The data on hazard are based on previous environmental information on fass.se. Environmental information is missing (2021-09-10). It is voluntary for manufacturers to provide information about environmental impact on fass.se. The information on risk comes from the reports by Goodpoint. Venlafaxine is monitored within the framework of EU water legislation.
Persistence. Venlafaxine is slowly degraded in the environment.
Bioaccumulation. Venlafaxine does not have the potential to accumulate in aquatic organisms.
Toxicity. Venlafaxine has high acute toxicity.
Risk. See the reports from Goodpoint.
Fass environmental information from 2020
Fass environmental information for Venlafaxin Actavis (venlafaxine) from Teva (downloaded 2020-11-16).
Persistence: No data.
Bioaccumulation: There is an estimated value of Log Pow in the literature: 3.280, indicating that venlafaxine has low potential for bioaccumulation.
Toxicity: No data.
Risk of environmental impact of venlafaxine cannot be excluded, since no ecotoxicity data are available.
Fass environmental information from 2011
Fass environmental information for Efexor Depot (venlafaxine) from Pfizer (downloaded 2011-04-11).
Persistence: Venlafaxine is not expected to be degraded into the environment. This is based on the inherent degradation study according to OECD 302 A.
Bioaccumulation: Log Kow = 0.5 at pH 7.
Acute toxicity: There are data for 3 trophic levels, lowest for algae EC50 = 4.8 mg/L.
It is not clear which year of sales data that is based on the calculation of PEC/PNEC. PEC/PNEC = 0.060 which gives the risk insignificant, i.e. consideration has not been given to measured levels in the environment.
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. Venlafaxine has been detected in fish exposed to purified wastewater, though in amounts below therapeutic drug levels in human.
Venlafaxine is included in Region Stockholm's table of pharmaceuticals with risk for negative environmental impact according to the environmental program 2017–2021. Venlafaxine has been detected in treated wastewater and surface water i Region Stockholm.
Report Goodpoint 2018
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.
EU water legislation
Venlafaxine is monitored within the framework of EU water legislation. "Substances for which doubt exists about their toxicity, or for which the sensitivity, reliability or comparability of the available monitoring methods are not adequate, should not be included in the watch list. The sulfonamide antibiotic sulfamethoxazole and the diaminopyrimidine antibiotic trimethoprim, the antidepressant venlafaxine and its metabolite O-desmethylvenlafaxine, a group of three azole pharmaceuticals (clotrimazole, fluconazole and miconazole) ... The inclusion of the various pharmaceuticals is consistent with the EU Strategic Approach to Pharmaceuticals in the Environment, and the inclusion of the two antibiotics is also consistent with the European One Health Action Plan against Antimicrobial Resistance (AMR), which supports the use of the watch list to ‘improve knowledge of the occurrence and spread of antimicrobials in the environment’."
Suggestions on how to reduce emissions of venlafaxine
Concrete proposals on how to work to reduce emissions of environmentally harmful pharmaceuticals on the list have been developed in close cooperation with Region 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. (The Wise list is the drug formulary of essential medicines for common diseases in Region Stockholm from the Drug and Therapeutics Committee.) However, for such pharmaceuticals, there may be measures that could reduce the environmental impact.
Concrete proposal for venlafaxine
- Initially, non pharmacological treatment and/or measures (e.g., CBT and physical activity) taken alone or in combination with pharmaceuticals for the treatment of depression. Avoid overconsumption of alcohol.
- Venlafaxine is not recommended in the Wise list.
- Starter pack is available within the reimbursement system.
- Fass.se för vårdpersonal
- Goodpoint. Prioritering av läkemedel med miljörisk inom SLL. Stockholm: Goodpoint; 2016. Rapport LS 2016–0634.
- Bisesi JH, Bridges W, Klaine SJ. Effects of the antidepressant venlafaxine on fish brain serotonin and predation behavior. Aquat Toxicol. 2014;148:130-8.
- Grabicova K, Lindberg RH, Ostman M, Grabic R, Randak T, Larsson DG et al. Tissue-specific bioconcentration of antidepressants in fish exposed to effluent from a municipal sewage treatment plant. Sci Total Environ. 2014;488-489:46-50.
- 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.
- Goodpoint. Jämförande bedömning av miljörisk vid användning av citalopram, escitalopram, sertralin, fluoxetin, venlafaxin, paroxetin och klomipramin. Stockholm: Goodpoint; 2018.
- Official Journal of the European Union. Commission implementing decision (EU) 2020/1161 of 4 August 2020.
- Official Journal of the European Union. Commission implementing decision (EU) 2022/1307 of 22 July 2022.
Author: Health and Medical Care Administration, Region Stockholm