Evaluation of the potential environmental risk from the destination of medicines: an epidemiological and toxicological study

Salgado, Mariana Alves Resende; Salvador, Mariana R.; Baldoni, André de Oliveira; Thomé, Ralph Gruppi; Santos, Hélio Batista dos

doi:10.1007/s40199-020-00383-4

Cited by 7 publications

(3 citation statements)

References 53 publications

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“…The population lacks information on the proper disposal of unused and expired medications, like in Saudi Arabia [18] and Turkey, for example, which is a situation of concern since a signi cant portion of the population has unused medications in their homes, [19] including antibiotics [18] . In Brazil, the general public has been disposing of medicines in household waste containers and in other inappropriate ways, including ushing them down the toilet or sink [20] , practices also reported in several other parts of the world [21] .…”

Section: Discussionmentioning

confidence: 99%

Disposal of household medications: practices and attitudes of pharmacists when dispensing medication

Michelin

Bonifácio

Nagata³

et al. 2023

Preprint

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Background: Discarding pharmaceuticals in the garbage or into the sewage system are still the most common methods in many countries. This study aims to investigate the guidance provided by pharmacists to customers on the disposal of unused and expired household medications in São Paulo State, Brazil. Method: The study population consisted of 630 pharmacists from the State of São Paulo, the majority were women under 60 years old, who work in pharmacies that dispense commercial drugs. They answered an online questionnaire with questions composed in three blocks: demographic, work, and academic information on the pharmacist; the disposal of household medications; and the reverse logistics of these medications. An invitation to participate in the questionnaire was made via WhatsApp, individually and collectively. Inferential statistics were performed using the chi-square test, and were considered significant when p<0.05%. Results: Among the participating pharmacists, 56 (8.89%) and 216 (34.28%), respectively, stated that they rarely or never orient the customer regarding the disposal of unused and expired household medications, while 199 (31.59%) and 159 (25.24%), respectively, indicated that they almost always or always provide guidance. The frequency with which they provided guidance was influenced by the number of years since graduation (p=0.0047), the time they had worked in pharmacies and drugstores (p=0.0007), and whether or not they had a graduate degree (p=0.0181). Regarding the disposal of medications, among the 643 responses provided by the pharmacists, 516 (80.25%) indicated that they oriented customers to return them to a pharmacy. Conclusion: A small number of pharmacists always orient customers on the proper disposal that should be followed for unused and expired household medications, prioritizing their return to a pharmacy. In general, these pharmacists have longer periods of work experience and higher academic qualifications. Thus, it is important to increase knowledge through professional training and further education programs.

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Section: Discussionmentioning

confidence: 99%

Disposal of household medications: practices and attitudes of pharmacists when dispensing medication

Michelin

Bonifácio

Nagata³

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…The population lacks information on the proper disposal of unused and expired medications, like in Saudi Arabia [ 22 ] and Turkey, for example, which is a situation of concern since a significant portion of the population has unused medications in their homes, [ 23 ] including antibiotics [ 22 ]. In Brazil, the general public has been disposing of medicines in household waste containers and in other inappropriate ways, including flushing them down the toilet or sink [ 24 ], practices also reported in several other parts of the world [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Guidance provided by pharmacists to customers regarding to destination of unused household medications: disposal of household medications

