Concern about potential deleterious effects of pharmaceuticals in the
environment is growing fast. From wiping out vulture populations in
Asia, to feminization of fish, pharmaceuticals have shown to provoke
important consequences albeit at very low concentrations. A recent
article addresses the environmental impact of metered-dose inhalers for
asthma in the United Kingdom due to the greenhouse effects
hydrofluorocarbons they contain. Since 2005, it is mandatory for all new
drugs in Europe to be assessed for their environmental impact.
Crucially, this regulation solely refers to the active pharmaceutical
ingredient, not the “whole medicine” or finished medical product. This
can sometimes lead to incongruences. For instance, it does not consider
the environmental impact of the hydrofluorocarbons contained in MDIs.
Another example is Adasuve®, an antipsychotic (loxapine) aimed at the
rapid control of agitation in patients suffering from psychotic
disorders. The device was developed as a rapid systemic delivery of
loxapine by inhalation of a thermally generated aerosol for single use.
Apart from the active substance it holds a medical-grade plastic housing
and a lithium battery. Therefore, after every single use, a lithium
battery waste is produced. We envision that we are on a brink of a new
era in pharmacotherapy, in which environmental aspects of drugs are
taken into account. In definitive, we agree with Wilkinson & Woodcock.
When considering the environmental impact of pharmaceuticals, we need to
take into account the whole package.