Development of predicted environmental concentrations to prioritize the occurrence of pharmaceuticals in rivers from Catalonia

Environmental risk assessment of pharmaceuticals in wastewaters and reclaimed water from catalan main river basins

Aquatic pollution from pharmaceuticals is a growing environmental concern globally, particularly in Catalonia's primary water bodies, the Llobregat and Besòs rivers. This study investigates pharmaceutical residues in reclaimed water effluents from the Llobregat River and a wastewater treatment plant (WWTP) in the Besòs River, critical contributors to the region's water resources. Employing LC-MS/MS, 85 pharmaceutical residues were monitored, revealing elevated concentrations of tramadol, losartan, and gemfibrozil, commonly prescribed drugs in Catalonia. Surprisingly, downstream concentrations exceeded upstream levels significantly, indicating the adverse impact of reclaimed water on water quality. Furthermore, evaluation of WWTP efficiency displayed varying removal rates, from 10 % to 99.8 %, highlighting treatment inadequacies for certain compounds. Predictive environmental concentrations (PECs) aligned closely with measured values, affirming the utility of predictive models in early-stage research. Risk assessment via the risk quotient (RQ) method identified atorvastatin and chlorpromazine as surpassing toxicity thresholds. This study underscores the urgent need to address pharmaceutical contamination in urban rivers and reclaimed waters in Catalonia. By highlighting treatment inefficacies and potential ecological risks, it contributes to the development of sustainable water management strategies and environmental conservation efforts in the region. Efforts should focus on continuously monitoring specific compounds, evaluating their individual toxicity, and implementing appropriate remediation techniques in WWTPs to safeguard water quality and aquatic ecosystems.

Co-occurrence, toxicity, and biotransformation pathways of metformin and its intermediate product guanylurea: Current state and future prospects for enhanced biodegradation strategy

Accumulation of metformin and its biotransformation product "guanylurea" are posing an increasing concern due to their low biodegradability under natural attenuated conditions. Therefore, in this study, we reviewed the unavoidable function of metformin in human body and the route of its release in different water ecosystems. In addition, metformin and its biotransformation product guanylurea in aquatic environments caused certain toxic effects on aquatic organisms which include neurotoxicity, endocrine disruption, production of ROS, and acetylcholinesterase disturbance in aquatic organisms. Moreover, microorganisms are the first to expose and deal with the release of these contaminants, therefore, the mechanisms of biodegradation pathways of metformin and guanylurea under aerobic and anaerobic environments were studied. It has been reported that certain microbes, such as Aminobacter sp. and Pseudomonas putida can carry potential enzymatic pathways to degrade the dead-end product "guanylurea", and hence guanylurea is no longer the dead-end product of metformin. However, these microbes can easily be affected by certain geochemical cycles, therefore, we proposed certain strategies that can be helpful in the enhanced biodegradation of metformin and its biotransformation product guanylurea. A better understanding of the biodegradation potential is imperative to improve the use of these approaches for the sustainable and cost-effective remediation of the emerging contaminants of concern, metformin and guanylurea in the near future.

Selection of pharmaceuticals of concern in reclaimed water for crop irrigation in the Mediterranean area

The reuse of reclaimed water in agriculture is being fostered in areas suffering from water scarcity. However, water pollutants can compromise food safety and pose a risk for the environment. This study aims to select the pharmaceutical compounds worth monitoring and investigating when reclaimed water is used for tomato and lettuce irrigation. A comprehensive study was first conducted to identify the pharmaceuticals frequently detected in secondary wastewater effluents in Catalonia (Northeast Spain). Priority pharmaceuticals were further selected based on their occurrence in secondary effluents, persistence (removal in conventional treatment), bioaccumulation potential, toxicity for aquatic organisms, and the risks they pose to the terrestrial environment and human health (through the consumption of crops). Out of the 47 preselected priority compounds, six could pose a risk to organisms living in soil irrigated with reclaimed water and seven could be potentially taken up by the crops. Nonetheless, no risk for human consumption was foreseen.

