Risks to aquatic organisms posed by human pharmaceutical use

In order to help prioritize future research efforts within the US, risks associated with exposure to human prescription pharmaceutical residues in wastewater were estimated from marketing and pharmacological data. Masses of 371 active pharmaceutical ingredients (APIs) dispensed in the US in 2004 were estimated from marketing data, and then divided by therapeutic dose rate to normalize for potency. Metabolic inactivation of the 50 most dispensed APIs was estimated from published data, and active metabolites were tabulated. Comparing maximum likely average wastewater concentrations of API-associated activity to exposure rates that produce therapeutic effects in humans suggests that the threat to healthy human adults from aquatic exposure is low, even when likely mixture effects are considered. Comparing predicted wastewater concentrations to human therapeutic plasma concentrations suggests that some APIs may be present at sufficient concentrations to affect organisms which eliminate them inefficiently. Comparing predicted antimicrobial concentrations to published minimum inhibitory concentrations suggests that antibacterial APIs in wastewater, but probably not antifungal APIs, may select for low-level antimicrobial resistance. The taxonomic distribution of molecular targets of the 50 most dispensed APIs suggests that potential effects of some APIs are likely restricted to vertebrates, while other APIs can probably affect many eukaryotic and prokaryotic clades.