Hazardous drugs (NIOSH's list-group 1) in healthcare settings: Also a hazard for the environment?

Application of a multifunctional chemotherapy infusion device for reducing antineoplastic drug extravasation

Objective

This study aimed to address the challenges associated with antineoplastic drug extravasation during intravenous administration, through the development of a novel chemotherapy infusion device. A secondary objective was to mitigate associated risks to healthcare personnel, patients, caregivers and the environment.

Methods

A water-soluble fluorescent solution was used as a surrogate for antineoplastic chemotherapy agents to assess the potential for drug extravasation and the associated risks of occupational exposure during intravenous administration. The investigation identified risks related to drug extravasation, which informed the development of the novel infusion device.

Results

In experiment 1, conventional methods for replacing infusion bags resulted in drug extravasation during the second bag change across all procedures conducted by 9 operators. Specifically, extravasation was observed in 81 out of 90 procedures. In experiment 2, the newly designed multifunctional chemotherapy infusion device, which requires each infusion bag to be punctured only once, was used. Under these conditions, the same 9 operators performed 90 procedures, with extravasation occurring in only 2 instances.

Conclusion

The multifunctional chemotherapy infusion device facilitates the efficient administration of intravenous chemotherapy while addressing the issue of drug extravasation associated with traditional infusion devices during the delivery of antineoplastic drugs. This device effectively reduces the risk of occupational injuries among healthcare workers, reduces harm to patients and their caregivers, and mitigates environmental contamination.

Tailored Fibrils Approach via Ag(I).Peptidomimetic-Based Interface Design: Efficient Encapsulation of Diverse Active Pharmaceutical Ingredients in Wastewater Remediation during Effluent Treatment Plant (ETP) Processing

Pharmaceutical pollution in wastewater poses significant environmental and public health concerns worldwide. Chloramphenicol (CP), an antibiotic widely used in medical and veterinary applications, is among the active pharmaceutical ingredients (APIs) frequently detected in aquatic environments. This study explored the encapsulation of chloramphenicol API in contaminated wastewater using rationally designed fibrations based on the silver metal ion-directed self-assembly of fibrillator-type self-assembling ligand (ANS-3). We further investigated the removal of various commonly prescribed drugs, including antibiotics such as β-lactam (amoxicillin), fluoroquinolone (ciprofloxacin), aminoglycoside (neomycin), and tetracycline; antiparasitic agents with antiprotozoal properties (praziquantel and metronidazole); nonsteroidal anti-inflammatory drugs (NSAIDs) such as phenylbutazone and ketoprofen; the vasodilator isoxsuprine; amphiphilic antidepressants (amitriptyline); and the antiviral drug amantadine. The findings validated the crucial influence of polar multifunctionality and structural complexity in enhancing interactions with Ag.ANS-3 matrix, emphasizing its potential for efficient drug sequestration. First, picolinic acid (PA) and phenylalanine (F) were evaluated for their ability to form fibrillar structures, and their morphological characterization revealed well-defined fibrillar networks with varying degrees of porosity and interconnectivity. Then, the strategic inclusion of leucine in synthesizing ANS-3 facilitated the formation of robust fibrillar networks, employing its hydrophobic interactions to drive the self-assembly process. Finally, the encapsulation of APIs was evaluated using Ag(I) metal ion-driven ANS-3 based self-assembled nanofibrous material. This research contributes to the development of innovative physicochemical wastewater treatment strategies for environmental remediation and validates the importance of rational design in encapsulation-based wastewater remediation technologies.

Mechanisms underlying dose-limiting toxicities of conventional chemotherapeutic agents

Dose-limiting toxicities (DLTs) are severe adverse effects that define the maximum tolerated dose of a cancer drug. In addition to the specific mechanisms of each drug, common contributing factors include inflammation, apoptosis, ion imbalances, and tissue-specific enzyme deficiencies. Among various DLTs are bleomycin-induced pulmonary fibrosis, doxorubicin-induced cardiomyopathy, cisplatin-induced nephrotoxicity, methotrexate-induced hepatotoxicity, vincristine-induced neurotoxicity, paclitaxel-induced peripheral neuropathy, and irinotecan, which elicits severe diarrhea. Currently, specific treatments beyond dose reduction are lacking for most toxicities. Further research on cellular and molecular pathways is imperative to improve their management. This review synthesizes preclinical and clinical data on the pharmacological mechanisms underlying DLTs and explores possible treatment approaches. A comprehensive perspective reveals knowledge gaps and emphasizes the need for future studies to develop more targeted strategies for mitigating these dose-dependent adverse effects. This could allow the safer administration of fully efficacious doses to maximize patient survival.