Environmental occurrence, risk, and removal strategies of pyrazolones: A critical review

Pyrazolones, widely used as analgesic and anti-inflammatory pharmaceuticals, have become a significant concern because of their persistence and widespread presence in engineered (e.g., wastewater treatment plants) and natural environments. Thus, the urgent task is to ensure the effective and cost-efficient removal of pyrazolones. Advanced oxidation processes are the most commonly used removal method. Furthermore, the biodegradation of pyrazolones has been exploited using microbial communities or pure strains; however, screening for efficient degrading bacteria and clarifying the biodegradation mechanisms required further research. In this critical review, we overview the environmental occurrence of pyrazolones, their potential ecological health risks, and their corresponding removal techniques (e.g., O3 oxidation, photocatalysis, and Fenton-like process). We also emphasize the prospects for the risk and contamination control of pyrazolones in various environments using physicochemical-biochemical coupling technology. Collectively, the environmental occurrence of pyrazolones poses significant public health concerns, necessitating heightened attention and the implementation of effective methods to minimize their environmental risks.

Evaluation of ceramic passive samplers using a mixed-mode strong cation-exchange sorbent to monitor polar contaminants in river water

Although most of the analytical methods developed for the monitoring of contaminants in environmental waters are based on discrete grab sampling, an alternative of increasing interest is the use of passive sampling. Methods based on passive sampling provide the sampling and pre-concentration of the analytes in-situ, which makes the sample treatment less time consuming and costly than using discrete grab sampling. In this study, ceramic passive samplers (CPSs) using mixed-mode strong cation-exchange sorbent (Oasis MCX) as retention phase were evaluated for the determination of a group of 21 therapeutic and illicit drugs and some of their metabolites in river water samples that were determined by liquid chromatography-tandem mass spectrometry. After assessing the stability of the analytes, the CPSs were calibrated for 9 days with bottled water and river water, obtaining, for the 19 stable compounds, sample rates (Rs) ranging between 0.180 and 1.767 mL/day and diffusion coefficients (De) between 2.02E-8 and 2.81E-7 cm2/s. Once calibrated, CPSs were deployed for the determination of contaminants in the Ebre River, with good reproducibility, and some of the analytes were determined, including amongst others, gabapentin at 76 ng/L, caffeine at 203 ng/L or diclofenac amine at 57 ng/L. The passive sampling method herein presented is simple and feasible and allows the time-integrated analysis of pharmaceuticals and drugs at trace levels in river water. This study opens the possibility of using other mixed-mode sorbents or other types of sorbents as retaining phase on CPSs for the determination of very polar contaminants in water.

The impact of pharmaceutical pollutants on daphnids - A metabolomic approach

Pharmaceuticals have been classified as emerging contaminants in the aquatic ecosystem, mainly due to their increased use and improper disposal. A significant range of pharmaceutical compounds and their metabolites have been globally detected in surface waters and pose detrimental effects to non-target organisms. Monitoring pharmaceutical water pollution relies on the analytical approaches for their detection, however, such approaches are limited by their sensitivity limit and coverage of the wide range pharmaceutical compounds. This lack of realism in risk assessment is bypassed with effect-based methods, which are complemented by chemical screening and impact modelling, and are able to provide mechanistic insight for pollution. Focusing on the freshwater ecosystem, in this study we evaluated the acute effects on daphnids for three distinct groups of pharmaceuticals; antibiotics, estrogens, and a range of commonly encountered environmentally relevant pharmaceutical pollutants. Combining several endpoints such as mortality, biochemical (enzyme activities) and holistic (metabolomics) we discovered distinct patterns in biological responses. In this study, changes in enzymes of metabolism e.g. phosphatases and lipase, as well as the detoxification enzyme, glutathione-S-transferase, were recorded following acute exposure to the selected pharmaceuticals. A targeted analysis of the hydrophilic profile of daphnids revealed mainly the up-regulation of metabolites following metformin, gabapentin, amoxicillin, trimethoprim and β-estradiol. Whereas gemfibrozil, sulfamethoxazole and oestrone exposure resulted in the down-regulation of majority of metabolites.

