The Global Use of Medicines [Internet]. 2023. https://www.iqvia.com/insights/the-iqvia-institute/reports-and-publications/reports/the-global-use-of-medicines-2023. Cited 2 June 2024.

Angeles LF, Mullen RA, Huang IJ, Wilson C, Khunjar W, Sirotkin HI, et al. Assessing pharmaceutical removal and reduction in toxicity provided by advanced wastewater treatment systems. Environ Sci Water Res Technol. 2020;6:62–77.

Article  CAS  Google Scholar 

Khan NA, Vambol V, Vambol S, Bolibrukh B, Sillanpaa M, Changani F, et al. Hospital effluent guidelines and legislation scenario around the globe: a critical review. J Environ Chem Eng. 2021;9: 105874.

Article  CAS  Google Scholar 

BIO Intelligence Service. Study on the environmental risks of medicinal products, Final Report prepared for Executive Agency for Health and Consumers. 2013 Dec.

Pharmaceutical residues in freshwater. OECD; 2019.

Lu M-C, Chen YY, Chiou M-R, Chen MY, Fan H-J. Occurrence and treatment efficiency of pharmaceuticals in landfill leachates. Waste Manag. 2016;55:257–64.

Article  CAS  PubMed  Google Scholar 

Wilkinson JL, Boxall ABA, Kolpin DW, Leung KMY, Lai RWS, Galbán-Malagón C, et al. Pharmaceutical pollution of the world’s rivers. Proc Natl Acad Sci. 2022;119.

Correia D, Domingues I, Faria M, Oliveira M. Effects of fluoxetine on fish: what do we know and where should we focus our efforts in the future? Sci Total Environ. 2023;857: 159486.

Article  CAS  PubMed  Google Scholar 

Musson SE, Townsend TG. Pharmaceutical compound content of municipal solid waste. J Hazard Mater. 2009;162:730–5.

Article  CAS  PubMed  Google Scholar 

Yu X, Sui Q, Lyu S, Zhao W, Liu J, Cai Z, et al. Municipal solid waste landfills: an underestimated source of pharmaceutical and personal care products in the water environment. Environ Sci Technol. 2020;54:9757–68.

Article  CAS  PubMed  Google Scholar 

Baynes A, Lange A, Beresford N, Bryden E, Whitlock K, Tyler CR, et al. Endocrine disruption is reduced but still widespread in Wild Roach (Rutilus rutilus) living in English Rivers. Environ Sci Technol. 2023;57:12632–41.

Article  CAS  PubMed  Google Scholar 

Säfholm M, Ribbenstedt A, Fick J, Berg C. Risks of hormonally active pharmaceuticals to amphibians: a growing concern regarding progestagens. Philos Trans R Soc B Biol Sci. 2014;369:20130577.

Article  Google Scholar 

Kidd KA, Paterson MJ, Rennie MD, Podemski CL, Findlay DL, Blanchfield PJ, et al. Direct and indirect responses of a freshwater food web to a potent synthetic oestrogen. Philos Trans R Soc B. 2014;369:20130578.

Article  Google Scholar 

Giwercman A. Estrogens and phytoestrogens in male infertility. Curr Opin Urol. 2011;21:519–26.

Article  PubMed  Google Scholar 

Rochira V, Carani C. Estrogens, male reproduction and beyond. Estrogens, male reproduction and beyond. 2000.

Rozati R, Reddy PP, Reddanna P, Mujtaba R. Role of environmental estrogens in the deterioration of male factor fertility. Fertil Steril. 2002;78:1187–94.

Article  PubMed  Google Scholar 

Sharpe RM, Skakkebaek NE. Are oestrogens involved in falling sperm counts and disorders of the male reproductive tract? Lancet. 1993;341:1392–6.

Article  CAS  PubMed  Google Scholar 

Hall JM, Korach KS, Hall JE. Endocrine-disrupting chemicals [Internet]. 2024. https://www.uptodate.com/contents/endocrine-disrupting-chemicals. Cited 19 Sept 2024.

Rinde M. Poison pill: the mysterious die-off of India’s vultures [Internet]. Science History Institute. https://www.sciencehistory.org/stories/magazine/poison-pill-the-mysterious-die-off-of-indias-vultures/. Cited 2 June 2024.

Frank EG, Sudarshan A. The social costs of keystone species collapse : evidence from the decline of vultures in India. The Warwick Economics Research Paper Series (TWERPS) [Internet]. 2022. https://ideas.repec.org//p/wrk/warwec/1433.html. Cited 19 Sept 2024.

Walsh TR, Gales AC, Laxminarayan R, Dodd PC. Antimicrobial resistance: addressing a global threat to humanity. PLoS Med. 2023;20: e1004264.

Article  PubMed  PubMed Central  Google Scholar 

Grenni P, Ancona V, Barra CA. Ecological effects of antibiotics on natural ecosystems: a review. Microchem J. 2018;136:25–39.

Article  CAS  Google Scholar 

Earl K, Sleight H, Ashfield N, Boxall ABA. Are pharmaceutical residues in crops a threat to human health? J Toxicol Environ Health A. 2024;87:773–91.

Article  CAS  PubMed  Google Scholar 

Schapira M, Manor O, Golan N, Kalo D, Mordehay V, Kirshenbaum N, et al. Involuntary human exposure to carbamazepine: a cross-sectional study of correlates across the lifespan and dietary spectrum. Environ Int. 2020;143: 105951.