Pharmaceuticals in the Environment: A hospital pharmacy's perspective

Drugs do not disappear once they have been excreted. In fact, 992 active principles have already been measured in the different environmental matrices. A recent study led by scientists from the University of York has studied the presence of drugs in the rivers of more than 100 different countries, showing that environmental contamination by pharmaceuticals is a global issue and that, concentrations found are frequently harmful to the environment. In this work, we have tried to briefly expose the problem of environmental contamination with medicines, but above all, we have tried to address the possible solutions, with a perspective from the field of hospital pharmacy. This is a very complex matter (a wicked problem), since it involves multiple stakeholders with different visions and interests regarding medicines. In order to find solutions, we will probably need to act at all steps of the drug's life cycle. Until now, health professionals have been part of the problem. It is time for us to be part of the solution.

[Translated article] Pharmaceuticals in the environment: A hospital pharmacy perspective

Drugs do not disappear once they have been excreted. In fact, 992 active principles have already been measured in the different environmental matrices. A recent study led by scientists from the University of York has studied the presence of drugs in the rivers of more than 100 different countries, showing that environmental contamination by pharmaceuticals is a global issue and that, concentrations found are frequently harmful to the environment. In this work, we have tried to briefly expose the problem of environmental contamination with medicines, but above all, we have tried to address the possible solutions, with a perspective from the field of hospital pharmacy. This is a very complex matter (a wicked problem), since it involves multiple stakeholders with different visions and interests regarding medicines. In order to find solutions, we will probably need to act at all steps of the drug's life cycle. Until now, health professionals have been part of the problem. It is time for us to be part of the solution.

Arginine Biosynthesis Mediates Wulingzhi Extract Resistance to Busulfan-Induced Male Reproductive Toxicity

Busulfan, an indispensable medicine in cancer treatment, can cause serious reproductive system damage to males as a side effect of its otherwise excellent therapeutic results. Its widespread use has also caused its accumulation in the environment and subsequent ecotoxicology effects. As a Chinese medicine, Wulingzhi (WLZ) has the effects of promoting blood circulation and improving female reproductive function. However, the potential effects of WLZ in male reproduction and in counteracting busulfan-induced testis damage, as well as its probable mechanisms, are still ambiguous. In this study, busulfan was introduced in a mouse model to evaluate its production of the testicular damage. The components of different WLZ extracts were compared using an untargeted metabolome to select extracts with greater efficacy, which were further confirmed in vivo. Here, we demonstrate abnormal spermatogenesis and low sperm quality in busulfan-injured testes. The WLZ extracts showed a strong potential to rehabilitate the male reproductive system; this effect was more prominent in room-temperature extracts. Additionally, both water and ethanol WLZ extracts at room temperature alleviated various busulfan-induced adverse effects. In particular, WLZ recovered spermatogenesis, re-activated arginine biosynthesis, and alleviated the increased oxidative stress and inflammation in the testis, ultimately reversing the busulfan-induced testicular injury. Collectively, these results suggest a promising approach to protecting the male reproductive system from busulfan-induced adverse side effects, as well as those of other similar anti-cancer drugs.

Predicted concentrations of antineoplastic drugs in the aquatic environment: The case of Ría de Vigo (NW, Spain)

The European Medicines Agency (EMA) mandates Environmental Risk Assessments (ERAs) since 2006 to determine potential risks of new marketed medicines. Drugs with a Predicted Environmental Concentration (PEC) in inland surface waters exceeding 0.01 μg L-1 require further environmental risk assessment. PEC may be refined based on prevalence data and/or based on the treatment regimen. In this study, based on EMA regulations, refined PEC of 108 antineoplastic drugs in coastal waters were determined based on the consumption in a coastal health area during 2021, identifying six drugs with potential environmental risk in surface waters (hydroxyurea, capecitabine, abiraterone, ibrutinib, imatinib and 5-fluorouracil) and two in marine ecosystem (hydroxyurea and capecitabine). Comparison of these refined PECs with data from marketing laboratories revealed significant disparities, suggesting the need for regular updates, especially with changes in drug indications or financing. Notably, the identified drugs are not yet on the main reference lists of emerging contaminants.

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.

