Kommersiellt obunden läkemedelsinformation riktad till läkare och sjukvårdspersonal

Sertraline

Information

No new environmental information for sertraline is published on fass.se (2021-06-24). It is voluntary for manufacturers to provide information on the environmental impact on fass.se. This summary information about persistence, bioaccumulation and toxicity comes from previous Fass environmental information. The information on risk comes from the report by Goodpoint 2018.

Persistence. Sertraline is slowly degraded in the environment
Bioaccumulation. Sertraline does not have the potential to accumulate in aquatic organisms.
Toxicity. Sertraline has very high acute toxicity.
Risk. See the report from Goodpoint.

Detailed information

Fass environmental information

Fass environmental information for Zoloft (sertraline) (downloaded 2011-04-08).

Hazard

Persistence: "9–32% sertraline remains after 45 days biodegradation active sludge method; Indirect photolysis, half-life 4.6 days."

Bioaccumulation: "Log Kow at pH 7 = 2.9; Calculated Log D at pH 7.0 = 2.39; Calculated BCF = 10.4."

Acute toxicity: There are data for 3 trophic levels, lowest for algae (Green algae) 14 days EC50 = 0.056 mg/L.

Risk

PEC/PNEC is based on sales data in Sweden in year 2007. PEC/PNEC = 6.96 which gives the risk moderate.

Report Goodpoint 2016

Levels of several SSRI/SNRI exceed the concentrations that have an influence on aquatic organisms, particularly invertebrates. However, studies with the very least effect concentrations have been questioned. Sertraline has been detected i wild fish in concentrations near therapeutic levels in human.

Sertraline is included in Region Stockholm's table of pharmaceuticals with risk for negative environmental impact according to the environmental program 2017–2021. Sertraline has been detected in treated wastewater in Region Stockholm.

Report Goodpoint 2018

Comparative assessment of environmental risk in the use of citalopram, escitalopram, sertraline, fluoxetine, venlafaxine, paroxetine and clomipramine in Sweden (Report Goodpoint 2018).

Overall, there is a risk profile for the studied antidepressants.

The Wise list

Sertraline 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 sertraline

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 sertraline

  • In the first place, non pharmacological treatment and/or measures (eg, CBT and physical activity) taken alone or in combination with pharmaceuticals for the treatment of depression. Avoid overconsumption of alcohol.
  • Sertralin is recommended in the Wise list.
  • Avoid randomized prescribing of SSRIs (for example, sertraline). Evaluate and reconsider the treatment with SSRIs. Can you as the doctor stop the medication?
  • Starter pack is available within the reimbursement system.

References

  1. Fass.se för vårdpersonal
  2. Goodpoint. Prioritering av läkemedel med miljörisk inom SLL. Stockholm: Goodpoint; 2016. Rapport LS 2016–0634.
  3. Goodpoint. Jämförande bedömning av miljörisk vid användning av citalopram, escitalopram, sertralin, flouxetin, venlafaxin, paroxetin och klomipramin. Stockholm: Goodpoint; 2018.
  4. 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.
  5. 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.
  6. Johnson DJ, Sanderson H, Brain RA, Wilson CJ, Solomon KR. Toxicity and hazard of selective serotonin reuptake inhibitor antidepressants fluoxetine, fluvoxamine, and sertraline to algae. Ecotoxicology and Environmental Safety. 2007;67:128–139.
  7. Provtagningar av läkemedelsrester i vatten, sediment och fisk för Region Stockholm.
  8. Region Stockholm. Förteckning över miljöbelastande läkemedel med åtgärdsförslag framtagen inom ramen för Region Stockholms miljöprogram 2017–2021.
  9. Region Stockholms läkemedelskommitté. Kloka listan (The Wise list).
  10. Ulfvarson J, Adami J, Wredling R, et al. Controlled withdrawal of selective serotonin reuptake inhibitor drugs in elderly patients in nursing homes with no indication of depression. Eur J Clin Pharmacol . 2003 Dec;59(10):735-40. doi: 10.1007/s00228-003-0687-y.

Author: Health and Medical Care Administration, Region Stockholm