Water pollution threats in important bird and biodiversity areas from Spain

Chemical pollution is still an underestimated threat to surface waters from natural areas. This study has analysed the presence and distribution of 59 organic micropollutants (OMPs) including pharmaceuticals, lifestyle compounds, pesticides, organophosphate esters (OPEs), benzophenone and perfluoroalkyl substances (PFASs) in 411 water samples from 140 Important Bird and Biodiversity Areas (IBAs) from Spain, to evaluate the impact of these pollutants in sites of environmental relevance. Lifestyle compounds, pharmaceuticals and OPEs were the most ubiquitous chemical families, while pesticides and PFASs showed a detection frequency below 25% of the samples. The mean concentrations detected ranged from 0.1 to 301 ng/L. According to spatial data, agricultural surface has been identified as the most important source of all OMPs in natural areas. Lifestyle compounds and PFASs have been related to the presence of artificial surface and wastewater treatment plants (WWTPs) discharges, which were also an important source of pharmaceuticals to surface waters. Fifteen out of 59 OMPs have been found at levels posing a high risk for the aquatic IBAs ecosystems, being the insecticide chlorpyrifos, the antidepressant venlafaxine and perfluorooctanesulfonic acid (PFOS) the most concerning compounds. This is the first study to quantify water pollution in IBAs and evidence that OMPs are an emerging threat to freshwater ecosystems that are essential for biodiversity conservation.

Identification and Quantification of 29 Active Substances by HPLC-ESI-MS/MS in Lyophilized Swine Manure Samples

Veterinary drugs are frequently employed to treat and prevent diseases in food-producing animals to improve animal health and to avoid the introduction of microorganisms into the food chain. The analysis of the presence of pharmaceutical residues in animal manure could help to evaluate the legal and illegal practices during food production without harming the animals and to correctly manage manure when it is going to be applied as a fertilizer. This article describes a method for the simultaneous analysis of 29 active substances, mostly antibiotics and antiparasitic agents. Substances were extracted from lyophilized manure with a methanol:McIlvaine solution and analyzed with HPLC-ESI-MS/MS and a C18 HPLC column. The method was validated following European guidelines, the achieved trueness was between 63 and 128% (depending on the analytes), and the linearity was between 100 and 1500 µg/kg. The applicability of the method was demonstrated in 40 manure samples collected from pig farms where tetracycline was quantified in 7.5% of the samples. These results show the viability of this non-invasive method for the control of the legal and illegal administration of pharmaceuticals in food-producing animals.

Sorption of cefdinir, memantine, praziquantel and trimethoprim in sediment and soil samples

The everyday use of various pharmaceuticals to treat humans or animals means that they are increasingly found in the environment. Contamination of the soil can cause the active ingredients to be strongly sorbed to the soil or sediment. In the worst case, they can also be expected to occur in the aquatic environment due to their different polarity. In this study, four drugs from different therapeutic classes (trimetoprim, memantine, cefdinir, praziquantel) were used in dissolved form in two sediment and three soil samples to obtain data that can describe their fate and behavior in the environment. The sorption affinities of the pharmaceuticals were described using linear, Freundlich and Dubinin-Radushkevich sorption isotherms. The highest K_d values were obtained for cefdinir, while memantine and praziquantel tended to be present in water due to their very low sorption coefficients. The studied influence of pH showed a negative trend for memantine and trimetoprim, while an increase in ionic strength resulted in higher K_d values for all drugs. The sorption mechanism for all tested samples was best described by the pseudo-secondary kinetic model (R² > 0.9999).

Pilot monitoring scheme of water pollutants in Important Bird and Biodiversity Areas

In this study we have established a monitoring scheme to determine the presence and distribution of widely used pharmaceuticals, pesticides, organophosphate esters (OPEs) and perfluoroalkyl substances (PFAS) in water bodies from Important Bird and Biodiversity Areas (IBAs) from Spain. The monitoring scheme included the georeferenced sampling of rocky mountain, Atlantic forest, riparian forest, Mediterranean forest, agricultural, inland aquatic and coastal aquatic IBAs, with the aim to evaluate the impact of widely used chemicals in those aquatic resources. Water samples were extracted using a generic solid-phase extraction protocol and analyzed by 3 analytical methods based on liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS). Quality parameters such as compound recovery, intra and inter-day variation, linearity and limits of detection were calculated in order to validate the methods. In addition, the ionization conditions and the optimization of the most appropriate transitions permitted unequivocal identification. Once the sampling and analytical procedure was set-up, 59 target compounds were monitored in 63 samples. Pharmaceutical, followed by pesticides, OPEs and PFAS were widespread along all IBAs studied at concentrations from 0.5 to 41083 ng/L. Overall, this study highlights the need to monitor the presence of contaminants in areas of high ecological interest to contribute to pollution control and mitigation towards protection of biodiversity.

