Pharmaceuticals in the Surface Water of the USA: A Review

Adsorption of ibuprofen using cysteine-modified silane-coated magnetic nanomaterial

Industrialization and growth of the pharmaceutical companies have been a boon to the mankind in our day to day life in myriad ways. However, due to the uninhibited release of these active pharmaceutical compounds into the water systems has caused detrimental effects to the genetic pool. In this study, L-cysteine-modified 3-glycidyloxypropyltrimethoxysilane-coated magnetic nanomaterial showed a maximum removal of the efficiency of 82.90% for the nanomaterial dosage of 30 mg at an initial concentration of 50 mg L^-1 at pH 6.0. Further, the nanomaterial showed reusability efficiency up to 80% for three cycles. The adsorption kinetics follow the pseudo-second-order reaction and the adsorption isotherm model best fits the Langmuir isotherm proving the adsorption process to be a monolayer sorption on a monolayer surface. This magnetic nanomaterial could serve as a promising tool for the removal of pharmaceutical compounds from aqueous solutions. Graphical abstract ᅟ.

Characterization and source identification of tetracycline antibiotics in the drinking water sources of the lower Yangtze River

The occurrence and spatio-temporal patterns of five tetracyclines (TCs) and six of their degradation products were investigated in twenty-eight drinking water sources along the lower Yangtze River (LYR) over dry, normal and flood seasons. Tetracycline (TC), oxytetracycline (OTC) and doxytetracycline (DXC) were the dominant antibiotics detected with the highest occurrence. The maximum concentrations of TC, OTC and DXC were found in dry season as 11.16, 18.98, and 56.09 ng/L, respectively, because of the low dilution, low degradation, and high consumption in this season. Cluster analysis indicated distinct variations in the TCs' compositional profiles in both space and time. OTC and its metabolites contributed 18.5-59.6% of the TC load in dry season, possibly due to the seasonally increased release of pharmaceutical OTCs from sewage effluents, but they were seldom detected in other seasons. Pollution load index analysis showed that tributaries carrying large amounts of veterinary TCs derived from breeding wastewater and untreated rural sewage contributed larger proportions of the TC load for most drinking water sources than sewage outlets. The contribution ratio of the TC load from tributaries (74.5%) was approximately three times higher than that from sewage discharges (25.5%). The study demonstrated that the control of load from tributaries is the key to mitigating TC pollution of the drinking water sources in the LYR. An effective source tracking method for evaluating the contribution of antibiotic load from multiple diffuse pollution origins and identifying the high-risk contamination sources was established for antibiotic management and control.

Contrasting photoreactivity of β2-adrenoceptor agonists Salbutamol and Terbutaline in the presence of humic substances

The photodegradation reactions of two typical β2-adrenoceptor agonists, salbutamol (SAL) and terbutaline (TBL), alone, and in the presence of Aldrich humic acid (AHA) or Suwannee River fulvic acid (SRFA) were investigated by steady-state photolysis experiments, laser flash photolysis (LFP), kinetic modeling and quantum calculation. AHA and SRFA (2-20 mgC L^-1) accelerated the phototransformation of both SAL and TBL. For SAL, an inhibiting effect of oxygen on the photodegradation was observed that is fully consistent with the main involvement of excited triplet states of HS (³HS*). On the contrary, oxygen drastically enhanced the photodegradation of TBL showing that ³HS* were negligibly involved in the reaction. The involvement of singlet oxygen was also ruled out because of the low reaction rate constant measured between TBL and singlet oxygen. Quantum calculations were therefore performed to explore whether oxygenated radicals could through addition reactions explain the differences of reactivity of TBL and SAL in oxygen medium. Interestingly, calculations showed that in the presence of oxygen, the addition of phenoxyl on TBL led to the formation of adducts and to the loss of TBL while the same addition reaction on SAL partly regenerated the starting compound and at the end degraded SAL less efficiently. This study is of high relevance to understand the processes involved in SAL and TBL phototransformation and the photoreactivity of HS. Moreover, our findings suggest that TBL might be a promising probe molecule to delineate the role of oxygenated radicals.

