Minnesota Department of Health, Saint Paul, MN 55164, USA.
Int J Environ Res Public Health. 2018 Jun 22;15(7):1308. doi: 10.3390/ijerph15071308.
Americans fill upward of four billion prescriptions for pharmaceuticals each year, and many of those pharmaceuticals eventually make their way into the environment. Hundreds of different active pharmaceutical ingredients (APIs) are detected in ambient waters and source water used for drinking water in the U.S. Very few of these drugs have health-based guidance values that suggest a safe level for individuals exposed in the ambient environment through drinking water. The Minnesota Department of Health (MDH) has developed a novel method to derive screening-level human health guidance values for APIs. This method was designed for rapid evaluation and relies on Food and Drug Administration (FDA)-approved drug labels and limited additional public data resources for necessary information. MDH developed an analytical framework using traditional and novel uncertainty and adjustment factors specific to the information available for APIs. This framework, along with an estimated lowest therapeutic dose (LTD), was used to derive screening reference dose (sRfD) values. Water screening values (WSV) were then derived using the sRfD, a relative source contribution factor (RSC), and a water intake rate for infants to represent a highly exposed population. MDH used this new method to derive water screening values for 119 APIs that are commonly prescribed and/or commonly monitored in Minnesota waters, including antibiotics, antidepressants, steroids, and other classes of drugs. The derived WSVs can be used to provide context to environmental detections, prioritize APIs for further health-based guidance development, prioritize APIs for future environmental monitoring studies, and inform the development or refinement of analytical methods.
美国人每年开出的处方药超过 40 亿张,其中许多药物最终进入了环境。在美国,环境水中和饮用水源水中检测到数百种不同的活性药物成分 (API)。这些药物中只有极少数有基于健康的指导值,表明在环境中通过饮用水暴露的个体处于安全水平。明尼苏达州卫生部 (MDH) 开发了一种新方法来推导出 API 的筛选水平人类健康指导值。该方法旨在进行快速评估,并依赖于食品和药物管理局 (FDA) 批准的药物标签和有限的其他公共数据资源来获取必要的信息。MDH 为 API 开发了一个分析框架,该框架使用了传统和新颖的不确定性和调整因素,这些因素特定于 API 可用的信息。该框架与估计的最低治疗剂量 (LTD) 一起用于推导出筛选参考剂量 (sRfD) 值。然后使用 sRfD、相对源贡献因子 (RSC) 和婴儿的水摄入量推导出水筛选值 (WSV),以代表高度暴露的人群。MDH 使用这种新方法推导出了在明尼苏达州水中常用处方和/或监测的 119 种 API 的水筛选值,包括抗生素、抗抑郁药、类固醇和其他类别的药物。推导的 WSV 可用于为环境检测提供背景信息,为基于健康的指导值开发进一步优先考虑 API,为未来的环境监测研究优先考虑 API,并为分析方法的开发或改进提供信息。