Promoting Sustainable Prescribing-A Case Study Presenting Experiences From Two Swedish Drug and Therapeutics Committees.

During the past two decades, it has become evident that pharmaceuticals is an emerging environmental problem. In this study, we present the experiences from two Swedish Drug & Therapeutics Committees (DTCs) on how they integrate environmental considerations into their formularies and continuous professional education activities. A cross sectional study was performed describing activities to promote sustainable prescribing conducted during two decades by the DTCs in the Swedish regions of Gävleborg and Västernorrland, along with trends in sales of diclofenac and fluoroquinolones between 2000 and 2024. The two DTCs integrate environmental considerations in their formularies and continuous professional education activities. Further acitivities include monitoring of prescribing, dialogue with water suppliers and pharmacies, as well as information and communication to the general public. The total utilization of diclofenac for systemic use peaked with 127 kg in Gävleborg and 137 kg in Västernorrland in 2011, after which the amounts declined. The topical formulations were mainly sold as over-the-counter and increased until 2016, when it started to decline. The amounts of ciprofloxacin and norfloxacin increased until 2012 when they started to decline. This case study from two Swedish regions illustrates how environmental considerations can be incorporated into the DTC's mission to promote rational and responsible medication use. We believe it may be valuable for different stakeholders to show potential ways in how to promote a more sustainable use of medicines.