Article  CAS  PubMed  Google Scholar 

Finckh S, Beckers L-M, Busch W, Carmona E, Dulio V, Kramer L, et al. A risk based assessment approach for chemical mixtures from wastewater treatment plant effluents. Environ Int. 2022;164: 107234.

Article  CAS  PubMed  Google Scholar 

Brack W, Aissa SA, Backhaus T, Dulio V, Escher BI, Faust M, et al. Effect-based methods are key. The European Collaborative Project SOLUTIONS recommends integrating effect-based methods for diagnosis and monitoring of water quality. Environ Sci Europe. 2019;31:10.

Cannata C, Backhaus T, Bramke I, Caraman M, Lombardo A, Whomsley R, et al. Prioritisation of data-poor pharmaceuticals for empirical testing and environmental risk assessment. Environ Int. 2024;183: 108379.

Article  CAS  PubMed  Google Scholar 

Gunnarsson L, Snape JR, Verbruggen B, Owen SF, Kristiansson E, Margiotta-Casaluci L, et al. Pharmacology beyond the patient—the environmental risks of human drugs. Environ Int. 2019;129:320–32.

Article  CAS  PubMed  Google Scholar 

Moermond CTA, Berg C, Bergstrom U, Bielská L, Evandri MG, Franceschin M, et al. Proposal for regulatory risk mitigation measures for human pharmaceutical residues in the environment. Regul Toxicol Pharmacol. 2023;143: 105443.

Article  CAS  PubMed  Google Scholar 

Roos V, Gunnarsson L, Fick J, Larsson DGJ, Rudén C. Prioritising pharmaceuticals for environmental risk assessment: towards adequate and feasible first-tier selection. Sci Total Environ. 2012;421–422:102–10.

Article  PubMed  Google Scholar 

European Medicines Agency. Environmental risk assessment of medicinal products for human use—scientific guideline [Internet]. 2024. https://www.ema.europa.eu/en/environmental-risk-assessment-medicinal-products-human-use-scientific-guideline#topics. Cited 2 June 2024.

FDA Center for Drug Evaluation and Research. Environmental Assessment of Human Drug and Biologics Applications [Internet]. FDA; 2020. https://www.fda.gov/regulatory-information/search-fda-guidance-documents/environmental-assessment-human-drug-and-biologics-applications. Cited 2 June 2024.

Reform of the EU pharmaceutical legislation—European Commission [Internet]. 2024. https://health.ec.europa.eu/medicinal-products/pharmaceutical-strategy-europe/reform-eu-pharmaceutical-legislation_en. Cited 19 Sept 2024.

Proposal amending Water Directives—European Commission [Internet]. https://environment.ec.europa.eu/publications/proposal-amending-water-directives_en. Cited 19 Sept 2024.

Proposal for a revised Urban Wastewater Treatment Directive—European Commission [Internet]. https://environment.ec.europa.eu/publications/proposal-revised-urban-wastewater-treatment-directive_en. Cited 19 Sept 2024.

Piët JD, Booth A, Donker EM, De Ponti F, Lunghi C, Poluzzi E, et al. Environmentally sustainable prescribing: recommendations for EU pharmaceutical legislation. Lancet Planet Health. 2024;S2542519624002304.

Wang J, Li S, He B. Chinese physicians’ attitudes toward eco-directed sustainable prescribing from the perspective of ecopharmacovigilance: a cross-sectional study. BMJ Open. 2020;10: e035502.

Article  PubMed  PubMed Central  Google Scholar 

Domingo-Echaburu S, Abajo Z, Sánchez-Pérez A, Elizondo-Alzola U, De La Casa-Resino I, Lertxundi U, et al. Knowledge and attitude about drug pollution in pharmacy students: a questionnaire-based cross sectional study. Curr Pharm Teach Learn. 2023;15:461–7.

Article  PubMed  Google Scholar 

Blom IM, Rupp I, de Graaf IM, Kapitein B, Timmermans A, Sperna Weiland NH. Putting planetary health at the core of the medical curriculum in Amsterdam. Lancet Planet Health. 2023;7:e15–7.

Article  PubMed  Google Scholar 

Hernandez-Palacios R, Pfleger S, Medrano J, Orive G, Lertxundi U. Inappropriate prescribing in older people: not only a patient safety issue but an avoidable source of environmental harm. Age Ageing. 2024;53:afae119.

Paut Kusturica M, Jevtic M, Ristovski JT. Minimizing the environmental impact of unused pharmaceuticals: review focused on prevention. Front Environ Sci. 2022;10.

Diorazio LJ, Richardson P, Sneddon HF, Moores A, Briddell C, Martinez I. Making sustainability assessment accessible: tools developed by the ACS Green Chemistry Institute Pharmaceutical Roundtable. ACS Sustain Chem Eng. 2021;9:16862–4.

Article  CAS  Google Scholar 

Vidaurre R, Bramke I, Puhlmann N, Owen SF, Angst D, Moermond C, et al. Design of greener drugs: aligning parameters in pharmaceutical R&D and drivers for environmental impact. Drug Discov Today. 2024;29: 104022.

Article  CAS  PubMed  Google Scholar 

Domingo-Echaburu S, Hernandez-Palacios R, Orive G, Lertxundi U. A proposal to reduce the amount of permethrin entering wastewater resultant from topical use to treat scabies. Sci Total Environ. 2024;925: 171787.

Article  CAS  PubMed  Google Scholar 

Bielfeldt S, Urquhart D, Brandt M, Hennighausen N, Bazzanella R. Reduction of residual topical diclofenac in waste water by a wiping procedure before hand washing. Chemosphere. 2022;292: 133350.

Article  CAS  PubMed