In this work a step forward in investigating the use of prescription drugs, namely erectile dysfunction products, at European level was taken by applying the wastewater-based epidemiology approach. 24-h composite samples of untreated wastewater were collected at the entrance of eight wastewater treatment plants serving the catchment within the cities of Bristol, Brussels, Castellón, Copenhagen, Milan, Oslo, Utrecht and Zurich. A validated analytical procedure with direct injection of filtered aliquots by liquid chromatography-tandem mass spectrometry was applied. The target list included the three active pharmaceutical ingredients (sildenafil, tadalafil and vardenafil) together with (bio)transformation products and other analogues. Only sildenafil and its two human urinary metabolites desmethyl- and desethylsildenafil were detected in the samples with concentrations reaching 60 ng L-1. The concentrations were transformed into normalized measured loads and the estimated actual consumption of sildenafil was back-calculated from these loads. In addition, national prescription data from five countries was gathered in the form of the number of prescribed daily doses and transformed into predicted loads for comparison. This comparison resulted in the evidence of a different spatial trend across Europe. In Utrecht and Brussels, prescription data could only partly explain the total amount found in wastewater; whereas in Bristol, the comparison was in agreement; and in Milan and Oslo a lower amount was found in wastewater than expected from the prescription data. This study illustrates the potential of wastewater-based epidemiology to investigate the use of counterfeit medication and rogue online pharmacy sales.
Environment international. 2018 Apr 02 [Epub ahead of print]
Ana Causanilles, Daniela Rojas Cantillano, Erik Emke, Richard Bade, Jose Antonio Baz-Lomba, Sara Castiglioni, Erika Castrignanò, Emma Gracia-Lor, Félix Hernández, Barbara Kasprzyk-Hordern, Juliet Kinyua, Ann-Kathrin McCall, Alexander L N van Nuijs, Benedek G Plósz, Pedram Ramin, Nikolaos I Rousis, Yeonsuk Ryu, Kevin V Thomas, Pim de Voogt
KWR Watercycle Research Institute, Chemical Water Quality and Health, P.O. Box 1072, 3430 BB Nieuwegein, The Netherlands; Institute for Biodiversity and Ecosystem Dynamics, University of Amsterdam, P.O. Box 94248, 1090 GE Amsterdam, The Netherlands., Centro de Recursos Hídricos para Centroamérica y El Caribe (HIDROCEC), Sede Regional Chorotega, Universidad Nacional, Costa Rica., KWR Watercycle Research Institute, Chemical Water Quality and Health, P.O. Box 1072, 3430 BB Nieuwegein, The Netherlands., Research Institute for Pesticides and Water, University Jaume I, Avda. Sos Baynat s/n, 12071 Castellón, Spain; School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia., Norwegian Institute for Water Research (NIVA), Gaustadalléen 21, 0349 Oslo, Norway., IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Department of Environmental Health Sciences, Via La Masa 19, 20156 Milan, Italy., University of Bath, Department of Chemistry, Faculty of Science, Bath BA2 7AY, United Kingdom., Research Institute for Pesticides and Water, University Jaume I, Avda. Sos Baynat s/n, 12071 Castellón, Spain; IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Department of Environmental Health Sciences, Via La Masa 19, 20156 Milan, Italy., Research Institute for Pesticides and Water, University Jaume I, Avda. Sos Baynat s/n, 12071 Castellón, Spain., Toxicological Center, Department of Pharmaceutical Sciences, Campus Drie Eiken, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium., Eawag, Swiss Federal Institute of Aquatic Science and Technology, CH-8600 Dübendorf, Switzerland., Department of Environmental Engineering, Technical University of Denmark, Miljøvej, Building 115, DK-2800 Kgs. Lyngby, Denmark; Department of Chemical Engineering, University of Bath, Claverton Down, Bath BA2 7AY, UK., Department of Environmental Engineering, Technical University of Denmark, Miljøvej, Building 115, DK-2800 Kgs. Lyngby, Denmark; Department of Chemical and Biochemical Engineering, Technical University of Denmark, Søltofts Plads, Building 229, DK-2800 Kgs. Lyngby, Denmark., Norwegian Institute for Water Research (NIVA), Gaustadalléen 21, 0349 Oslo, Norway; Queensland Alliance for Environmental Health Science (QAEHS), University of Queensland, 39 Kessels Road, Coopers Plains, QLD 4108, Australia., KWR Watercycle Research Institute, Chemical Water Quality and Health, P.O. Box 1072, 3430 BB Nieuwegein, The Netherlands; Institute for Biodiversity and Ecosystem Dynamics, University of Amsterdam, P.O. Box 94248, 1090 GE Amsterdam, The Netherlands. Electronic address: .