Prioritizing pharmaceuticals based on environmental risks in the aquatic environment in China

In last two decades, the number of detected activated pharmaceutical ingredients (APIs) in the natural environment worldwide has increased due to their widespread use in daily life. However, given the large number of APIs that are currently in use (approximate 850 are on the market in China), it is impractical to investigate the occurrence, ecotoxicological effects, and perform environmental risk assessment for all drugs. Therefore, it is crucial to rank and prioritize APIs in the environment to identify the compounds of high concern. In China, since information on API usage is not available, an attempt was made to use the number of products per API (the number of pharmaceutical commodities that contain a particular API) on the market multiplied by its daily dose (average daily dose of medication for adults used for the primary therapeutic purpose) to replace the usage in the exposure modeling. Coupled with the hazard assessment, including acute and chronic toxicity of aquatic ecological effects and potential effects related to the therapeutic mode of action, risk scores were estimated and used for ranking. Application of the approach was illustrated for 259 APIs with product number no less than 4. A list of 20 APIs was finally identified as a potential priority, including drugs of cardiovascular, nervous system, respiratory system, musculoskeletal system and antibiotics. In the future, this approach could be applied to prioritize APIs in other countries/regions where information on API usage are limited or non-existent.