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Pharmaceuticals and Environment

Here you can find information about the environmental impact of pharmaceuticals. You can search for a substance name. The environmental risk refers to the use of a pharmaceutical. The knowledge support is based on three sources:
1. environmental information from the European Medicines Agency's (EMA's) European Public Assessment Reports (EPARs)
2. environmental information on Fass.se
3. environmental risk assessments for certain substances based on concentrations measured in the environment in Sweden and effect studies.

Based on the two first-mentioned sources, environmental information is missing for many medicinal products. The database is based on Region Stockholm's work in Sweden and may mean, for example, that information about the Wise list, the drug formulary of recommended essential medicines for the entire Stockholm healthcare region, has been included.

Information about the classification

In a document there is information about the classification of the environmental hazard and the environmental risk. The classification of the risk is usually based on theoretical calculations of the risk. For more information see Classification.

For some substances there is also a risk assessment made on the basis of concentrations measured in the environment in Sweden and efficacy studies with high quality. These assessments are presented in the documents for the substances and are made by independent ecotoxicological expertise. Continuous work is underway to provide more substance documents with this type of environmental information and also present comparisons of environmental risk between substances intended for the same indication. Based on this type of risk assessment, a table of environmentally hazardous drugs Pdf, 41 kB. was developed within the framework of Region Stockholm's environmental program 2017–2021.


Kidd KA, Backhaus T, Brodin T, Inostroza PA, McCallum ES. Environmental risks of pharmaceutical mixtures in aquatic ecosystems: reflections on a decade of research. Environ Toxicol Chem. 2023 Aug 2. doi: 10.1002/etc.5726. Epub ahead of print. PMID: 37530415.

Bengtsson-Palme J, Abramova A, Berendonk TU, et al. Towards monitoring of antimicrobial resistance in the environment: For what reasons, how to implement it, and what are the data needs?, Environment International, Volume 178, 2023, 108089, ISSN 0160-4120, https://doi.org/10.1016/j.envint.2023.108089.

Elkanah Linder, Johanna Villén, Marmar Nekoro, Björn Wettermark, Sofia Kälvemark Sporrong. Stakeholders' perspectives and use of web-based knowledge support for environmental information on pharmaceuticals. Exploratory Research in Clinical and Social Pharmacy. Volume 11, 2023, 100303, ISSN 2667-2766, https://doi.org/10.1016/j.rcsop.2023.100303.

Daniela Gildemeister, Caroline T.A. Moermond, Cecilia Berg, Ulrika Bergström, Lucie Bielská, Maria Grazia Evandri, Marco Franceschin, Boris Kolar, Mark H.M.M. Montforts, Christine Vaculik. Improving the regulatory environmental risk assessment of human pharmaceuticals: Required changes in the new legislation. Regulatory Toxicology and Pharmacology, Volume 142, 2023, 105437, ISSN 0273-2300, https://doi.org/10.1016/j.yrtph.2023.105437

Moermond CTA, Berg C, Bergström U, Bielská L, Evandri MG, Franceschin M, Gildemeister D, Montforts MHMM. Proposal for regulatory risk mitigation measures for human pharmaceutical residues in the environment. Regul Toxicol Pharmacol. 2023 Jul 9:105443. doi: 10.1016/j.yrtph.2023.105443. Epub ahead of print. PMID: 37433367.

European Commission. EU steps up the fight against antimicrobial resistance.

Linder E, Wettermark B, Ovesjö ML, Sporrong SK, Ramström H. Knowledge support for environmental information on pharmaceuticals: experiences among Swedish Drug and Therapeutics Committees. BMC Health Serv Res. 2023 Jun 12;23(1):618

European Health Union: EU steps up the fight against antimicrobial resistance
European Commission

Sweden’s successful approach to antibiotic resistance can be used as inspiration in other countries

Inda-Díaz, J.S., Lund, D., Parras-Moltó, M. et al. Latent antibiotic resistance genes are abundant, diverse, and mobile in human, animal, and environmental microbiomes. Microbiome 11, 44 (2023). https://doi.org/10.1186/s40168-023-01479-0

Huch, S., Nersisyan, L., Ropat, M. et al. Atlas of mRNA translation and decay for bacteria. Nat Microbiol (2023). https://doi.org/10.1038/s41564-023-01393-z

Karin Rystedt, Petra Edquist, Christian G Giske, Katarina Hedin, Mia Tyrstrup, Gunilla Skoog Ståhlgren, Pär-Daniel Sundvall, Charlotta Edlund, Effects of penicillin V on the faecal microbiota in patients with pharyngotonsillitis—an observational study, JAC-Antimicrobial Resistance, Volume 5, Issue 1, February 2023, dlad006, https://doi.org/10.1093/jacamr/dlad006

Berglund, F., Ebmeyer, S., Kristiansson, E. et al. Evidence for wastewaters as environments where mobile antibiotic resistance genes emerge. Commun Biol 6, 321 (2023). https://doi.org/10.1038/s42003-023-04676-7

Nozomu Obana, Hiraku Takada, Caillan Crowe-McAuliffe, Mizuki Iwamoto, Artyom A Egorov, Kelvin J Y Wu, Shinobu Chiba, Victoriia Murina, Helge Paternoga, Ben I C Tresco, Nobuhiko Nomura, Andrew G Myers, Gemma C Atkinson, Daniel N Wilson, Vasili Hauryliuk, Genome-encoded ABCF factors implicated in intrinsic antibiotic resistance in Gram-positive bacteria: VmlR2, Ard1 and CplR, Nucleic Acids Research, 2023;, gkad193, https://doi.org/10.1093/nar/gkad193

Hartman E A R, van de Pol A C, Heltveit-Olsen S R, Lindbæk M, Høye S, Lithén S S et al. Effect of a multifaceted antibiotic stewardship intervention to improve antibiotic prescribing for suspected urinary tract infections in frail older adults (ImpresU): pragmatic cluster randomised controlled trial in four European countries BMJ 2023; 380 :e072319 doi:10.1136/bmj-2022-072319

Helle Håkonsen, Simone Dohle, Henric Rhedin, Tove Hedenrud. Preferences for medicines with different environmental impact – a Swedish population-based study. Environmental Advances (2023), doi: https://doi.org/10.1016/j.envadv.2023.10035

Helwig, K, Niemi, L, Stenuick, JY, et al. (2023), Broadening the perspective on reducing pharmaceutical residues in the environment. Environ Toxicol Chem. Accepted Author Manuscript. https://doi.org/10.1002/etc.5563

Blomstrand E, Kumar Rajasekharan A, Atefyekta S, Andersson M. Cross-linked lyotropic liquid crystal particles functionalized with antimicrobial peptides. International Journal of Pharmaceutics 627 (2022) 122215

Stepulane A, Kumar Rajasekharan A, and Andersson M. Multifunctional surface modification of PDMS for antibacterial contact killing and drug-delivery of polar, nonpolar, and amphiphilic drugs. ACS Appl. Bio Mater. 2022, 5, 5289−5301

Nada Hanna, Ashok J Tamhankar, Cecilia Stålsby Lundborg. Antibiotic concentrations and antibiotic resistance in aquatic environments of the WHO Western Pacific and South-East Asia regions: a systematic review and probabilistic environmental hazard assessment. Lancet Planet Health 2023; 7: e45–54.

Brandis G, Larsson J, Elf J. Antibiotic perseverance increases the risk of resistance development. PNAS 2023 Vol. 120 No. 2 e2216216120.

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