This summary information comes from Fass with the exception of risk. The information on risk comes from the report by Goodpoint.
Persistence. No data.
Bioaccumulation. No data.
Toxicity. No data.
Risk. See the report from Goodpoint.
Fass environmental information
Fass environmental information for Sobril (oxazepam) from Pfizer (downloaded 2020-11-05).
Persistence: It can not be excluded that oxazepam is persistent, since data are lacking.
Bioaccumulation: It can not be excluded that oxazepam may bioaccumulate, since data are lacking.
Toxicity: No data.
Risk of environmental impact of oxazepam cannot be excluded, since no ecotoxicity data are available.
In Sweden oxazepam has been found in wild fish in concentrations that can cause changes in the behavior of fish. These behavioral changes can cause potential effects on the ecological balance.
Oxazepam is included in Region Stockholm's table of pharmaceuticals with risk for negative environmental impact according to the environmental program 2017–2021.
Results from studies of a large Swedish lake has shown that oxazepam is difficult to degrade and can persist for several decades, which entails a risk of accumulation. The substance has been detected in the environment in Sweden in concentrations very close to the concentrations that affect the behavior of fish. A dissertation from 2020 showed that the effect of oxazepam decreased on fish groups and that degradation is slower in an ecosystem than in laboratory environments.
Pharmaceutial residues in the aquatic environment in Sweden
Oxazepam has been detected in treated wastewater, surface water and drinking water in Region Stockholm.
The Wise list
Oxazepam is recommended in the Wise list. The Wise list is the drug formulary of essential medicines for common diseases in Region Stockholm from the Drug and Therapeutics Committee. 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 the emissions of oxazepam
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 oxazepam
- Temporary anxiety does not need to be treated pharmacologically.
- Oxazepam is recommended as a temporary symptom relief for anxiety disorders in the elderly and as withdrawal treatment in alcohol disorders in the Wise list.
- Benzodiazepines may impair cognition and increase the risk of falls and thus fractures in the elderly. Only oxazepam in the lowest effective dose and for a short time (maximum 2 weeks) can be recommended for the elderly. However, all benzodiazepines should be avoided as far as possible.
- Calming agents should only be used for short-term treatment.
- Small packages are available within the reimbursement system.
- 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.
- Brodin T, Fick J, Jonsson M, Klaminder J. (2013) Dilute Concentrations of a Psychiatric Drug Alter Behavior of Fish from Natural Populations. Science 339(6121): 814-815.
- Klaminder J, Brodin T, Sundelin A, Anderson NJ, Fahlman J, Jonsson M et al. Long-Term Persistence of an Anxiolytic Drug (Oxazepam) in a Large Freshwater Lake. Environ Sci Technol. 2015;49:10406-12.
- Fahlman J. The fate and effect of pharmaceuticals in boreal surface waters. Dissertation for PhD. Umeå University. 2020.
- 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 Stockholms läkemedelskommitté. Kloka listan (the Wise list).
- Region Stockholm Drug and Therapeutics Committee. The Wise List 2015.
Author: Health and Medical Care Administration, Region Stockholm