Adapting and applying common methods used in pharmacovigilance to the environment: A possible starting point for the implementation of eco-pharmacovigilance

Future Healthcare Workers and Ecopharmacovigilance: Where Do We Stand?

With the rapid development of the pharmaceutical industry and constant growth of drug usage, ecopharmacovigilance (EPV) has emerged as a way of coping with and minimizing the effects that drugs have on the environment. EPV concerns and describes unwanted effects that the use of a specific drug could have on the environment. The US, EU and Cananda are the improving position of EPV, both in legislation and practice. EPV requires further development as previous studies have shown that neither the general population nor healthcare professionals have enough knowledge about the subject. Improving awareness and knowledge about this topic is a key task for the future of EPV. The main objective was to determine students' level of knowledge about ecopharmacovigilance and to examine ways of storing and disposing of unused and expired drugs. Students' knowledge and habits were examined by a previously published survey. The survey contains twenty questions divided into three parts and the possibility of writing an additional note. There was no difference in the level of knowledge between the students of different studies. Also, students who had a family member working as healthcare professional did not show a higher level of knowledge compared to the others. Pharmacy students had a greater intention to educate their environment about EPV when compared to students of the other studies. This is in the line with a previous study which showed that the general public expects that pharmacists and physicians educate them about EPV. Medicine and dental medicine students will become prescribers after finishing their studies, and as such, they should be informed about eco-directed sustainable prescribing (EDSP) as part of an EPV strategy. More than half of the participants reported good adherence to prescribers' instruction, which decreased the amount of unused drugs. Most of the students found that the drug expiration date was legible, but they did not check it often. In comparison with similar studies, Croatian students had more knowledge and better practices concerning EPV and drug disposal. Structured learning strategies and curriculum implementation for EPV are much needed for further raising awareness about the subject among healthcare professionals and the public.

Hazards of antiviral contamination in water: Dissemination, fate, risk and their impact on fish

Antiviral drugs are a cornerstone in the first line of antiviral therapy and their demand rises consistently with increments in viral infections and successive outbreaks. The drugs enter the waters due to improper disposal methods or via human excreta following their consumption; consequently, many of them are now classified as emerging pollutants. Hereby, we review the global dissemination of these medications throughout different water bodies and thoroughly investigate the associated risk they pose to the aquatic fauna, particularly our vertebrate relative fish, which has great economic and dietary importance and subsequently serves as a major doorway to the human exposome. Our risk assessment identifies eleven such drugs that presently pose high to moderate levels of risk to the fish. The antiviral drugs are likely to induce oxidative stress, alter the behaviour, affect different physiological processes and provoke various toxicological mechanisms. Many of the compounds exhibit elevated bioaccumulation potential, while, some have an increased tendency to leach through soil and contaminate the groundwater. Eight antiviral medications show a highly recalcitrant nature and would impact the aquatic life consistently in the long run and continue to influence the human exposome. Thereby, we call for urgent ecopharmacovigilance measures and modification of current water treatment methods.

Attitudes and opinions about ecopharmacovigilance from multi-disciplinary perspectives: a cross-sectional survey among academic researchers in China

As a promising upstream strategy to reduce the environmental loads of pharmaceutical emerging contaminants (PECs) through source control, ecopharmacovigilance (EPV) is concerned with the set of activities to identify, evaluate, understand, and prevent against diverse PEC-related problems, and has been accepted as a multi-disciplinary and multi-stakeholder system. This cross-sectional observational survey aimed to assess the attitudes and opinions about EPV from multi-disciplinary perspectives among Chinese academic professors from four main EPV-related disciplines including pharmacy, management, clinical medicine, and environmental and ecological science based on a self-developed questionnaire. Forty-two usable survey instruments were acquired. Results showed that the responding Chinese academic researchers from different disciplines expressed consistently positive attitudes and strong intentions for EPV, in spite of several disparities existing among disciplinary groups showing that pharmacy and medical researchers felt more certain of the environmental adverse effects of PECs, and researchers in pharmacy and environmental and ecological science were more interested in EPV. A multi-disciplinary consensus was achieved in regard to the types of key stakeholders in EPV practices including the pharmaceutical manufacturers, the public, the drug safety authority, hospitals, and the environmental protection agency. The main roles and responsibilities of each stakeholder identity in EPV practices were summarized based on the expert opinions.

Targeted eco-pharmacovigilance as an optimized management strategy for adverse effects of pharmaceuticals in the environment

From a perspective of drug administration, eco-pharmacovigilance (EPV) has been proposed as a new approach to prevent the environmental risks posed by pharmaceutical emerging contaminants. However, it is impracticable to practice unitary and rigor EPV process for all the pharmaceutical substances with complex and diversified chemical, biological or toxicological properties. We proposed the "targeted EPV" that is the science and activities associated with the targeted detection, evaluation, understanding, and prevention of adverse effects of high-priority hazardous pharmaceuticals in the environment, especially focusing on the control of main anthropogenic sources of pharmaceutical emission among key stakeholders in high-risk areas could be used as an optimized management strategy for pharmaceutical pollution. "Targeted EPV" implementation should focus on the targeted monitoring of the occurrence of high-priority pharmaceuticals in environmental samples, the targeted reporting of over-standard discharge, the targeted management for main emission sources, the targeted legislation and researches on high-priority pharmaceutical pollutants, as well as the targeted educational strategies for specific key populations.