Stability and toxicity studies for duloxetine and econazole on Spirodela polyrhiza using chiral capillary electrophoresis

Stability and toxicity studies for duloxetine and econazole were achieved using individual solutions and their mixtures. Stability of drugs racemates and enantiomers was investigated under abiotic and biotic conditions. Toxicity was evaluated for the first time on Spirodela polyrhiza. EC50 values were calculated for each individual drug and for their binary mixture. Real (not nominal) concentrations determined by Capillary Electrophoresis were employed in the calculations of toxicity parameters. The use of a 25 mM phosphate buffer (pH 3.0) with 1.5% S-β-CD as chiral selector at a temperature of 30 °C and a separation voltage of -20 kV enabled the simultaneous enantiomeric separation of duloxetine and econazole in 7.5 min with enantiomeric resolutions of 7.9 and 6.5, respectively. For individual solutions, decay percentages under abiotic conditions were higher for duloxetine (80%) than for econazole (60%), while in presence of Spirodela polyrhiza they increased for duloxetine but not for econazole. Econazole showed the highest decay percentages under abiotic or biotic conditions (100%) in binary mixtures. EC50 values for duloxetine and econazole enabled to include both drugs within the group of very toxic compounds although econazole showed a higher toxicity than duloxetine and the binary mixture.

pH-Dependent Uptake and Sublethal Effects of Antihistamines in Zebrafish (Danio rerio) Embryos

Reported off-target effects of antihistamines in humans draw interest in ecotoxicity testing of first- and second-generation antihistamines, the latter of which have fewer reported side effects in humans. Because antihistamines are ionizable compounds, the pH influences uptake and toxicity and thus is highly relevant when conducting toxicity experiments. Zebrafish embryo toxicity tests were performed with the 3 first-generation antihistamines ketotifen, doxylamine, and dimethindene and the 2 second-generation antihistamines cetirizine and levocabastine at pH 5.5, 7.0, and 8.0. We detected effects on survival, phenotype, swimming activity, and heart rate for 4 antihistamines with the exception of levocabastine, which did not show any lethal or sublethal effects. When compared to lethal concentrations, effect concentrations neither of phenotype malformation nor of swimming activity or heart rate deviated by more than a factor of 10 from lethal concentrations, indicating that all sublethal effects were fairly nonspecific. First-generation antihistamines are weak bases and showed decreasing external effect concentrations with increasing neutral fraction, accompanied by increased uptake in the fish embryo. As a result, internal effect concentrations were independent from external pH. The pH-dependent toxicity originates from speciation-dependent uptake, with neutral species taken up in higher amounts than the corresponding ionic species. Cetirizine, which shifts from a zwitterionic to an anionic state in the measured pH range, did not show any pH-dependent uptake or toxicity. Environ Toxicol Chem 2019;00:1-11. © 2019 SETAC.

Experiments and numerical simulation on the degradation processes of carbamazepine and triclosan in surface water: A case study for the Shahe Stream, South China

