine, methamphetamine, MDMA, MDA, and methadone varied between 46 ± 7 and 87 ± 3%. The maximum concentration level of MDMA found can pose some low risk for Daphnia magna. The rest of the compounds detected in effluents did not show any toxic effects on fish, Daphnia magna, or algae. However, when the cumulative estimated risk quotient values were evaluated, there might be a low risk for Daphnia magna and algae in the receiving environment.

Using Experimental Models to Decipher the Effects of Acetaminophen and NSAIDs on Reproductive Development and Health

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin (acetylsalicylic acid), diclofenac and ibuprofen (IBU), and analgesic drugs, such as acetaminophen (APAP, or paracetamol), are widely used to treat inflammation and pain. APAP and IBU are over-the-counter drugs and are among the most commonly taken drugs in the first trimester of pregnancy, even in combination. Furthermore, these drugs and their metabolites are released in the environment, and can be frequently detected in wastewater, surface water, and importantly in drinking water. Although their environmental concentrations are much lower than the therapeutics doses, this suggests an uncontrolled low-dose exposure of the general population, including pregnant women and young children, two particularly at risk populations. Epidemiological studies show that exposure to these molecules in the first and second trimester of gestation can favor genital malformations in new-born boys. To investigate the cellular, molecular and mechanistic effects of exposure to these molecules, ex vivo studies with human or rodent gonadal explants and in vivo experiments in rodents have been performed in the past years. This review recapitulates recent data obtained in rodent models after in utero or postnatal exposure to these drugs. The first part of this review discusses the mechanisms by which NSAIDs and analgesics may impair gonadal development and maturation, puberty development, sex hormone production, maturation and function of adult organs, and ultimately fertility in the exposed animals and their offspring. Like other endocrine disruptors, NSAIDs and APAP interfere with endocrine gland function and may have inter/transgenerational adverse effects. Particularly, they may target germ cells, resulting in reduced quality of male and female gametes, and decreased fertility of exposed individuals and their descendants. Then, this review discusses the effects of exposure to a single drug (APAP, aspirin, or IBU) or to combinations of drugs during early embryogenesis, and the consequences on postnatal gonadal development and adult reproductive health. Altogether, these data may increase medical and public awareness about these reproductive health concerns, particularly in women of childbearing age, pregnant women, and parents of young children.

A critical review on ibuprofen removal from synthetic waters, natural waters, and real wastewaters by advanced oxidation processes

Ibuprofen (IBP) is one ubiquitous drug prescribed as anti-inflammatory, analgesic, and antipyretic. It has been detected in effluents of wastewater plant treatments, sewage sludge, hospital wastewaters, surface waters, and drinking water due to its continuous release to the environment, mainly from the excretion in the urine of animals and humans. IBP is a carcinogenic and non-steroidal endocrine disrupting drug with harmful effects over fungal, bacterial, algae, microorganisms, crustacean, and fish species, and can be potentially hazard for human health. Since conventional treatments remove inefficiently this drug, many advanced oxidation processes (AOPs) have been developed aiming their abatement from waters to avoid their harmful health problems. This paper presents an exhaustive and critical review on the application of AOPs to treat synthetic waters, natural waters, and real wastewaters polluted with IBP alone or mixed with other common drugs covering up to 2020. The characteristics and main results obtained for single, hybrid, and sequential treatments are described. Dielectric barrier or pulsed-corona discharges are detailed among the single processes. Hybrid processes such as photocatalysis (UV/H₂O₂, UV/chlorine, TiO₂/UV), hybrid ozonation (O₃/H₂O₂, electro-peroxone, catalytic ozonation), Fenton-based processes (photo-Fenton, electro-Fenton, photoelectro-Fenton), zero-valent iron, ultrasonic, peroxymonosulfate, and persulfate, are discussed. The effect of the kind of irradiation (UV, visible, solar) on photo-assisted processes is analyzed. Sequential processes with biological pre- or post-treatments using or not membranes for natural water and real wastewater remediation are described. Finally, 38 by-products detected during IBP removal by AOPs are reported, allowing envisaging three parallel pathways for its initial degradation.

Insights into the acute effect of anti-inflammatory drugs on activated sludge systems with high solids retention time

The increase in the occurrence of the pharmaceuticals in the environmental compartments is becoming emerging concern as it reflects their inefficient treatment in the wastewater treatment plants which are the main sources of these micropollutants. Non-steroidal anti-inflammatory drugs (NSAIDs) are one of the most commonly prescribed and frequently detected pain medications in wastewater treatment plants. A lab scale sequencing batch reactor (SBR) was operated for seven months and acute inhibitory effect of NSAIDs on activated sludge was tested with respirometry. Culture amendment with different concentrations of NSAIDs in the presence as well as absence of nitrification inhibitor resulted in considerable variation in the oxygen uptake rate (OUR) profiles. The decrease in OUR and nitrate production rate governed with reduced heterotrophic and nitrification activity. The kinetics of half saturation for growth and maximum autotrophic growth rates are determined to be affected negatively by the acute impact of anti-inflammatory pharmaceuticals even at the environmentally relevant concentrations. High removal of tested NSAIDs was observed even for the first time introduce with these compounds.

