title: Pharmaceuticals in the environment in Italy: causes, occurrence, effects and control.
abstract: OBJECTIVE
  Environmental contamination by pharmaceuticals is an emerging issue. Until recently, information on medicinal substances released into the environment was scant, but several studies have now been published. Data are, however, usually scattered and a systematic approach to this subject is generally lacking. Moreover, because of differences in the prevalence of diseases, treatment habits and options, or simply for market reasons, the pollution profile can differ significantly in different countries. The aim of this work is to review the papers dealing with environmental contamination by pharmaceuticals in Italy, with the aim of providing a comprehensive view on a national scale.
  
  
  METHODS
  Papers related to environmental contamination by pharmaceuticals in Italy were reviewed, in order to offer a comprehensive view of this subject. Topics included analysis, occurrence, monitoring, modelling, treatment, control of the emissions, and ecotoxicological effects of pharmaceuticals in the environment.
  
  
  CONCLUSIONS
  The literature suggests that pharmaceuticals are widespread contaminants, entering the environment from a myriad of scattered points. Patients, in case of drugs for human use, or animals for veterinary drugs, are the main sources of contamination. Pharmaceuticals can be ranked according to environmental loads, predicted by multiplying sales figures by the rate of metabolism in man or animals. Priority pharmaceuticals, i.e. the molecules of concern for the environment, can be measured in waste and surface water by liquid chromatography-tandem mass spectrometry, and the loads detected are generally comparable to the predicted ones. Pharmaceuticals are designed to stimulate a response in humans and animals at low doses, with a very specific target, so the implications for human health and the environment need to be assessed. In vitro and in vivo studies suggest that pharmaceutical principles, taken singularly or in combinations, and concentrations close to those detected in the environment, may have ecotoxicological effects. The sewage system is an important point in the control of contamination, but sewage treatment plants are not able efficiently to abate a substantial part of water-borne pharmaceuticals. Several variables play a role, however, in the processes of waste water treatment, and could be specifically adjusted to improve the efficiency of drug abatement, mitigating the potential environmental hazards.
  
  
  CONCLUSIONS
  Pharmaceuticals in the environment are becoming a subject of global concern, with potential environmental consequences. Further knowledge of the causes, occurrence and effects of drugs as environmental pollutants is necessary for a better understanding of this ecological issue, as well as to improve abatement strategies, and to mitigate subtle environmental consequences.
authors.affiliation: Department of Environmental Health Sciences, Mario Negri Institute for Pharmacological Research, via Eritrea 62, 20157 Milan, Italy. zuccato@marionegri.it
authors.forename: Ettore
authors.initials: E
authors.lastname: Zuccato
authors.forename: Sara
authors.initials: S
authors.lastname: Castiglioni
authors.forename: Roberto
authors.initials: R
authors.lastname: Fanelli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Reitano
authors.forename: Renzo
authors.initials: R
authors.lastname: Bagnati
authors.forename: Chiara
authors.initials: C
authors.lastname: Chiabrando
authors.forename: Francesco
authors.initials: F
authors.lastname: Pomati
authors.forename: Carlo
authors.initials: C
authors.lastname: Rossetti
authors.forename: Davide
authors.initials: D
authors.lastname: Calamari
mesh_terms: D000818:Animals; D064420:Drug-Related Side Effects and Adverse Reactions / Q000209:etiology; D004784:Environmental Monitoring; D004787:Environmental Pollution / Q000517:prevention & control*; D006801:Humans; D007558:Italy; D004364:Pharmaceutical Preparations / Q000032:analysis*; D014865:Waste Disposal, Fluid; D014874:Water Pollutants, Chemical / Q000032:analysis* / Q000633:toxicity
chemical_list: D004364:Pharmaceutical Preparations; D014874:Water Pollutants, Chemical