We examined the occurrence and fate of pharmaceuticals and personal care products in surface water by combining laboratory experiments with numerical simulations. The degradation processes of two typical PPCPs (triclosan and carbamazepine) collected from the Shahe Stream were studied. Hydrolysis, biodegradation, and photolysis were the three major routes of triclosan (TCS) and carbamazepine (CBZ) degradation. A central composite design method was used to investigate the effects of related natural parameters (including pH, dissolved oxygen, salinity, temperature, light intensity, and humic acid) on the TCS and CBZ degradation processes in the laboratory. Our results showed that the main degradation pathway of CBZ and TCS was direct photolysis during the daytime and that the maximal biodegradation rates of CBZ and TCS occurred at 22 °C when the optimum temperature function was used. Based on our experimental results, the observed degradation of CBZ and TCS followed pseudo-first-order kinetics, and the degradation kinetic equations under the influence of multiple natural parameters were established with estimated average degradation rate constants of 1.2452E-7 s^-1 and 3.1260E-5 s^-1 for CBZ and TCS, respectively. The degradation rate constants were incorporated into a one-dimensional, simply integrated hydrodynamic and water quality model. The proposed numerical model was applied to depict the transportation and transformation of CBZ and TCS in surface water and was validated by observational data from the Shahe Stream. The results showed that our model reproduced the observed patterns of CBZ and TCS concentrations reasonably, with slight overestimations compared to the observed data; the relative errors between the simulated and the observed concentrations were 5.85%-6.82% for CBZ and -156.85%--7.18% for TCS. According to our simulation, the spatial distribution of TCS in surface water was determined by biochemical degradation processes that were most affected by temperature under natural conditions; in contrast, the distribution of CBZ was largely controlled by diffusion.

Sub-lethal effects induced by a mixture of different pharmaceutical drugs in predicted environmentally relevant concentrations on Lithobates catesbeianus (Shaw, 1802) (Anura, ranidae) tadpoles

The increasing consumption of medications by humans has negative effects such as the increased disposal of these compounds in the environment. Little is known about how the disposal of a "drug mix" (DM) in aquatic ecosystems can affect their biota. Thus, we evaluated whether the exposure of Lithobates casteibeianus tadpoles to a DM composed of different medication classes (antibiotic, anti-inflammatory, antidepressant, anxiolytic, analgesic, and antacid drugs)-at environmentally relevant concentrations-may change their oral morphology, trigger behavioral disorders, and have mutagenic effects on erythrocyte cells. Based on our data, animals exposed to the DM showed changes in mandibular sheath pigmentation, dentition, and swimming activity, as well as atypical behavior in the social aggregation test [with co-specific and interspecific (Physalaemus cuvieri) individuals] and antipredatory defensive response deficit (chemical stimulus from Odonata larvae), after 15 exposure days. The mutagenic analysis revealed higher frequency of nuclear abnormalities in the erythrocytes of tadpoles exposed to the DM (e.g., multilobulated, blebbed, kidney-shaped, notched nucleus, binuclear, and micronucleated erythrocytes). Given the chemical complexity of the DM, we assumed that several organic functions may have been affected, either by the isolated, synergistic, antagonistic, or additive action of DM compounds. Finally, our study confirms the toxicological potential of DM in L. catesbeianus tadpoles, with emphasis to impacts that can affect the fitness of individuals and their natural populations. Thus, we suggest that more attention should be given to the disposal of medications in the environment and reinforce the need of improving water and sewage treatment systems.

The assessment of the eco-toxicological effect of gabapentin on early development of zebrafish and its antioxidant system

Gabapentin (GAB) is an emerging contaminant that is frequently detected in water bodies across the globe. The present study used zebrafish as a model organism to investigate the effects of GAB on the early development of zebrafish and on its antioxidant system. Acute toxicity tests indicated that the 96 h LC50 value of GAB for zebrafish embryos was 59.9 g L-1. Further, it was observed that GAB causes malformation of embryos such as hemagglutination and pericardial edema. Compared to the control group, a significant enhancement (p < 0.05) of heartbeat rates was found at GAB concentrations exceeding 50 mg L-1, while the swimming frequency was clearly increased upon exposure to GAB at a concentration of 100 mg L-1 (p < 0.05). Additionally, the development of the zebrafish embryo was also negatively impacted after exposure to GAB as demonstrated by significantly decreased body lengths. Exposure to GAB at concentrations exceeding 50 mg L-1 significantly influenced the development of zebrafish, leading to malformation of organs and abnormal movements. Although no significant developmental effects of GAB were observed at environmentally relevant concentrations (0.1 and 10 μg L-1), further research about the antioxidant system confirmed that severe oxidant injury happened inside the organisms. catalase (CAT), lactate dehydrogenase (LDH), glutathione S-transferase (GST), glutathione (GSH) and the ability of inhibition of hydroxyl radicals (IHR) were used as biomarkers in the present study to illustrate GAB toxicity at environmentally relevant concentrations. The results showed that activities of CAT, LDH and GST as well as IHR were all elevated after GAB exposure, which proved that ROS were formed in the body as derived from GAB exposure. Among all of these biomarkers, CAT was the most sensitive one to evaluate the influence of GAB, and showed a significant increase even at a very low exposure concentration (0.1 μg L-1).

