Kommersiellt obunden läkemedelsinformation riktad till läkare och sjukvårdspersonal

Venlafaxine

Hazard 5 P 3 B 0 T 2 Risk See below

Information

The T-value in the score for hazard refers to acute toxicity. Underlying data for P, B and T are from Fass.se, see below.

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 the Stockholm County Council'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 in Stockholm County in the last five years (2012–2016).

Fass environmental information

Fass environmental information for Efexor Depot (venlafaxine) (downloaded 2011-04-11).

Hazard

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 4.8 mg/L.

Risk

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.

New environmental information is published on Fass.se for venlafaxin from Teva (2018-07-10). However, in the new environmental information it is stated that data is missing. It is voluntary for manufacturers to provide information about environmental impact on fass.se.

Suggestions on how to reduce the release 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 the Stockholm Drug and Therapeutics Committee's expert advice. 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 venlafaxine

  • Initially, 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.
  • Venlafaxine is not recommended in the Wise List.
  • Starter pack is available within the reimbursement system.

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.

References

  1. Fass.se för vårdpersonal
  2. Goodpoint. Prioritering av läkemedel med miljörisk inom SLL. Stockholm: Goodpoint; 2016. Rapport LS 2016–0634.
  3. Bisesi JH, Bridges W, Klaine SJ. Effects of the antidepressant venlafaxine on fish brain serotonin and predation behavior. Aquat Toxicol. 2014;148:130-8.
  4. 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.
  5. Fick J, Lindberg RH, Tysklind M, Larsson DG. Predicted critical environmental concentrations for 500 pharmaceuticals. Regul Toxicol Pharmacol. 2010;58:516-23.
  6. SLL. Sammanställning av läkemedelsprovtagningar - Bearbetning av regional försäljningsstatistik av läkemedel samt datamaterial från Stockholms läns landstings mätprogram för läkemedelssubstanser i vattenmiljö, 2012–2016.
  7. Stockholms läns landsting. Förteckning över miljöbelastande läkemedel med åtgärdsförslag framtagen inom ramen för SLL:s miljöprogram 2017–2021.
  8. Goodpoint. Jämförande bedömning av miljörisk vid användning av citalopram, escitalopram, sertralin, fluoxetin, venlafaxin, paroxetin och klomipramin. Stockholm: Goodpoint; 2018.

Author: Health and Medical Care Administration, Region Stockholm