Green pharmacy and pharmEcovigilance: prescribing and the planet

Abstract

Active pharmaceutical ingredients (APIs) are ubiquitous environmental contaminants, resulting primarily from excretion and bathing and from disposal of leftover drugs by consumers and healthcare facilities. Although prudent disposal of leftover drugs has attracted the most attention for reducing API levels in the aquatic environment, a more effective approach would prevent the generation of leftover drugs in the first place. Many aspects of the practice of medicine and pharmacy can be targeted for reducing environmental contamination by APIs. These same modifications -focused on treating humans and the environment as a single, integral patient -could also have collateral outcomes with improved therapeutic outcomes, and with a reduced incidence of unintended poisonings, drug interactions and drug diversion, and lower consumer costs.

Prioritization methodology for the monitoring of active pharmaceutical ingredients in hospital effluents

“…Sulfamethoxazole was selected because it exhibits relatively high rank and was proposed as a representative API to follow in Swiss surface waters (G€ otz et al, 2010b). Furthermore, it has been found in drinking water (Daughton and Ruhoy, 2011), and is considered as mutagenic (Isidori et al, 2005). The antibiotic metronidazole was retained though it is not really a hospital-specific molecule , but its contribution to the total load of urban micropollution can be important (Verlicchi et al, 2012a).…”

Medication Disposal #286

“…2 However, others have noted the main way drug residues enter water systems is by passage of drugs and drug metabolites in urine and feces. 7,8 Additionally, there is no clear scientific evidence of actual ecological harm brought about by pharmaceutical contamination of waste water. Given this, the FDA's recommendation to flush certain drugs that are very harmful if unintentionally ingested should be followed.…”

Ecopharmacovigilance: Current state, challenges, and opportunities in China

“…[34536] Although medication utilization in China has gradually changed from improving the accessibility of medications to the rational use of medications, there still are some irrational medication uses of antibiotics, glucocorticoids, and injections prescribed for patients in the rural. [37] And the quality control of prescription practice and pharmaceutical education to patients could be essential to control drug abuse and then implement EPV.…”

“…This includes guidance for patients, take-back schemes, and disposal practices. [36] Pharmaceutical take-back programs are an important part of EPV, and may help prevent leftover pharmaceuticals in the environment from being misused. [38] In China, these programs have become a routine practice of drug administration, which should be continued and strengthened under the principle of EPV.…”