The environmental impact of pharmaceuticals in Italy: Integrating healthcare and eco‐toxicological data to assess and potentially mitigate their diffusion to water supplies

Abstract

Pharmaceuticals can reach the environment at all stages of their lifecycle and accumulate in the ecosystem, potentially reaching toxic levels for animals and plants. In recent years, efforts have been made to map and control this hazard. Assessing country‐specific environmental risks could drive regulatory actions towards eco‐friendlier drug utilization and disposal practices. By starting from a list of 25 environmentally hazardous pharmaceuticals developed by Region Stockholm, we integrated eco‐toxicological and 2019–2021 Italian drug utilization data to estimate the environmental impact of pharmaceuticals in Italy. We calculated the risk as the ratio between the predicted environmental concentration (PEC) and the predicted no‐effect concentration (PNEC). We found a high risk for levonorgestrel, ciprofloxacin, amoxicillin, azithromycin, venlafaxine, sertraline and diclofenac and a moderate risk for ethinyloestradiol, oestradiol and clarithromycin. This analysis can be periodically performed to identify the pharmaceuticals with the highest risk for the environment and ascertain if containment measures should be implemented.

A Pretty Kettle of Fish: A Review on the Current Challenges in Mediterranean Teleost Reproduction

“…Furthermore, the inadvertent release of pharmaceutical compounds into aquatic environments is also a source of concern due to their possible toxic effects on aquatic wildlife’s reproductive activities. These chemicals include a wide range of medications, comprising antibiotics and antidepressants, and are able to enter the waterways through various routes, such as wastewater discharge, improper disposal, and excretion by humans and animals [ 165 ]. Fish can ultimately be exposed to pharmaceutical compounds directly from the water or through the food web, also leading to the bioaccumulation of these chemicals in their tissues [ 166 , 167 ].…”

Assessing the environmental impact of medicines in Italy using data from the Italian Medicines Agency

“…Inspired by the Swedish example, the Finnish Pharmaceutical Information Centre (Pharmaca) has integrated environmental information on medicines into the Pharmaca Fennica online service 13,14 . Other countries, such as Norway and Italy, have contributed to the development of their country-specific environmental risk assessments for medicines through publications in the scientific literature 15,16 .…”

A collection of Predicted No-Effect Concentrations of human pharmaceuticals and their metabolites

“…For instance, in the case of the European Public Assessment Reports (EPAR), information must be extracted from PDFs organized by brand name. Similarly, the Swedish National Formulary of Drugs (FASS) website arranges information on webpages classified by brand name and presented in the Swedish language, further adding to the complexity 4,5 .…”