Investigation of pharmaceutically active compounds in an urban receiving water: Occurrence, fate and environmental risk assessment

Pharmaceutically active compounds (PhACs) recently have been recognized to constitute a health risk for aquatic ecosystems. The major pathways of PhACs to enter the aquatic environment are excretion and discharge of effluents through sewage treatment plants (STPs). The occurrence, bioaccumulation and risk assessment of lipophilic PhACs, including erythromycin, ketoconazole, indomethacin, diclofenac, gemfibrozil, bezafibrate, propranolol, carbamazepine, sertraline and 17α-ethinylestradiol were investigated in a river that receives effluents from STP. The results indicate that the PhACs were extensively existed in fish, sediment, suspended particulate matter (SPM), colloidal phase (5 kDa to 1 µm) and truly dissolved phase (< 5 kDa) water, with total concentration of ten PhACs (Σ₁₀PhACs) of ND-19.6 ng/g, 7.3-11.2 ng/g, 25.3-101.5 ng/g, 10.1-27.7 ng/L and 67.0-107.6 ng/L, respectively. The Σ₁₀PhACs for particulate and water samples collected from STP's outfall site were higher than those collected from upstream and downstream, indicating that the STP is an important PhACs source of river. However, the Σ₁₀PhACs in sediment showed no significant statistical differences in the sampling area, and which was 3.5-9.5 times lower than those in SPM samples. The colloidal phase contributed 2.5-28.5% of erythromycin, 5.8-45.6% of ketoconazole, 8.4-32.2% of indomethacin, 7.0-21.4% of diclofenac, 11.6-36.9% of gemfibrozil, 10.2-45.9% of bezafibrate, 5.9-16.8% of propranolol, 1.9-11.1% of carbamazepine and 1.1-23.8% of sertraline in the aquatic environment. This suggests that aquatic particulates (e.g., colloids and SPM) maybe an important carrier for PhACs in the aquatic system. In general, the Σ₁₀PhACs in the tissues of fish were in order as follows: kidney > brain > liver > gill > muscle. Based on truly dissolved concentrations of PhACs in the water, bioaccumulation factors were between 3.7 and 2727.3 in the fish tissues, sertraline exhibited bioaccumulation potential. In all the risk assessments, erythromycin could cause most harmful adverse health effects for the most sensitive algae group based on the acute and chronic data. In addition, the risk quotient values for diclofenac toward fish were higher than 1. These results indicate that the PhACs pose a potential risk to the aquatic organisms, especially for chronic risk.

Prevalence of selected pharmaceuticals in surface water receiving untreated sewage in northwest Pakistan

This study investigated the occurrence of four non-steroidal anti-inflammatory drugs (NSAIDs) and four benzodiazepines/anti-depressants (ADs) in municipal wastewater in Mardan city, Pakistan, and in River Kabul and River Indus receiving untreated sewage. Liquid chromatography with a triple quadrupole tandem mass spectrometry (LC-MS/MS) was used for the analysis of paracetamol, diclofenac, ibuprofen, and codeine (NSAIDs) and diazepam, bromazepam, lorazepam, and temazepam (ADs). Except codeine and lorazepam, all the target compounds were observed in sewage and surface water in various concentrations. In sewage, paracetamol was found at the higher end (32.4 μg/L) of the reported ranges in literature for other countries. Results of river samples showed that the target compounds were usually lower in concentration than the respective EC₅₀ values for aquatic organisms. However, the levels for paracetamol and ibuprofen were critical depicting the consequence of untreated disposal. Environmental risk assessment by estimating the risk quotient (RQ) as the ratio of measured environmental concentration and predicted no-effect concentration showed medium to high (RQ > 1 and 0.1 < RQ < 1) risk from paracetamol and ibuprofen to aquatic organisms in River Kabul and Kalpani stream, Pakistan.