Long-Term Calculation of Predicted Environmental Concentrations to Assess the Risk of Anticancer Drugs in Environmental Waters

This study reports the consumption data for 132 anticancer drugs in Catalonia (NE Spain) during the period of 2013-2017 and calculates the predicted environmental concentrations (PECs) in wastewater effluents and rivers. This long-term analysis can determine the evolution of drugs present in the environment according to prescriptions and serve as an adequate tool to determine their presence and impact. Data showed that out of 132 compounds prescribed, 77 reached wastewater effluents, which accounted for the most consumed, those excreted in the highest doses, and the least biodegradable. Once diluted in receiving river waters, only mycophenolic acid and hydroxycarbamide had PEC values higher than 10 ng L-1, which is the value set by the European Medicines Agency (EMA) to carry out further risk assessment. It was also observed that compounds present in river water are those that can pose a high risk, given their persistence and capability to bioaccumulate. Therefore, this study shows that the estimation of PEC, together with physico-chemical properties of detected compounds, is a useful tool to determine the long-term presence and fate of this new class of emerging contaminants.

Environmental and human health risk assessment of mixture of Covid-19 treating pharmaceutical drugs in environmental waters

This study identified ecological and human health risks exposure of COVID-19 pharmaceuticals and their metabolites in environmental waters. Environmental concentrations in aquatic species were predicted using surface water concentrations of pharmaceutical compounds. Predicted No-Effect Concentrations (PNEC) in aquatic organisms (green algae, daphnia, and fish) was estimated using EC₅₀/LC₅₀ values of pharmaceutical compounds taken from USEPA ECOSAR database. PNEC for human health risks was calculated using the acceptable daily intake values of drugs. Ecological PNEC revealed comparatively high values in algae (Chronic toxicity PNEC values, high to low: ribavirin (2.65 × 10⁵ μg/L) to ritonavir (2.3 × 10^-1 μg/L)) than daphnia and fish. Risk quotient (RQ) analysis revealed that algae (Avg. = 2.81 × 10⁴) appeared to be the most sensitive species to pharmaceutical drugs followed by daphnia (Avg.: 1.28 × 10⁴) and fish (Avg.: 1.028 × 10³). Amongst the COVID-19 metabolites, lopinavir metabolites posed major risk to aquatic species. Ritonavir (RQ = 6.55) is the major drug responsible for human health risk through consumption of food (in the form fish) grown in pharmaceutically contaminated waters. Mixture toxicity analysis of drugs revealed that algae are the most vulnerable species amongst the three trophic levels. Maximum allowable concentration level for mixture of pharmaceuticals was found to be 0.53 mg/L.

Ecological Risk Assessment of Pharmaceuticals in the Transboundary Vecht River (Germany and The Netherlands)

Millions of people rely on active pharmaceutical ingredients (APIs) to prevent and cure a wide variety of illnesses in humans and animals, which has led to a steadily increasing consumption of APIs across the globe and concurrent releases of APIs into the environment. In the environment, APIs can have a detrimental impact on wildlife, particularly aquatic wildlife. Therefore, it is essential to assess their potential adverse effects to aquatic ecosystems. The European Water Framework Directive sets out that risk assessment should be performed at the catchment level, crossing borders where needed. The present study defines ecological risk profiles for surface water concentrations of 8 APIs (carbamazepine, ciprofloxacin, cyclophosphamide, diclofenac, erythromycin, 17α-ethinylestradiol, metformin, and metoprolol) in the Vecht River, a transboundary river that crosses several German and Dutch regions. Ultimately, 3 main goals were achieved: 1) the geo-referenced estimation of API concentrations in surface water using the geography-referenced regional exposure assessment tool for European rivers; 2) the derivation of new predicted-no-effect concentrations for 7 of the studied APIs, of which 3 were lower than previously derived values; and 3) the creation of detailed spatially explicit ecological risk profiles of APIs under 2 distinct water flow scenarios. Under average flow conditions, carbamazepine, diclofenac, and 17α-ethinylestradiol were systematically estimated to surpass safe ecological concentration thresholds in at least 68% of the catchment's water volume. This increases to 98% under dry summer conditions. Environ Toxicol Chem 2022;41:648-662. © 2021 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC.

