This summary information comes from Fass and the risk from the report from Goodpoint.
Persistence. No data.
Bioaccumulation. No data.
Toxicity. No data.
Risk. See below
Fass environmental information
Fass environmental information for Stesolid (diazepam) from Teva (downloaded 2020-10-20).
Persistence: It can not be excluded that diazepam is persistent, as data are lacking.
Bioaccumulation: It can not be excluded that diazepam may bioaccumulate, as data are lacking.
Toxicity: No data.
Risk of environmental impact of diazepam cannot be excluded, since no ecotoxicity data are available.
Manufacturer has on fass.se stated that that data about the environmental impact is missing for the substance so that the environmental risk cannot be calculated. It is voluntary for manufacturers to provide information on the environmental impact on fass.se.
Report Goodpoint and Region Stockholm's table of pharmaceuticals
The levels of diazepam measured in Swedish waters are low and are not expected to pose any environmental risk, but diazepam is metabolized partly to oxazepam, which has been measured in concentrations posing a risk. Oxazepam has been detected in treated wastewater, surface water and drinking water in Region Stockholm. This means that the use of diazepam may contribute to the environmental risk and the substance is therefore included in Region Stockholm's table of pharmaceuticals with risk for negative environmental impact according to the environmental programme 2017–2021.
The Wise list
Diazepam is recommended in the Wise list. 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.
Suggestions on how to reduce emissions of diazepam
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 diazepam
- Diazepam, rectally and intravenously, is recommended for epilepsy and status migrainosus in the Wise list.
- Long-acting benzodiazepines, such as diazepam tablets, should be avoided to the elderly.
- Fass för vårdpersonal.
- Goodpoint. Prioritering av läkemedel med miljörisk inom SLL. Stockholm: Goodpoint; 2016. Rapport LS 2016–0634.
- IVL Swedish Environmental Research Institute Ltd. Fick J, Lindberg RH, Kaj L, Brorström-Lundén E. Results from the Swedish National Screening Programme 2010. Subreport 3. Pharmaceuticals.
- IVL Swedish Environmental Research Institute Ltd Fick J, Lindberg RH, Fång J, Magnér J, Kaj L, Brorström-Lundén E. Screening 2014. Analysis of pharmaceuticals and hormones in samples from WWTPs and receiving waters. Rapport C 135.
- Oggier DM, Weisbrod CJ, Stoller AM, Zenker AK, Fent K. Effects of diazepam on gene expression and link to physiological effects in different life stages in zebrafish Danio rerio. Environ Sci Technol. 2010;44:7685-91.
- Stockholm Vatten. Läkemedelsrester i Stockholms vattenmiljö. 2010. ISBN 978-91-633-6642-0.
- Provtagningar av läkemedelsrester i vatten, sediment och fisk för Region Stockholm.
- Region Stockholm. Förteckning över miljöbelastande läkemedel med åtgärdsförslag framtagen inom ramen för Region Stockholms miljöprogram 2017–2021.
- Region Stockholm. Kloka listan (Wise list).
- Region Stockholm. The Wise list 2015.
Author: Health and Medical Care Administration, Region Stockholm