River water treatment using electrocoagulation for removal of acetaminophen and natural organic matter

Electrocoagulation (EC) was assessed for removal of acetaminophen and natural organic matter (measured as UV₂₅₄) from river water. Process was assessed for time, electrode materials, inter electrode distance, and voltage. Best conditions for removal of acetaminophen and UV₂₅₄ absorbance were 60 min reaction time, aluminum-aluminum electrodes, 2 cm inter electrode distance, and 9 V. Acetaminophen tested at 1, 2, 5, 10, and 20 mg L^-1 showed that treatment efficiency decreased as the concentration increased. The main mechanism for removal of acetaminophen was H bonding with Al(OH)₃ flocs; this was confirmed by XRD and FT-IR spectrum. Pseudo-second order kinetics model exhibited a good fit on experimental data for acetaminophen removal at different concentrations. Univariate ANOVA indicated statistically significant difference between treatments for acetaminophen removal (F_2.76 = 136, P = <0.001). A significant linear correlation was found between UV₂₅₄ absorbance and acetaminophen removal at different concentrations. Preliminary analysis suggest that EC will cost US$ 0.22/m³ for river water treatment. The lab-scale EC process was compared with a full-scale water treatment plant for removal of natural organic matter. Water treatment plant after multiple levels of purification was not able to fully remove UV₂₅₄ absorbance whereas EC treatment showed good efficiency.

Pharmaceuticals and the environment

The marked progress and increase in the number of medications available for the treatment of conditions and diseases left a footprint on the surrounding environment. The consumption of medications for human and veterinarian use impact the terrestrial and marine environment and affects the ecosystem. The increase in environmental awareness regarding pharmaceutical related activities led to the development of principles and measures to mitigate a negative environmental impact. Various measures were introduced to promote green manufacturing and practices which led to the development of alternative techniques and processes, which are of benefit to both the environment and the industry. Distributors and pharmacists can contribute through the efficient management of everyday operations which include better stock taking and rotation, grouping deliveries and reducing unused medications. The incorporation of green practices in the pharmacy curriculum empowers future pharmacists with skills and competences required at the place of work to decrease the impact of processes and medicines on the environment. The presence of a pharmacist workforce which is more conscientious about the environment leads to the needed ripple effect to embrace and implement green principles in different pharmacy related settings. Patients should also be educated to avoid hoarding of medications and dispose of medication in a safe and appropriate manner. The implementation of green practices results in a decrease in the use of chemicals and production of waste which in turn leads to a decrease in pollutants which have an impact on climate change.

Fate of environmental pollutants: A review

A review of the literature published in 2019 on topics associated with the fate of environmental pollutants is presented. Environmental pollutants covered include pharmaceuticals, antibiotic-resistant bacteria and genes, pesticides and veterinary medicines, personal care products and emerging pollutants, PFAS, microplastics, nanomaterials, heavy metals and radionuclides, nutrients, pathogens and indicator organisms, and oil and hydrocarbons. For each pollutant, the occurrence in the environment and/or their fate in engineered as well as natural systems in matrices including water, soil, wastewater, stormwater, runoff, and/or manure is presented based on the published literature. The review includes current developments in understanding pollutants in natural and engineered systems, and relevant physico-chemical processes, as well as biological processes.

Ketoprofen affects swimming behavior and impairs physiological endpoints of Daphnia magna

Ketoprofen (KET) is a nonsteroidal anti-inflammatory and analgesic drug commonly used in human and veterinary medicine. This compound is detected in aquatic reservoirs however, little is known about its influence on cladocerans. Therefore, the aim of our study was to determine the influence of KET at concentrations of 0.005 mg/L, 0.05 mg/L, 0.5 mg/L, 5 mg/L and 50 mg/L on behavioral (swimming speed, hopping frequency) and physiological endpoints (heart rate, thoracic limb activity, mandible movements) of Daphnia magna after 24 h and 48 h exposure. The study showed that swimming speed frequency was decreased after 24 h and 48 h at all the concentrations used in the experiment. Hopping frequency was also inhibited, however the lowest amount of the drug induced transient increase of the parameter after 24 h and its subsequent decrease to the control level after 48 h. Although after 24 h of the exposure physiological parameters: heart rate, thoracic limb activity and mandible movements showed slightly lower sensitivity to KET than the behavioral endpoints: were found to be inhibited after 48 h. The results revealed that both behavioral and physiological endpoints of daphnids responded to KET also at the environmental level, therefore in natural conditions this drug should be considered as a hazardous toxicant to crustaceans.