Residues of Cardiovascular and Lipid-Lowering Drugs Pose a Risk to the Aquatic Ecosystem despite a High Wastewater Treatment Ratio in the Megacity Shanghai, China

The residues of pharmaceuticals in surface waters of megacities and ecotoxicological implications are of particular concern. In this study, we combined field investigations and model simulations to explore the contamination of cardiovascular and lipid-lowering drugs, one group of the most prescribed medications globally, in surface waters of a typical megacity, Shanghai, with a high wastewater treatment ratio (≈96%). Among 26 target substances, 19 drugs were detected with aqueous concentrations ranging from 0.2 (ketanserin) to 715 ng/L (telmisartan). Of them, angiotensin II receptor antagonists, telmisartan and irbesartan, were dominant besides β-blockers. Spatial distribution analysis demonstrated their much higher levels in tributaries compared to the mainstream. The results of model simulations and field investigation revealed relatively low concentrations of cardiovascular and lipid-lowering drugs in surface waters of Shanghai compared to other cities in highly developed countries, which is associated with low per capita usage in China. Ecotoxicological studies in zebrafish embryos further revealed developmental effects, including altered hatching success and heart rate, by irbesartan, telmisartan, lidocaine, and their mixtures at ng/L concentrations, which are typical levels in surface waters. Overall, the present results suggest that the high wastewater treatment ratio was not sufficient to protect fish species in the aquatic ecosystem of Shanghai. Exposure to cardiovascular and lipid-lowering drugs and associated risks will further increase in the future due to healthcare improvements and population aging.

Watershed-Scale Risk to Aquatic Organisms from Complex Chemical Mixtures in the Shenandoah River

River waters contain complex chemical mixtures derived from natural and anthropogenic sources. Aquatic organisms are exposed to the entire chemical composition of the water, resulting in potential effects at the organismal through ecosystem level. This study applied a holistic approach to assess landscape, hydrological, chemical, and biological variables. On-site mobile laboratory experiments were conducted to evaluate biological effects of exposure to chemical mixtures in the Shenandoah River Watershed. A suite of 534 inorganic and organic constituents were analyzed, of which 273 were detected. A watershed-scale accumulated wastewater model was developed to predict environmental concentrations of chemicals derived from wastewater treatment plants (WWTPs) to assess potential aquatic organism exposure for all stream reaches in the watershed. Measured and modeled concentrations generally were within a factor of 2. Ecotoxicological effects from exposure to individual components of the chemical mixture were evaluated using risk quotients (RQs) based on measured or predicted environmental concentrations and no effect concentrations or chronic toxicity threshold values. Seventy-two percent of the compounds had RQ values <0.1, indicating limited risk from individual chemicals. However, when individual RQs were aggregated into a risk index, most stream reaches receiving WWTP effluent posed potential risk to aquatic organisms from exposure to complex chemical mixtures.

Aqueous stability and degradation of psychiatric and neuroactive compounds and its biological activity in Daphnia magna

Pharmaceuticals and other emerging contaminants are continuously released into the aquatic environment, considered as 'pseudo-persistent' pollutants. Many compounds degrade fast in the environment, but sometimes their transformation products (TPs) are equally or even more toxic than the parental compounds, raising concern about the potential risks to the environment. In this way, the crustacean Daphnia magna (D. magna) is one of the most widely used organisms in aquatic toxicology studies, since it is an interesting non-vertebrate model to study via neurotransmitters the toxicological consequences of contaminants. In this study, the stability in water of 17 neuroactive compounds using ultra-high-performance liquid chromatography (UHPLC) coupled to a MS/MS detector was evaluated. In order to assess the stability of the compounds, samples of 1 ng μL^-1 were analyzed at different times (0, 24 and 48 h). No degradation was observed for most of the studied compounds, except for apomorphine and 6-hydroxydopamine that were degraded completely in the first 24 h. The behavioral assay was based in the automatized delivery of visible light stimuli. Most of the tested compounds altered motile responses to light significantly. The pharmaceuticals memantine, imidacloprid, fluoxetine, deprenyl, diazepam, apomorphine and 6-hydroxydopamine decreased motile responses to light. Conversely, pilocarpine, scopolamine, nicotine and p-chlorophenylalanine increased motile responses. Despite the observed degradation of apomorphine and 6-hydroxydopamine, their degradation products (APO-TP1 and 6OH-TP1) were stable and so their effects on behavior. This study shows that a degradation or transformation of the main pollutant is not always linked to a decrease in its toxicity.

