Determination of the psychoactive drugs carbamazepine and diazepam in hospital effluent and identification of their metabolites

Abstract

This study addresses the occurrence of carbamazepine and diazepam and their metabolites in the wastewater of the University Hospital (HUSM) of the Federal University of Santa Maria, RS-Brazil. Samples were collected from three sampling points of the sewage treatment system: point A ('emergency effluent'), point B ('general effluent') and point C ('water course-receptor'). Eight metabolites were identified: carbamazepine-10-11-epoxide, 10-dihydro-carbamazepine, 2-OH-carbamazepine, iminoquinone, acridone, nordiazepam, oxazepam and temazepam. The mean concentrations in the emergency, general effluent and water course-receptor were as follows: 433.0 ± 4.7, 349.0 ± 5.0 and 485.0 ± 5.6 ng L(-1), for carbamazepine and 550.0 ± 4.3, 441.0 ± 7.9 and 586.6 ± 9.3 ng L(-1), for diazepam, respectively. Liquid chromatography with electrospray ionization tandem mass spectrometry (LC-QqLIT-MS) proved to be a method fit-to-purpose. The determination of carbamazepine and diazepam, and the identification of active metabolites showing environmental persistence (carbamazepine-10-11-epoxide, nordiazepam and oxazepam) revealed the need for a more effective treatment of the HUSM effluent. As far as we know, no similar study has been carried out on the wastewater of Brazilian hospitals.

Studies on photodegradation process of psychotropic drugs: a review

“…Increasing consumption of psychotropic drugs entails their release to the environment through various routes, for instance with patients’ excretions (parent compounds, metabolites, and their conjugates), the pharmaceutical industry, hospital wastewater, medical waste, or agriculture (Evgenidou et al 2015 ; Silva et al 2015 ). In the case of hospital effluents, the presence of psychiatric pharmaceuticals, as well as their metabolites, is a well-known problem: carbamazepine, its derivatives, and sulpiride were found in the effluents of Takatsuki City hospital in Japan (Azuma et al 2016 ), and diazepam, carbamazepine, and their metabolites were detected in effluents from Santa Maria hospital (Brasil) (de Almeida et al 2015 ). Similarly, psychotropic drugs were found in effluents from Beijing hospital (China, 22 substances) (Yuan et al 2013 ) and from two hospitals in northern Italy (Verlicchi et al 2012 ).…”

Characterization, Source and Risk of Pharmaceutically Active Compounds (PhACs) in the Snow Deposition Near Jiaozhou Bay, North China

“…Nitrazepam was found in the range of 0.21-0.35 ng/L with a high frequency of detection (100%). Nitrazepam was previously detected at a high mean concentration of 441 ng/L in the wastewater from the University Hospital of Santa Maria [51], which can explain its presence.…”

Análise da presença de benzodiazepínicos no ambiente aquático e o possível cenário de impacto ambiental / Analysis of the presence of benzodiazepines in the aquatic environment and the possible environmental impact scenario

“…Na tabela 1 são apresentados dados de três estudos realizados no Brasil a partir de 2014 (PIVETTA et al 2020;ALMEIDA et al, 2015;FERREIRA, 2014) Com relação à concentração dos benzodiazepínicos nos ambientes estudados, Almeida et al (2015) relatam 625,8 ng/L de diazepam em águas provenientes de esgoto hospitalar, enquanto uma concentração menor deste fármaco (335,0 ng/L) foi encontrada por Ferreira (2014) Apesar de grande parte dos estudos analisarem a presença de benzodiazepínicos em amostras de água (afuentes, efluentes e rios), cinco artigos também descreveram a presença destes fármacos em amostras de lodo, que são misturas de terra e matéria orgânica presente no fundo do ambiente aquático (JELIC et al, 2011;JELIC et al, 2012;MATROIANNI et al, 2013;SUBEDI et al, 2015;LEI et al, 2021). Nestas amostras, a maior concentração encontrada foi de lorazepam (15 ng/g) (SUBEDI et al, 2015), e a menor concentração de midazolam (0,18 ng/g) (LEI et al, 2021) (tabela 2).…”