Pharmaceuticals in the environment--a human risk?

Pharmaceuticals in the environment and their potential toxic effects are emerging research areas, which is also reflected in the drug approval regulation. This far, focus has mainly been directed toward potential effects on nature and wildlife. In this paper, human risk as a consequence of exposure via the environment has been addressed and assessed. The synthetic estrogen 17alpha-ethinylestradiol (EE2), the antibiotic phenoxymethylpenicillin (Pen V), and the antineoplastic drug cyclophosphamide (CP) were chosen as modeling substances based on criteria of receptor specificity, elevated risk for human population groups for which the pharmaceuticals are not therapeutically intended, different modes of action, and prescription frequency. Attention has been focused on emissions from the use phase and subsequent diffuse release via the sewer systems. A reasonable worst-case environmental fate and human exposure were estimated using the software EUSES on worst-case emission quantities. The results indicate a negligible human risk connected to the environmental exposure for these substances. Danish conditions have been used as the modeling area, but the results are assumed to be valid for regions with similar drug consumption profiles.