Abiotic degradation and environmental toxicity of ibuprofen: Roles of mineral particles and solar radiation

The growing medical and personal needs of human populations have escalated release of pharmaceuticals and personal care products into our natural environment. This work investigates abiotic degradation pathways of a particular PPCP, ibuprofen, in the presence of a major mineral component of soil (kaolinite clay), as well as the health effects of the primary compound and its degradation products. Results from these studies showed that the rate and extent of ibuprofen degradation is greatly influenced by the presence of clay particles and solar radiation. In the absence of solar radiation, the dominant reaction mechanism was observed to be the adsorption of ibuprofen onto clay surface where surface silanol groups play a key role. In contrast, under solar radiation and in the presence of clay particles, ibuprofen breaks down to several fractions. The decay rates were at least 6-fold higher for irradiated samples compared to those of dark conditions. Toxicity of primary ibuprofen and its secondary residues were tested on three microorganisms: Bacillus megaterium, Pseudoaltermonas atlantica; and algae from the Chlorella genus. The results from the biological assays show that primary PPCP is more toxic than the mixture of secondary products. Overall, however, biological assays carried out using only 4-acetylbenzoic acid, the most abundant secondary product, show a higher toxic effect on algae compared to its parent compound.

The effect of hydraulic retention time in onsite wastewater treatment and removal of pharmaceuticals, hormones and phenolic utility substances

Micropollutants such as pharmaceuticals, hormones and phenolic utility chemicals in sewage water are considered to be an emerging problem because of increased use and observed adverse effects in the environment. The study provides knowledge on the removal efficiency of micropollutants with a range of physical and chemical properties in three commercially available onsite wastewater treatment facilities (OWTFs), tested on influent wastewater collected from 2500 person equivalents in Bildchen, Germany. A longer hydraulic retention time would in theory be expected to have a positive effect, and this study presents results for three different OWTFs in full-scale comparable tests under natural conditions. A range of 24 different pharmaceuticals, five phenols and three hormones were analyzed. Flow-proportional consecutive sampling was performed in order to determine the removal efficiency. Twenty-eight substances were detected in the effluent wastewater out of 32 substances included. Average effluent concentrations of Simvastatin, Estrone, Estradiol and Ethinylestradiol were above the indicative critical-effect concentration of pharmacological effect on fish in all facilities. Average effluent concentrations of both Diclofenac and Estradiol were higher than the Environmental Quality Standards applied in Sweden (190-240 times and 9-35 times respectively). The removal efficiency of micropollutants was high for substances with high logK_ow, which enhance the adsorption and removal with sludge. Low removal was observed for substances with low logK_ow and acidic characteristics, and for substances with stabilizing elements of the chemical structure. Facilities that use activated sludge processes removed hormones more efficiently than facilities using trickling filter treatment technique. Moreover, longer hydraulic retention time increased the removal of pharmaceuticals, hormones, turbidity and total nitrogen. Removal of Caffeine, Ibuprofen, Estrone, Naproxen and Estradiol, was strongly correlated to the sludge and particles removal. Thus, the efficiency of the tested OWTFs could be improved by adjusting the technical methods and increasing the hydraulic retention time.

