1. Local emission estimates of pharmaceuticals: case study for Lithuania Jolita Kruopienė Kaunas University of Technology, Institute of Environmental Engineering (APINI)

2. Data on sales / consumption of pharmaceuticals Sales data in Lithuania in 2005 – from IMS Health Further on the data are referred to as consumption data.

3. Data on sales / consumption of pharmaceuticals Sales data in Lithuania in 2005 – from IMS Health Further on the data are referred to asconsumption data.

4. Consumption data Mass = (DOT x DDD) / F One substance – single ATC code & single DDD value e.g. fluoxetine ATC code:N06AB03, DDD is:20 mg.

5. Consumption data One substance – two or more ATC codes, two or more DDD values The worst case assumption by using the biggest DDD value for calculations possible overestimation e.g. Finasteride: ATC code D11AX10, DDD = 1 mg, ATC code G04CB0, DDD = 5 mg

6. Consumption of pharmaceuticals Use of pahamaceuticals: 517 substances. 436 substances remain vitamins (e.g. ascorbic acid), microelements (e.g. calcium), substances synthesized in human body (e.g. insuline)

7. Consumption of pharmaceuticals Aspirin: 37681 kg Paracetamol:14101 kg Amoxicillin: 11148.5 kg Metformin:10957.5 kg < 0.001 kg (< 1 g) 0.001 – 1 kg 1 – 100 kg100 – 1000 kg 1000 – 10000 kg (1-10 t) > 10000 kg (>10 t) Number2210821172194 Frequency, % 5.024.848.416.54.40.9

8. Load to the environment Emission estimates are a worse worst case scenario assuming 1)sales figures equal consumption, 2)outlet from WWTP is the only gate to the environment, 3)no human metabolism, 4)no degradation in WWTP.

9. Load to the environment Emission estimates are a worse worst case scenario assuming 1)sales figures equal consumption, 2)outlet from WWTP is the only gate to the environment, 3)no human metabolism, 4)no degradation in WWTP.

10. Load to the environment Emission estimates are a worse worst case scenario assuming 1)sales figures equal consumption, 2)outlet from WWTP is the only gate to the environment, 3)no human metabolism, 4)no degradation in WWTP.

11. Load to the environment Emission estimates are a worse worst case scenario assuming 1)sales figures equal consumption, 2)outlet from WWTP is the only gate to the environment, 3)no human metabolism, 4)no degradation in WWTP.

12. Load to the environment Emission estimates are a worse worst case scenario assuming 1)sales figures equal consumption, 2)outlet from WWTP is the only gate to the environment, 3)no human metabolism, 4)no degradation in WWTP.

13. Load to the environment Emission estimates are a worse worst case scenario assuming 1)sales figures equal consumption, 2)outlet from WWTP is the only gate to the environment, 3)no human metabolism, 4)no degradation in WWTP. Total load depends on population density only.

14. Maximum load to the environment

15. Water basins and major cities in Lithuania

16. Environmental concentrations Worst case scenario: PEC values for 147 pharmaceuticals used in Lithuania in 2005 exceed the EU action level of 0.01 mg/l, i.e. pharmaceuticals used in amount higher than 37.5 kg/year might cause a risk to the environment.

17. Environmental concentrations Worst case scenario: PEC values for 147 pharmaceuticals used in Lithuania in 2005 exceed the EU action level of 0.01 mg/l, i.e. pharmaceuticals used in amount higher than 37.5 kg/year might cause a risk to the environment.

18. Environmental concentrations Worst case scenario: PEC values for 147 pharmaceuticals used in Lithuania in 2005 exceed the EU action level of 0.01 mg/l, i.e. pharmaceuticals used in amount higher than 37.5 kg/year might cause a risk to the environment.

19. PEC / PNEC Availability of toxicity data –PNEC calculated for 37 substances Only 3 pharmaceuticals exceed the PEC/PNEC ratio of 1: –amoxicillin, –ciprofloxacin –spiramycin.

20. PEC / PNEC Availability of toxicity data –PNEC calculated for 37 substances Only 3 pharmaceuticals exceed the PEC/PNEC ratio of 1: –amoxicillin, –ciprofloxacin –spiramycin.

21. PEC / PNEC Availability of toxicity data –PNEC calculated for 37 substances Only 3 pharmaceuticals exceed the PEC/PNEC ratio of 1: –amoxicillin, –ciprofloxacin –spiramycin.

22. Taking into account metabolism Even 60-70% of amoxicillin is excreted unchanged in urine. ~ 35% of ciprofloxacine is excreted in urine as unchanged drug Spiramycin is mainly excreted by non renal processes. Urinary excretion accounts for ~14% of an administered dose

23. Taking into account metabolism Even 60-70% of amoxicillin is excreted unchanged in urine. ~ 35% of ciprofloxacine is excreted in urine as unchanged drug Spiramycin is mainly excreted by non renal processes. Urinary excretion accounts for ~14% of an administered dose

24. Taking into account metabolism Even 60-70% of amoxicillin is excreted unchanged in urine. ~ 35% of ciprofloxacine is excreted in urine as unchanged drug Spiramycin is mainly excreted by non renal processes. Urinary excretion accounts for ~14% of an administered dose

25. Taking into account treatment in WWTP - About 80% of effluents in Lithuania undergo biological treatment - No biological treatment in Kaunas yet 60% sorption onto sewage sludge is reported for amoxicillin 65% of ciprofloxacin was eliminated by sorption, and 30% was detected in the effluent

26. Taking into account treatment in WWTP - About 80% of effluents in Lithuania undergo biological treatment - No biological treatment in Kaunas yet 60% sorption onto sewage sludge is reported for amoxicillin 65% of ciprofloxacin was eliminated by sorption, and 30% was detected in the effluent

27. Taking into account treatment in WWTP - About 80% of effluents in Lithuania undergo biological treatment - No biological treatment in Kaunas yet 60% sorption onto sewage sludge is reported for amoxicillin 65% of ciprofloxacin was eliminated by sorption, and 30% was detected in the effluent

28. Load of amoxicillin to the environment