Environmental information for citalopram is missing on fass.se (2020-10-12). It is voluntary for manufacturers to provide information about environmental impact on fass.se. This summary information on persistence, bioaccumulation and toxicity is based on previous environmental information in Fass from 2018. For risk, see the environmental assessments from Goodpoint.
Persistence. The potential for persistence of citalopram cannot be excluded, due to lack of data.
Bioaccumulation. Citalopram has low potential for bioaccumulation.
Toxicity. Citalopram has very high acute toxicity.
Risk. See the environmental assessments from Goodpoint 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.
Fass environmental information for Cipramil (citalopram) from H. Lundbeck AB (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 algae (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.
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 Region Stockholm'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 Region Stockholm. The method for analysis does not distinguish between the different enantiomers.
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.
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.
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 groups. 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
Author: Health and Medical Care Administration, Region Stockholm