The environmental impact of pharmaceuticals in Italy: integrating healthcare and eco-toxicological data to assess and potentially mitigate their diffusion to water supplies.

Pharmaceuticals can reach the environment at all stages of their lifecycle and accumulate in the ecosystems, potentially reaching toxic levels for animals and plants. In recent years, efforts have been made to map and control this hazard. Assessing country-specific environmental risks could drive regulatory actions toward eco-friendlier drug utilisation and disposal practices. By starting from a list of 25 environmentally hazardous pharmaceuticals developed by the Region Stockholm, we integrated eco-toxicological and 2019 - 2021 Italian drug utilisation data to estimate the environmental impact of pharmaceuticals in Italy. We calculated the risk as the ratio between the Predicted Environmental Concentration and the Predicted No-Effect Concentration. We found a high risk for levonorgestrel, ciprofloxacin, amoxicillin, azithromycin, venlafaxine, sertraline, and diclofenac and a moderate risk for ethinylestradiol, estradiol, and clarithromycin. This analysis can be periodically performed to identify the pharmaceuticals with the highest risk for the environment and ascertain if containment measures should be implemented.