Evidence map›Paper›PMID 40098545›Full record

ArticleBritish journal of clinical pharmacology2025

Assessing the environmental impact of medicines in Italy using data from the Italian Medicines Agency.

Valentina Giunchi, Michele Fusaroli, Agnese Cangini, Filomena Fortinguerra, Simona Zito, Andrea Pierantozzi, Carlotta Lunghi, Elisabetta Poluzzi, Francesco Trotta

Abstract read
In one paragraph

Article in British journal of clinical pharmacology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Valentina GiunchiDepartment of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.ORCID https://orcid.org/0000-0001-5841-8520
Michele FusaroliDepartment of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.ORCID https://orcid.org/0000-0002-0254-2212
Agnese CanginiItalian Medicines Agency (AIFA), Rome, Italy.ORCID https://orcid.org/0000-0002-1640-3993
Filomena FortinguerraItalian Medicines Agency (AIFA), Rome, Italy.ORCID https://orcid.org/0000-0002-6587-9808
Simona ZitoItalian Medicines Agency (AIFA), Rome, Italy.
Andrea PierantozziItalian Medicines Agency (AIFA), Rome, Italy.
Carlotta LunghiDepartment of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.ORCID https://orcid.org/0000-0001-7636-6285
Elisabetta PoluzziDepartment of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
Francesco TrottaItalian Medicines Agency (AIFA), Rome, Italy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimThis study builds on the environmental risk analysis presented in the 2022 National Report on Medicines Use in Italy by the Italian Medicines Agency and aims to assess the environmental risk posed by medicines in Italy and its regions.

methodsThe analysis selected 90 medicines based on three criteria: high utilization, low predicted no effect concentration (PNEC), and inclusion or candidacy for the European Watch List. For each medicine, the environmental risk was computed as the ratio between the predicted environmental concentration (PEC) and the PNEC. The PEC was derived following the approach of the Swedish Association of Pharmaceutical Industries and Italian drug utilization data. The risk was classified high if the ratio was greater than 10 and moderate if greater than 1.

resultsOverall, 13 medicines were identified as posing a high risk, including cardiovascular agents, antibiotics, analgesics, antidepressants and antiparasitic agents. The high risk was driven by either a very low PNEC (eg, estradiol and lacidipine) or high utilization (eg, amoxicillin, ibuprofen and diclofenac). Regional analysis showed higher risk due to high consumption for azithromycin and ofloxacin in central and southern Italy, and for levonorgestrel in northern Italy.

conclusionThis study points to the need for prioritizing targeted sampling in surface waters for medicines estimated at high risk. To prevent and mitigate the risk, a more conscious clinical practice coupled with appropriate waste management are required.

Indexed as

Environmental ExposureHumansItalyPharmaceutical PreparationsRisk AssessmentPharmaceutical Preparationsdrug safetydrug utilizationenvironmental impact of medicinessustainability of medicines use

Identifiers

PMID40098545
PMCPMC12035592

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.