Abstract Body

Introduction

In general practice, the greatest CO₂ emission (49%) is caused by pharmaceuticals. Also, pharmaceutical residues in effluents can lead to ecotoxicity. Adding sustainability as an extra criterium to achieve advices of good quality in guidelines is therefore urgently needed. Many doctors are motivated to work more sustainable, but are hindered by lack of knowledge. Our goal was to give information on environmental impact of pharmaceuticals in two Dutch guidelines: ‘Asthma in adults’ and ‘Anaemia’.

Methods

During the development of both guidelines, we collected published data on environmental impact of pharmaceuticals, information on pharmaceutical ingredients and additives from the Summary of Product Characteristics (SMPC) of each registered drug and used information on environmental impact from the Swedish website www.fass.se. We consulted an expert on environmental impact of greenhouse gases used in MDI’s for the treatment of asthma. For the impact of residues of iron supplements on water we consulted a toxicologist and pharmacist.

Results

Sustainability was used as one of the criteria for therapeutical advice in both updated guidelines. We added information on the negative impact of MDI’s when choosing an inhaler for the treatment of asthma. We preferred ferrous fumarate tablets for the treatment of iron deficiency and advised against the use of ferrous sulfate slow release tablets that are not fully biodegradable.

Conclusion

Implementing environmental impact of pharmaceuticals in guidelines through a multidisciplinary approach, can be an effective way of increasing knowledge on sustainability of pharmaceuticals and can give doctors tools to prescribe more environmentally friendly.