Pharmaceuticals and environmental risk assessment in municipal wastewater treatment plants and rivers from Peru

This is the first study dealing with removal of the pharmaceutical substances in municipal wastewater treatment plants (MWWTPs) from Peru and the impact of these compounds in surface waters receiving treated wastewater. To this aim, samples from MWWTP of Lima (Peruvian Coast), MWWTP of Cusco, Puno and Juliaca (Peruvian Highlands), as well surface water (confluence of Torococha and Coata rivers in Juliaca) were analyzed. A total of 38 target pharmaceuticals were included in this study and were determined by Liquid Chromatography coupled to tandem Mass Spectrometry (LC-MS/MS). Around 60% and 75% of the target pharmaceuticals could be quantified in surface water and MWWTPs, respectively. Acetaminophen was the drug found at the highest concentration, and it was present in all the treated wastewater samples reaching average values above 100 μg/L in the department of Puno. The gabapentin anti-epileptic drug (up to 11.85 μg/L in MWWTP Lima) and the antibiotics clarithromycin, trimethoprim, ciprofloxacin, sulfamethoxazole and azithromycin (1.86 to 4.47 μg/L in MWWTP Lima) were also found at moderate concentrations in the treated wastewater. In surface water, the highest concentration corresponded also to acetaminophen (28.70 μg/L) followed by sulfamethoxazole (4.36 μg/L). As regards the pharmaceuticals removal, data of this work showed that the MWWTP Cusco (aerobic biologic process by synthetic trickling filters as secondary treatment) was more efficient than the MWWTP Lima (a preliminary treatment that combines grilles, sand trap, degreaser-aerated and sieved of 1.0 mm). However, many pharmaceuticals (around 50% of the compounds investigated) presented concentrations in treated wastewater similar or even higher than in influent wastewater. The environmental ecological risk of pharmaceuticals was assessed based on calculated Risk Quotient (RQ) in the treated wastewater and surface water from the concentration data found in the samples. According to our data, three antibiotics (clarithromycin, ciprofloxacin, clindamycin) and the analgesic acetaminophen posed high environmental risk (RQ ≥ 1) on the aquatic environment. In the river, all antibiotics (except norfloxacin) as well as the analgesic-anti-inflammatory compounds acetaminophen, diclofenac posed a high environmental risk (RQ ≥ 1). Based on data reported in this work for the first time in water samples from Peru, it can be deduced that the treatment processes applied in important cities from Peru are not enough efficient to remove pharmaceuticals in wastewater. As a consequence, severe environmental risks associated to the presence of pharmaceuticals in treated wastewater and surface water are expected; so complementary treatment processes should be implemented in the MWWTPs for a more efficient elimination of these compounds.

Pharmaceutical Residues in Senior Residences Wastewaters: High Loads, Emerging Risks

Senior residences are health-care facilities that are socially-accepted for the assistance of elderly people. Since the elderly account for the foremost pharmaceutical-consuming age-group, senior residences become a hot-spot for pharmaceuticals discharge to the sewage grid. The objectives of the present study were to identify the bioactive pharmaceuticals in sewage waters from senior residences and to propose an on-site monitoring strategy for their control. In this study, we have studied the presence of 43 pharmaceuticals highly consumed by the elderly population in six senior residences located in Spain, France and Portugal. Wastewater was sampled directly from the water-chest in each residence during different times of the day throughout one week. Main compounds detected at the high µg L⁻¹ level were analgesic and antipyretic drugs such as acetylsalicylic acid, paracetamol, ibuprofen; antibiotics such as amoxicillin and sulfamethoxazole; compounds for the treatment of neuropathies as gabapentin, trazodone and valsartan; pharmaceuticals for the treatment of diabetes (vildagliptin) and anticancer drugs. The daily loads discharged were estimated and their fate was evaluated. The final objective of this study is to highlight the need to implement at-source waste water treatment procedures in senior residences, which have been identified as a point source pollution of pharmaceuticals.