A New Sensitive Fluorescence Sensor and Photocatalyst for Determination and Degradation of Sodium Valproate Using g-C3N4@Fe3O4@CuWO4 Nanocomposite and FCCD Optimization

In this research, carbon nitride nanocomposite coupled with Fe3O4 and CuWO4 was thermally synthesized and characterized by different techniques, including SEM, TEM, XRD, EDX, and FTIR. Due to sodium valproate's luminescence quenching of this nanocomposite, a reliable, accurate, sensitive, selective, and fast-acting sodium valproate assay was proposed. Optimization of this fluorescent sensor was carried out by the FCCD approach. In the optimum conditions, the plot of sodium valproate concentration versus nanocomposite fluorescence emission showed a linear response (R2 = 0.9918), with a range of 0-0.55 µM, the limit of detection (S/N = 3) equal to 0.85 nM and limit of qualification equal to 2.82 nM. Photocatalytic activity of g-C3N4@Fe3O4@CuWO4 (40%) nanocomposite exhibited a good potency to sodium valproate degradation. Active species of degradation including superoxide radicals, holes, and hydroxyl radicals were investigated using ammonium oxalate, benzoquinone, and 2-propanol to identify the mechanism of photodegradation action. The activity of benzoquinone in the photocatalytic process led to a reduction in the rate of analyte degradation, which indicates the prominent role of superoxide radicals compared to other species in the degradation process. The degradation rate of the analyte using the Fenton reagent was found to be around two times more than in the Fenton reagent-free process. The possible mechanism for the fluorescence sensor and photocatalytic degradation reaction was also discussed.

Analyzing the potential environmental impact of NIOSH list of hazardous drugs (group 2)

For the first time, several pharmaceuticals have been defined as priority substances in the new proposal of the revision of the Water Framework Directive (WFD). Consequently, environmental quality standards have been determined for several drugs. This is the case with the antiepileptic carbamazepine, which is considered as hazardous in healthcare settings by The National Institute for Occupational Safety and Health (NIOSH). This organism considers as such drugs that have shown teratogenicity, carcinogenicity, genotoxicity or other developmental, reproductive, or organ toxicity at low doses in studies with animals or humans. This study has been focused on the non-carcinogenic drugs classified in group 2, and their presence in the environment. This group contains many different therapeutic agents such as antineoplastics, psychoactive drugs, immunosuppressants and antivirals, among others. Of the 116 drugs included in the list, 26 have been found in aquatic environmental matrices. Certain drugs have received most attention (e.g., the antiepileptic carbamazepine, progesterone and the antidepressant paroxetine) while others completely lack environmental monitoring. Carbamazepine, fluconazole, paroxetine and warfarin have been found in invertebrates' tissues, whereas carbamazepine, oxazepam and paroxetine have been found in fish tissues. The main aim of the NIOSH's hazardous drug list is to inform healthcare professionals about adequate protection measures to prevent occupational exposure to these pharmaceuticals. However, this list contains useful information for other professionals and researchers such as environmental scientists. The paucity of relevant environmental data of certain hazardous pharmaceuticals might be important to help in the prioritization of compounds that may demand further research.

Cu Nanoparticle-Decorated Boron-Carbon-Nitrogen Nanosheets for Electrochemical Determination of Chloramphenicol

In the present work, irregular Cu nanoparticle-decorated boron-carbon-nitrogen (Cu-BCN) nanosheets were successfully synthesized. A Cu-BCN dispersion was deposited on a bare glassy carbon electrode (GCE) to prepare an electrochemical sensor (Cu-BCN/GCE) for the detection of chloramphenicol (CAP) in the environment. Cu-BCN was characterized using high-resolution scanning transmission electron microscopy (HRSTEM), scanning electron microscopy (SEM), X-ray diffraction (XRD) analysis, and X-ray photoelectron spectroscopy (XPS). The performance of the Cu-BCN/GCE was studied using electrochemical impedance spectroscopy (EIS), and its advantages were proven by electrode comparison. Differential pulse voltammetry (DPV) was used to optimize the experimental conditions, including the amount of Cu-BCN deposited, enrichment potential, deposition time, and pH of the electrolyte. A linear relationship between the CAP concentration and current response was obtained under the optimized experimental conditions, with a wide linear range and a limit of detection (LOD) of 2.41 nmol/L. Cu-BCN/GCE exhibited high stability, reproducibility, and repeatability. In the presence of various organic and inorganic species, the influence of the Cu-BCN-based sensor on the current response of CAP was less than 5%. Notably, the prepared sensor exhibited excellent performance in real-water samples, with satisfactory recovery.