Quantification of more than 150 micropollutants including transformation products in aqueous samples by liquid chromatography-tandem mass spectrometry using scheduled multiple reaction monitoring

A direct injection, multi residue analytical method separated in two chromatographic runs was developed utilizing scheduled analysis to simultaneously quantify 154 compounds, 84 precursors and 70 transformation products (TPs)/metabolites. Improvements in the chromatographic data quality, sensitivity and reproducibility were achieved by scheduling the analysis of each analyte into pre-determined retention time windows. This study shows the influence of the scan time on the dwell time and the number of data points per peak as well as the effect on the precision of analysis. Lowering the scan time decreased dwell time to a minimal value, however, this had no negative effects on the precision. Increasing the number of data points per peak by decreasing the scan time led to more accurate peak shapes. A final set of parameters was chosen to obtain a minimum of 10 data points per peak to guarantee accurate peak shapes and thus reproducibility of analysis. A validation of the method was performed for different water matrices yielding very good linearity for all substances, with limits of quantification mainly in the lower to mid ng/L-range and recoveries mainly between 70 and 125% for surface water, bank filtrate as well as influents and effluents of wastewater treatment plants. The analysis of environmental samples and wastewater revealed the occurrence of selected precursors and TPs in all analyzed matrices: 95% of the compounds in the target list could be quantified in at least one sample. The relevance of TPs and metabolites such as valsartan acid and clopidogrel acid was also confirmed by their detection in all aqueous matrices. Wastewater indicators such as acesulfame and diclofenac were detected at elevated concentrations as well as substances such as oxipurinol which so far were not in the focus of monitoring programs. The developed method can be used for rapid analysis of various water matrices without any sample enrichment and can aid the assessment of water quality and water treatment processes.

Metformin, an Anthropogenic Contaminant of Seidlitzia rosmarinus Collected in a Desert Region near the Gulf of Aqaba, Sinai Peninsula

A phytochemical investigation of Seidlitzia rosmarinus collected along the shoreline of the Gulf of Aqaba in the remote southern desert region of the Sinai peninsula has revealed the presence of the registered drug metformin (4). However, analysis of the ¹⁴C content revealed the drug to be an anthropogenic contaminant. Consequently, natural product researchers should be aware that compounds isolated from plants might originate from environmental contamination rather than biosynthesis. The new natural product N-(4-hydroxyphenylethyl)-α-chloroferuloylamide was isolated as a mixture of the E and Z isomers along with a number of other well-established secondary metabolites.

Long-term exposure of polychaetes to caffeine: Biochemical alterations induced in Diopatra neapolitana and Arenicola marina

In the last decade studies have reported the presence of several pharmaceutical drugs in aquatic environments worldwide and an increasing effort has been done to understand the impacts induced on wildlife. Among the most abundant drugs in the environment is caffeine, which has been reported as an effective chemical anthropogenic marker. However, as for the majority of pharmaceuticals, scarce information is available on the adverse effects of caffeine on marine benthic organisms, namely polychaetes which are the most abundant group of organisms in several aquatic ecossystems. Thus, the present study aimed to evaluate the biochemical alterations induced by environmentally relevant concentrations of caffeine on the polychaete species Diopatra neapolitana and Arenicola marina. The results obtained demonstrated that after 28 days exposure oxidative stress was induced in both species, especially noticed in A. marina, resulting from the incapacity of antioxidant and biotransformation enzymes to prevent cells from lipid peroxidation. The present study further revealed that D. neapolitana used glycogen and proteins as energy to develop defense mechanisms while in A. marina these reserves were maintained independently on the exposure concentration, reinforcing the low capacity of this species to fight against oxidative stress.

Characterization of Pharmaceuticals and Personal Care products in hospital effluent and waste water influent/effluent by direct-injection LC-MS-MS