Can pharmaceutical drugs used to treat Covid-19 infection leads to human health risk? A hypothetical study to identify potential risk

This is the first study to assess human health risks due to the exposure of 'repurposed' pharmaceutical drugs used to treat Covid-19 infection. The study used a six-step approach to determine health risk estimates. For this, consumption of pharmaceuticals under normal circumstances and in Covid-19 infection was compiled to calculate the predicted environmental concentrations (PECs) in river water and in fishes. Risk estimates of pharmaceutical drugs were evaluated for adults as they are most affected by Covid-19 pandemic. Acceptable daily intakes (ADIs) are estimated using the no-observed-adverse-effect-level (NOAEL) or no observable effect level (NOEL) values in rats. The estimated ADI values are then used to calculate predicted no-effect concentrations (PNECs) for three different exposure routes (i) through the accidental ingestion of contaminated surface water during recreational activities only, (ii) through fish consumption only, and (iii) through combined accidental ingestion of contaminated surface water during recreational activities and fish consumption. Higher risk values (hazard quotient, HQ: 337.68, maximum; 11.83, minimum) were obtained for the combined ingestion of contaminated water during recreational activities and fish consumption exposure under the assumptions used in this study indicating possible effects to human health. Amongst the pharmaceutical drugs, ritonavir emerged as main drug, and is expected to pose adverse effects on r human health through fish consumption. Mixture toxicity analysis showed major risk effects of exposure of pharmaceutical drugs (interaction-based hazard index, HI_int: from 295.42 (for lopinavir + ritonavir) to 1.20 for chloroquine + rapamycin) demonstrating possible risks due to the co-existence of pharmaceutical in water. The presence of background contaminants in contaminated water does not show any influence on the observed risk estimates as indicated by low HQ_add values (<1). Regular monitoring of pharmaceutical drugs in aquatic environment needs to be carried out to reduce the adverse effects of pharmaceutical drugs on human health.

Development of emission factors to estimate discharge of typical pharmaceuticals and personal care products from wastewater treatment plants

Due to the potential ecological and human health risks, pharmaceuticals and personal care products (PPCPs) are considered as contaminants of emerging concern. PPCPs can be discharged to the aquatic environment from various sources, including municipal wastewater treatment plants (WWTPs), animal feeding operations, hospitals, and pharmaceutical manufacturers. A major challenge to regional characterization of ecological and human health risks is identification of the environmental emissions of PPCPs. This study established a facile approach for calculation of PPCP emission factors from raw wastewater and wastewater effluent. Using reported concentrations from WWTPs, nine PPCPs, namely carbamazepine, ciprofloxacin, erythromycin, ibuprofen, ketoprofen, ofloxacin, sulfadiazine, sulfamethoxazole, and trimethoprim, were identified as priority contaminants based on environmental significance (i.e., high detection frequency and potential ecological risk) and data availability. Emission factors were calculated for the nine PPCPs in raw wastewater, secondary effluent, and tertiary effluent for low, medium and high emission scenarios according to the concentration distributions of these nine PPCPs. The emission factors were used to estimate the mass of the PPCPs discharged from the nine provinces and two municipalities of the Yangtze River valley. The total mass of the nine PPCPs emitted into the watershed was estimated as 3867 kg, 8808 kg and 21,464 kg for low, medium and high emission scenarios respectively in 2018. Although uncertainty is inevitable in the emission factors, the reported approach provides a viable alternative to top-down and multimedia fugacity estimation strategies that require an abundance of sewershed-, WWTP-, and compound-specific information that is difficult to collect in developing countries.

