The T-value in the score for hazard refers to acute toxicity. Underlying data for P, B and T are from Fass.se, see below.
Citalopram is a racemate of which one of the enantiomers, escitalopram (S-form), has the pharmacological effect. Therefore, see also the information about escitalopram.
Concentrations in the environment in Sweden for several SSRI/SNRIs exceed concentrations with reported effect on the aquatic environment, especially for invertebrates. However, studies with the very lowest effect concentrations are questioned. Levels of citalopram in fish exposed to treated wastewater are equivalent with therapeutic levels in humans.
Citalopram is included in the Stockholm County Council's table of pharmaceuticals with a negative environmental impact according to the environmental programme 2017–2021 based on lowest effect concentration, LOEC = 150 ng/L, and concentrations found in the environment. Citalopram has been detected in treated wastewater and surface water in Stockholm County in the last five years (2012–2016). The method for analysis does not distinguish between the different enantiomers.
In the Wise List escitalopram is recommended. Environmental classification of pharmaceuticals is taken into consideration, sometimes with other environmental aspects, when selecting pharmaceuticals for the Wise list. When comparable pharmaceuticals are equivalent to medical effects, safety and pharmaceutical efficacy, environmental impact and price are considered.
Fass environmental information for Cipramil (citalopram) (downloaded 2018-07-10).
Persistence: "The potential for persistence of Citalopram cannot be excluded, due to lack of data."
Bioaccumulation: Log Kow = 1.39.
Acute toxicity: There are data for 2 trophic levels, lowest for alae (Pseudokirchneriella subcapita) 1.6 mg/L.
Sales data are available for Sweden in the year 2013. PEC/PNEC: "As the base set is not complete, it is not possible to determine the most sensitive specie, and a PNEC cannot be derived." Risk of environmental impact of citalopram cannot be excluded, since there is not sufficient ecotoxicity data available.
Suggestions on how to reduce the release of citalopram and escitalopram
Concrete proposals on how to work to reduce emissions of environmentally harmful pharmaceuticals on the list have been developed in close cooperation with the Stockholm Drug and Therapeutics Committee's expert advice. The action proposals were developed from an environmental perspective. The patient's best always goes first and several pharmaceuticals on the list are also included in the Wise list. However, for such pharmaceuticals, there may be measures that could reduce the environmental impact.
Concrete proposal for citalopram and escitalopram
The risk assessment can not be excluded, according to Fass.se, is due to persistence and toxicity studies being incomplete, why a risk calculation has not been possible. It is voluntary for manufacturers to provide information on the environmental impact.
Comparative assessment of environmental risk in the use of citalopram, escitalopram, sertraline, fluoxetine, venlafaxine, paroxetine and clomipramine in Sweden.
Overall, there is a risk profile for the studied antidepressants.
Author: Health and Medical Care Administration, Region Stockholm