Two USEPA Regional Laboratories developed direct-injection LC/MS/MS methods to measure Pharmaceuticals and Personal Care Products (PPCPs) in water matrices. Combined, the laboratories were prepared to analyze 185 PPCPs (with 74 overlapping) belonging to more than 20 therapeutical categories with reporting limits at low part-per-trillion. In partnership with Suffolk County in NY, the laboratories conducted PPCP analysis on 72 samples belonging to 4 Water Systems (WS). Samples were collected at different stages of the WS (hospital effluents, WWTP influents/effluents) to assess PPCP relevance in hospital discharges, impact on WWTP performance and potential ecological risk posed by analytes not eliminated during treatment. Major findings include: a) acceptable accuracy between the two laboratories for most overlapping PPCPs with better agreement for higher concentrations; b) the measurement of PPCPs throughout all investigated WS with total PPCP concentrations ranging between 324 and 965 μg L(-1) for hospital effluent, 259 and 573 μg L(-1) for WWTP influent and 19 and 118 μg L(-1) for WWTP effluent; c) the variable contribution of hospital effluents to the PPCP loads into the WWTP influents (contribution ranging between 1% (WS-2) and 59% (WS-3); d) the PPCP load reduction after treatment for all WS reaching more than 95% for WS using activated sludge processes (WS-2 and WS-4), with inflow above 6500 m(3) d(-1), and having a lower percentage of hospital effluent in the WWTP influent; e) the relevance of four therapeutical categories for the PPCP load in WWTP effluents (analgesics, antidiabetics, antiepileptics and psychoanaleptics); and f) the risk quotients calculated using screening-level Predicted Non Effect Concentration indicate that WWTP effluents contain 33 PPCPs with potential medium to high ecological risk. To our knowledge no other monitoring investigation published in the scientific literature uses direct-injection methods to cover as many PPCPs and therapeutical categories in different types of WS.

Membrane bioprocesses for pharmaceutical micropollutant removal from waters

The purpose of this review work is to give an overview of the research reported on bioprocesses for the treatment of domestic or industrial wastewaters (WW) containing pharmaceuticals. Conventional WW treatment technologies are not efficient enough to completely remove all pharmaceuticals from water. Indeed, these compounds are becoming an actual public health problem, because they are more and more present in underground and even in potable waters. Different types of bioprocesses are described in this work: from classical activated sludge systems, which allow the depletion of pharmaceuticals by bio-degradation and adsorption, to enzymatic reactions, which are more focused on the treatment of WW containing a relatively high content of pharmaceuticals and less organic carbon pollution than classical WW. Different aspects concerning the advantages of membrane bioreactors for pharmaceuticals removal are discussed, as well as the more recent studies on enzymatic membrane reactors to the depletion of these recalcitrant compounds.

Eco-directed sustainable prescribing: feasibility for reducing water contamination by drugs

Active pharmaceutical ingredients (APIs) from the purchase and use of medications are recognized as ubiquitous contaminants of the environment. Ecological impacts can range from subtle to overt--resulting from multi-generational chronic exposure to trace levels of multiple APIs (such as in the aquatic environment) or acute exposure to higher levels (such as with wildlife ingestion of improperly discarded waste). Reducing API entry to the environment has relied solely on conventional end-of-pipe pollution control measures such as wastewater treatment and take-back collections of leftover, unwanted drugs (to prevent disposal by flushing to sewers). An exclusive focus on these conventional approaches has ignored the root sources of the problem and may have served to retard progress in minimizing the environmental footprint of the healthcare industry. Potentially more effective and less-costly upstream pollution prevention approaches have long been considered imprudent, as they usually involve the modification of long-established norms in the practice of clinical prescribing. The first pollution prevention measure to be proposed as feasible (reducing the dose or usage of certain select medications) is followed here by an examination of another possible approach--one that would rely on the excretion profiles of APIs. These two approaches combined could be termed eco-directed sustainable prescribing (EDSP) and may hold the potential for achieving the largest reductions in API entry to the environment--largely by guiding prescribers' decisions regarding drug selection. EDSP could reduce API entry to the environment by minimizing the need for disposal (as a consequence of avoiding leftover, unwanted medications) and reducing the excretion of unmetabolized APIs (by preferentially prescribing APIs that are more extensively metabolized). The potential utility of the Biopharmaceutics Drug Disposition Classification System (BDDCS) is examined for the first time as a guide for API prescribing decisions by revealing relative API quantities entering sewage via excretion.