Michelin,

Bonifácio,

Nagata

et al. 2023

BMC Health Serv Res

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Background Discarding pharmaceuticals in the garbage or into the sewage system are still the most common methods in many countries. This study aims to investigate the guidance provided by pharmacists to customers on the disposal of unused and expired household medications in São Paulo State, Brazil. Method The study population consisted of 630 pharmacists from the State of São Paulo, who work in community pharmacies. They answered an online questionnaire with questions composed in three blocks: demographic, work, and academic information on the pharmacist; guidance about the disposal of household medications; and knowledge regarding the reverse logistics of these medications. An invitation to participate in the questionnaire was made via WhatsApp, individually and collectively. Inferential statistics were performed using the chi-square test and were considered significant when p < 0.05%. Results Among the participating pharmacists, the majority were women under 60 years old,56 (8.89%) stated that they never orient the customer regarding the disposal of unused and expired household medications, while 574 (91,12%) indicated that they almost provide guidance. The frequency with which they provided guidance was influenced by the number of years since graduation (p = 0.0047), the time they had worked in pharmacies and drugstores (p = 0.0007), and whether or not they had a graduate degree (p = 0.0181). Regarding the disposal of medications, among the 643 responses provided by the pharmacists,516 (80.25%) indicated that they oriented customers to return them to a pharmacy. Conclusion A small number of pharmacists always orient customers on the proper disposal that should be followed for unused and expired household medications, prioritizing their return to a pharmacy. In general, these pharmacists have longer periods of work experience and higher academic qualifications. Thus, it is important to increase knowledge through professional training and further education programs.

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“…However, the occurrence of these chemical compounds in nature is due to the release of industrial effluents and domestic sewage without adequate and effective treatment (Maasz et al, 2019). According to Salgado et al (2021) the presence of drugs or its metabolized subproducts as result of body's excretion is an increasing concern of environmental contamination. It has been estimated that in 2030, the global consumption of antibiotics may be 200% higher than the 42 billion defined daily doses (DDD) estimated in 2015 (Klein et al, 2018).…”

mentioning

confidence: 99%

Environmental impacts of COVID-19 treatment: Toxicological evaluation of azithromycin and hydroxychloroquine in adult zebrafish

Mendonça-Gomes

Araújo

Luz

et al. 2021

Science of The Total Environment

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One of the most impact issues in recent years refers to the COVID-19 pandemic, the consequences of which thousands of deaths recorded worldwide, are still inferior understood. Its impacts on the environment and aquatic biota constitute a fertile field of investigation. Thus, to predict the impact of the indiscriminate use of azithromycin (AZT) and hydroxychloroquine (HCQ) in this pandemic context, we aim to assess their toxicological risks when isolated or in combination, using zebrafish ( Danio rerio ) as a model system. In summary, we observed that 72 h of exposure to AZT and HCQ (alone or in binary combination, both at 2.5 μg/L) induced the reduction of total protein levels, accompanied by increased levels of thiobarbituric acid reactive substances, hydrogen peroxide, reactive oxygen species and nitrite, suggesting a REDOX imbalance and possible oxidative stress. Molecular docking analysis further supported this data by demonstrating a strong affinity of AZT and HCQ with their potential antioxidant targets (catalase and superoxide dismutase). In the protein-protein interaction network analysis, AZT showed a putative interaction with different cytochrome P450 molecules, while HCQ demonstrated interaction with caspase-3. The functional enrichment analysis also demonstrated diverse biological processes and molecular mechanisms related to the maintenance of REDOX homeostasis. Moreover, we also demonstrated an increase in the AChE activity followed by a reduction in the neuromasts of the head when zebrafish were exposed to the mixture AZT+HCQ. These data suggest a neurotoxic effect of the drugs. Altogether, our study demonstrated that short exposure to AZT, HCQ or their mixture induced physiological alterations in adult zebrafish. These effects can compromise the health of these animals, suggesting that the increase of AZT and HCQ due to COVID-19 pandemic can negatively impact freshwater ecosystems.

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Evaluation of the potential environmental risk from the destination of medicines: an epidemiological and toxicological study

Cited by 7 publications

References 53 publications

Disposal of household medications: practices and attitudes of pharmacists when dispensing medication

Disposal of household medications: practices and attitudes of pharmacists when dispensing medication

Guidance provided by pharmacists to customers regarding to destination of unused household medications: disposal of household medications

Environmental impacts of COVID-19 treatment: Toxicological evaluation of azithromycin and hydroxychloroquine in adult zebrafish

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