2 Pathways to the Environment: Life Cycle of NSAIDs
The production of NSAIDs in the pharmaceutical industries may lead to their direct
discharge into liquid or solid waste systems. The manufactured NSAIDs are
transported and distributed to hospital pharmacies, which are prescribed for treating
musculoskeletal disorders, headaches, dysmenorrhea, and postoperative pain.
Table 1 summarized the NSAIDs consumption data of some countries in terms of
prescriptions issued. Acetylsalicylic acid (ASA) and paracetamol (PCT) lead the list
of the most prescribed NSAIDs. This could be explained due to their significant
benefits in a variety of indications. For instances, current evidence suggests ASA is
helpful for primary prevention of cardiovascular disease, primary prevention of
preeclampsia, and secondary prevention of colorectal adenomas [17, 18]. On the
other hand, PCT is the drug of choice in patients that cannot be treated with other
NSAIDs, such as people with bronchial asthma, peptic ulcer disease, hemophilia,
and salicylate-sensitized people. Furthermore, it is recommended as a first-line
treatment of pain associated with osteoarthritis [19].
Once administered NSAIDs are mainly excreted from the body in their metabolized form. Table 2 summarized the main metabolites of the NSAIDs found in
human urine. Since the elimination of NSAIDs depends largely on hepatic biotransformation, less than five percent of the dose is renal excreted in unchanged form.
Finally, this waste material is collected in wastewater treatment plants (WWTPs) and
either directly discharged untreated into the environment or passed through one or
more treatment steps before being discharged as effluent into the natural aquatic
environment.
3 Occurrence of NSAIDs
The occurrence of NSAIDs in the aquatic environment was firstly reported in 1985,
when Richardson and Bowron found ASA in multiple wastewater effluents of
England. Thirteen years later, Ternes [32] reported the occurrence of several
NSAIDs in multiple German WWTPs and rivers. Table 2 summarizes the data
collected from literature regarding the occurrence of NSAIDs about their presence
in the aquatic environment. Data collected have dates between 1985 and 2017 and
will be discussed in the subsequent sections (Table 3).
3.1 Wastewater
Metcalfe et al. [33] analyzed influent and effluent samples from 18 WWTPs of
Canada. Their results demonstrated ASA, naproxen (NPX), and ibuprofen (IBF)
Introduction and Historical Findings That Focused Nonsteroidal. . .
3
The production of NSAIDs in the pharmaceutical industries may lead to their direct
discharge into liquid or solid waste systems. The manufactured NSAIDs are
transported and distributed to hospital pharmacies, which are prescribed for treating
musculoskeletal disorders, headaches, dysmenorrhea, and postoperative pain.
Table 1 summarized the NSAIDs consumption data of some countries in terms of
prescriptions issued. Acetylsalicylic acid (ASA) and paracetamol (PCT) lead the list
of the most prescribed NSAIDs. This could be explained due to their significant
benefits in a variety of indications. For instances, current evidence suggests ASA is
helpful for primary prevention of cardiovascular disease, primary prevention of
preeclampsia, and secondary prevention of colorectal adenomas [17, 18]. On the
other hand, PCT is the drug of choice in patients that cannot be treated with other
NSAIDs, such as people with bronchial asthma, peptic ulcer disease, hemophilia,
and salicylate-sensitized people. Furthermore, it is recommended as a first-line
treatment of pain associated with osteoarthritis [19].
Once administered NSAIDs are mainly excreted from the body in their metabolized form. Table 2 summarized the main metabolites of the NSAIDs found in
human urine. Since the elimination of NSAIDs depends largely on hepatic biotransformation, less than five percent of the dose is renal excreted in unchanged form.
Finally, this waste material is collected in wastewater treatment plants (WWTPs) and
either directly discharged untreated into the environment or passed through one or
more treatment steps before being discharged as effluent into the natural aquatic
environment.
3 Occurrence of NSAIDs
The occurrence of NSAIDs in the aquatic environment was firstly reported in 1985,
when Richardson and Bowron found ASA in multiple wastewater effluents of
England. Thirteen years later, Ternes [32] reported the occurrence of several
NSAIDs in multiple German WWTPs and rivers. Table 2 summarizes the data
collected from literature regarding the occurrence of NSAIDs about their presence
in the aquatic environment. Data collected have dates between 1985 and 2017 and
will be discussed in the subsequent sections (Table 3).
3.1 Wastewater
Metcalfe et al. [33] analyzed influent and effluent samples from 18 WWTPs of
Canada. Their results demonstrated ASA, naproxen (NPX), and ibuprofen (IBF)
Introduction and Historical Findings That Focused Nonsteroidal. . .
3