Analysis of 44 pharmaceuticals consumed by elderly using liquid chromatography coupled to tandem mass spectrometry.

Elderly people represent about the 15% of the total world population and often include a polymedicated age group with an average consumption of 5-10 pills per day. The main pharmaceuticals consumed are antianalgesics, antidiabetics, anti-parkinson compounds, anti-convulsants, drugs to treat constipation and drugs to treat cancer. In this study, we have developed a multiresidue method for the analysis of 44 selected pharmaceuticals prioritized according to the foremost consumption by the elderly in effluents from senior residences. Given the complexity of these waters, method optimization included the selection of the extraction cartridge, pH and volume, and the optimization of the liquid chromatography-tandem mass spectrometry conditions to minimize matrix effects and obtain high yields. Good method performance was obtained, with recoveries between 27 and 116% and high sensitivity. The method was tested in a preliminar study to determine pharmaceuticals released in situ from the untreated effluents of the senior residences. High concentrations were detected, with levels between 0.20 and 2891 µg L-1 attributed to the high consumption of drugs in the studied residences, which gather around 100 residents. The most detected pharmaceuticals were aspirin, macrogol, levofloxacin, cyclophosphamide, diclofenac, ibuprofen, paracetamol, carbamazepine, levetiracetam, pregabalin, quetiapine, chlormetiazole, trazodone, caffeine, 2,4-dichlorobenzyl alcohol and amylmetacresol. This study describes the analytical conditions to determine the outmost consumed pharmaceuticals in wastewaters released from senior residences.

Pharmaceuticals released from senior residences: occurrence and risk evaluation.

One of the main pursuits, yet most difficult, in monitoring studies is to identify the sources of environmental pollution. In this study, we have identified health-care facilities from south European countries as an important source of pharmaceuticals in the environment. We have estimated that compounds consumed in by the elderly and released from effluents of senior residences can reach river waters at a concentration higher than 0.01 µg/L, which is the European Medicines Agency (EMA) threshold for risk evaluation of pharmaceuticals in surface waters. This study has been based on five health institutions in Portugal, Spain, and France, with 52 to 130 beds. We have compiled the pharmaceuticals dispensed on a daily base and calculated the consumption rates. From 54.9 to 1801 g of pharmaceuticals are consumed daily, with laxatives, analgesics, antiepileptics, antibiotics, and antidiabetic agents being the main drug families administered. According to excretion rates, dilution in the sewerage system, and elimination in wastewater treatment plants, macrogol, metformin, paracetamol, acetylcysteine, amoxicillin, and gabapentin, among others, are expected to reach river waters. Finally, we discuss the risk management actions related to the discharge of pharmaceuticals from senior residences to surface waters.