Environmental knowledge, behaviors, and attitudes regarding caffeine consumption among Chinese university students from the perspective of ecopharmacovigilance

Caffeine is considered the most representative pharmaceutical emerging contaminant (PEC) because of its ubiquity, high environmental abundance, uncovered ecological risks, and its indicator property for anthropogenic environmental inputs of PECs. Ecopharmacovigilance (EPV) targeting caffeine has been proposed as an optimized measure for the control of caffeine pollution sources and the related anthropogenic behaviors from the perspective of pharmacy administration. This cross-sectional study was conducted to evaluate the environmental knowledge, behaviors, and attitudes regarding caffeine consumption among university students, one of the groups with high caffeine consumption, from an EPV perspective. Three hundred and seven usable survey instruments were acquired. The mean score for environmental knowledge about caffeine consumption was 3.66 out of a total of 7. The consumption frequency of caffeinated drinks, food, or drugs among student respondents was low. Throwing away in "household garbage" was an important disposal mechanism for unconsumed caffeinated products. Most students showed positive attitudes and strong intentions toward caffeine pollution control from the perspective of targeted EPV. These data suggested high acceptance of EPV program targeting caffeine among university students. However, more should be done to enhance their related knowledge, and some strengthening interventions for the effective removal of residual caffeine in garbage are needed.

Liver function monitoring: a prospective nested case-control study of Salvia miltiorrhiza polyphenol injection

Instructions for Salvia miltiorrhiza polyphenol injections indicate abnormal liver function as an occasional adverse reaction, but the incidence of this adverse drug reaction (ADR) has increased in recent years. We assessed S. miltiorrhiza polyphenol ADRs by performing a nested case-control study(NCCS) and meta-analysis. In the NCCS, 2633 patients receiving this treatment in the First Affiliated Hospital of Bengbu Medical College were enrolled. Logistic regression models found that in 58 (2.2%) patients experiencing abnormal liver function, the risk for liver dysfunction was associated with sulfa drug allergy (OR = 7.874, 95%CI (1.280, 48.447), P = 0.026), payment methods (OR = 0.106, 95%CI (0.012, 0.934), P = 0.043), duration of administration (OR = 0.922, 95%CI (0.862, 0.986), P = 0.017), cefathiamidine (OR = 0.441, 95%CI (0.216, 0.900), P = 0.025), human serum albumin (OR = 1.958, 95%CI (1.011, 3.789), P = 0.046), Dazhu Rhodiola injection (OR = 2.599, 95%CI (1.112, 6.070), P = 0.027), or reduced glutathione (OR = 0.394, 95%CI (0.188, 0.826), P = 0.014). Meta-analysis of reports on S. miltiorrhiza polyphenol ADRs in controlled trials and other observational studies included 676 patients, of which 17 (2.17%; 95%CI (0.0105, 0.0358)) presented with liver dysfunction; associated ADR risk factors included co-administration of other drugs. Our NCCS and meta-analysis had similar ADR incidence rates, which were higher than the rate in the drug instructions. This study provides guidance for assessing liver dysfunction risks associated with S. miltiorrhiza polyphenol injections.

Attitudes and Practice Regarding Disposal for Unwanted Medications among Young Adults and Elderly People in China from an Ecopharmacovigilance Perspective

Due to the expensive cost and uncertain effectiveness of environmental management options in eliminating pharmaceutical residues, recently, decreasing the emission of pharmaceutical pollutants from a drug administration perspective has been considered a hot area of research. As a kind of drug administration for the environment, ecopharmacovigilance (EPV) emphasizes the source control of pharmaceutical pollutants. Disposal of unwanted medicines has been considered as the easiest target for source control of pharmaceutical contamination. Here, we focused on public attitudes and practice regarding disposal of unwanted medicines from the EPV perspective among 365 Chinese university young adults and 206 elderly retirement home residents. The results showed that the majority of respondents had positive attitudes, but exhibited inadequate awareness and poor practice. In addition, the young-adult respondents were found to pay more attention to the environmental problems posed by pharmaceutical residues, and be more supportive of the EPV intervention predominantly performed by pharmaceutical industries and pharmacists. Therefore, it is urgent to establish the standard medicine disposal protocols and educate the general public on the best way for medication disposal under the principle of EPV in China, and efforts on environmentally-preferred drug disposal under EPV should target for the specific demographics.

Comparison of the occurrence of antibiotic residues in two rural ponds: implication for ecopharmacovigilance

As a well-accepted drug-administration strategy for the minimization of environmental risks posed by pharmaceutical residues, ecopharmacovigilance (EPV) needs to guard against and control the pharmaceutical pollution sources. However, the underlying routes by which pharmaceuticals reach the environment vary significantly under different scenes, so it is necessary to implement different EPV measures in different backgrounds. This study detected the occurrence of antibiotic residues in two ponds within a Chinese rural community; assessed their ecological risks; compared and analyzed the geographic and demographic information, as well as the antibiotic-related anthropogenic behaviors of residents living around ponds, in order to trace the main entrances of antibiotics into the water environment; and then propose the EPV measures according to rural conditions. The results showed that the pollution degree of antibiotic residues was different between two studied ponds, which was manifested by the different antibiotic types and levels in water samples. And the possible main sources of antibiotic pollution in the studied rural water environment might include the application of human excretions and animal manures as fertilizers on the farmland, antibiotic use and inappropriate disposal in the clinic, and the direct disposal of the leftover antibiotics. From the perspective of drug administration, we then identified some suggestions on EPV measures which could be taken under existing rural conditions, including encouraging eco-directed sustainable prescribing of antibiotics in human and animals, improving take-back collection of unused antibiotics, building monitoring mechanism for antibiotic residues in the natural environment, identifying high-priority antibiotic residues, and implementing targeted EPV.