Metformin environmental exposure: A systematic review

This review discussed the occurrence, ecological impacts, and effects of metformin, a drug used for type 2 diabetes among other diseases. It is one of the most commonly found medicines in aquatic environments owing to its incomplete metabolism in the human body, and is eventually disposed in wastewater. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses were followed as a guide. After searching various databases, 48 eligible studies were selected for the review. Metformin reportedly occurs in different environmental matrices, as measurable concentrations of metformin are found in sewage (urban and hospital), influent/sludge/effluent from wastewater treatment plants, surface water (rivers, lakes, estuaries, oceans, and non-specific sources), tap/drinking water, and sediment (lake and recipient seawaters). Data on metformin detection in aquatic environments in 14 countries were studied, but a consensus on the risk patterns of pharmaceutical products was not determined. Many studies have been conducted on different test organisms, demonstrating that metformin can drive the expression of diverse genes, particularly those responsible for endocrine hormone pathways. Chronic exposure to metformin can be tested using models and other tools to understand this field, which remains largely unexplored. Our results contribute to the current ecotoxicology knowledge related to typically used drugs and provide a basis for further investigations.

Toxicity of the Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) acetylsalicylic acid, paracetamol, diclofenac, ibuprofen and naproxen towards freshwater invertebrates: A review

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) represent one of the main therapeutic classes of molecules contaminating aquatic ecosystems worldwide. NSAIDs are commonly and extensively used for their analgesic, antipyretic and anti-inflammatory properties to cure pain and inflammation in human and veterinary therapy. After use, NSAIDs are excreted in their native form or as metabolites, entering the aquatic ecosystems. A number of monitoring surveys has detected the presence of different NSAIDs in freshwater ecosystems in the ng/L - μg/L concentration range. Although the concentrations of NSAIDs in surface waters are low, the high biological activity of these molecules may confer them a potential toxicity towards non-target aquatic organisms. The present review aims at summarizing toxicity, in terms of both acute and chronic toxicity, induced by the main NSAIDs detected in surface waters worldwide, namely acetylsalicylic acid (ASA), paracetamol (PCM), diclofenac (DCF), ibuprofen (IBU) and naproxen (NPX), both singularly and in mixture, towards freshwater invertebrates. Invertebrates play a crucial role in ecosystem functioning so that NSAIDs-induced effects may result in hazardous consequences to the whole freshwater trophic chain. Acute toxicity of NSAIDs occurs only at high, unrealistic concentrations, while sub-lethal effects arise also at low, environmentally relevant concentrations of all these drugs. Thus, further studies represent a priority in order to improve the knowledge on NSAID toxicity and mechanism(s) of action in freshwater organisms and to shed light on their real ecological hazard towards freshwater communities.

Sale-based estimation of pharmaceutical concentrations and associated environmental risk in the Japanese wastewater system

Information on sales and emission of selected pharmaceuticals were used to predict their concentrations in Japanese wastewater influent through a >300 of pharmaceuticals data sink. A combined wastewater-based epidemiology and environmental risk analysis follow was established. By comparing predicted environmental concentrations (PECs) of pharmaceuticals in wastewater influent against measured environmental concentrations (MECs) reported in previous studies, it was found that the model gave accurate results for 17 pharmaceuticals (0.5 < PEC/MEC < 2), and acceptable results for 32 out of 40 pharmaceuticals (0.1 < PEC/MEC < 10). Although the majority of pharmaceuticals considered in the model were antibiotics and analgesics, pranlukast, a receptor antagonist, was predicted to have the highest concentration in wastewater influent. With regard to the composition of wastewater effluent, the Estimation Program Interface (EPI) suite was used to predict pharmaceutical removal through activated sludge treatment. Although the performance of the EPI suite was variable in terms of accurate prediction of the removal of different pharmaceuticals, it could be an efficient tool in practice for predicting removal under extreme scenarios. By using the EPI suite with input data on PEC in the wastewater influent, the PEC values of pharmaceuticals in wastewater effluent were predicted. The concentrations of 26 pharmaceuticals were relatively high (>1 μg/L), and the PECs of 6 pharmaceuticals were extremely high (>10 μg/L) in wastewater effluent, which could be attributed to their high usage rates by consumers and poor removal rates in wastewater treatment plants (WWTPs). Furthermore, environmental risk assessment (ERA) was carried out by calculating the ratio of predicted no effect concentration (PNEC) to PEC of different pharmaceuticals, and it was found that 9 pharmaceuticals were likely to have high toxicity, and 54 pharmaceuticals were likely to have potential toxicity. It is recommended that this is further investigated in detail. The priority screening and environmental risk assessment results on pharmaceuticals can provide reliable basis for policy-making and environmental management.