Department of Biomaterials Science and Technology, TechMed Centre, University of Twente, Enschede, The Netherlands.
Department of Environmental Science, Institute for Water and Wetland Research, Radboud University, Nijmegen, The Netherlands.
PLoS One. 2018 Jun 14;13(6):e0199095. doi: 10.1371/journal.pone.0199095. eCollection 2018.
Low amounts of human pharmaceuticals in the aquatic environment can affect bacteria, animals and ultimately humans. Here, the environmental consequences of a shift in prescription behavior from prednisolone to berberine was modeled using an environmental decision support system based on four consecutive steps: emission, fate, exposure and effect. This model estimates the relative aquatic and human health impacts of alternative pharmaceutical prescriptions throughout Europe. Since a Defined Daily Dose (DDD) of berberine has yet to be formulated, the environmental impacts of berberine and prednisolone were compared under the assumption of equal DDDs. Subsequently, the relative impact ratio indicates the extent to which the actual DDD of berberine might be higher to still be environmentally preferable over prednisolone. In fact, berberine can be administered at a six times higher dose throughout Europe before its impact on the aquatic environment exceeds that of one prescription of prednisolone. On average, the results for impacts on human health are similar, with the median impact ratio ranging between 5.87 and 22.8 depending on the level of drinking water purification. However, for some regions in Spain, Austria, Baltic States and Finland, berberine can only be considered an environmentally better alternative if it is administered at a lower dose than prednisolone. We conclude that for most regions in Europe it is, up until a certain dose of berberine, beneficial for the aquatic environment and therefore human health to prefer prescription of berberine over prednisolone.
低剂量的人类药物在水环境中会对细菌、动物乃至人类产生影响。在这里，我们使用基于四个连续步骤的环境决策支持系统（emission、fate、exposure 和 effect）来模拟从泼尼松龙到小檗碱的处方行为转变所带来的环境后果。该模型估计了在整个欧洲替代药物处方对水生和人类健康的相对影响。由于尚未制定小檗碱的定义日剂量（DDD），因此在假定等效 DDD 的情况下，比较了小檗碱和泼尼松龙的环境影响。随后，相对影响比表示小檗碱的实际 DDD 高出多少，仍能在环境方面优于泼尼松龙。实际上，在整个欧洲，小檗碱的剂量可以提高六倍，而其对水生环境的影响仍不会超过泼尼松龙的一个处方。平均而言，对人类健康的影响结果相似，中位数影响比在 5.87 至 22.8 之间变化，具体取决于饮用水净化程度。然而，对于西班牙、奥地利、波罗的海国家和芬兰的一些地区，只有当小檗碱的剂量低于泼尼松龙时，才能认为小檗碱在环境方面是更好的替代药物。我们的结论是，对于欧洲的大多数地区，在一定剂量的小檗碱范围内，选择小檗碱而不是泼尼松龙处方对水生环境有利，因此对人类健康也有益。
