Prescribing drugs: Environmental aspects

Environmental awareness is becoming increasingly important in medical practice. A key area of action is preventing the entry of pharmaceuticals into the environment, as their residues are increasingly detected across all environmental media, particularly in water bodies, where they have undesirable effects on flora and fauna.

Further information:

• Entry and occurrence of human pharmaceuticals in the environment
• Environmental effects of pharmaceutical substances
• Environmental aspects of the authorisation of human medicinal products

The medical profession can make a significant contribution to environmental protection by considering not only the therapeutic effectiveness of treatments but also their environmental impact. There are various ways to integrate environmental aspects into medical practice—without compromising patient health or restricting doctors' therapeutic freedom.

Environmental Checklist for Prescribing and Dispensing Medications

How can I, as a medical professional or pharmacist, contribute to reducing the input of pharmaceuticals into the environment?

Source: CC-BY 4.0 German Environment Agency, Ecologic Institute 2023

One key approach lies in prevention and strengthening all bodily systems, such as the cardiovascular and immune systems. This primarily involves preventive measures such as vaccinations, exercise prescriptions, health apps, invitations to preventive check-ups, and nutritional counselling. It is important to inform patients that immune system strengthening should not be seen as the sole solution for disease prevention. Rather, these measures contribute to overall health promotion and should be considered as part of a holistic treatment approach.

Additionally, non-medicinal treatments should be considered whenever possible and appropriate. Another crucial aspect is assessing the necessity of medications. It is worth considering whether prescribing and using a medicine can be postponed if non-medicinal approaches or home remedies could be equally effective without disadvantages.

For example, in mild cases of sleep disorders, recommending good sleep hygiene practices—such as maintaining a regular sleep schedule and reducing stress—could be prioritised before prescribing sleeping pills. Similarly, for mild pain, physiotherapy or acupuncture may be viable alternatives to painkillers.

Ultimately, the decision to prescribe medication should always be based on ensuring the best possible care for the patient.

A thorough approach to medical diagnosis and treatment is crucial to avoid overprescription and misprescription, which can unnecessarily burden the environment. By conducting a detailed medical history and continuously monitoring treatment progress, medication dosages and quantities can be optimised—for example, through regular monitoring of laboratory results and symptoms.

A targeted review of medications to identify non-essential drugs is another important step in reducing both the number and volume of prescribed medicines. Doctors could, for instance, conduct a medication review for older patients or request a medication analysis from a pharmacy to minimise the number of medications and reduce potential side effects and drug interactions. This process of "deprescribing" should be carried out carefully, always prioritising patient well-being.

Additionally, alternative application forms can help limit the amount of pharmaceutical substances released into the environment. For example, transdermal patches could be prescribed instead of topical pain relief gels for muscle or joint pain. Parenteral administration (e.g. injections or infusions) generally offers better dosage control, fewer side effects, and lower environmental impact. However, these are often not self-administered and are unpopular in use. In addition, many active substances are not available in parenteral forms of administration. Furthermore, prescribing smaller pack sizes can help reduce pharmaceutical waste. Patients should be thoroughly informed about proper medication use, dosage, and treatment duration, as well as the environmentally responsible disposal of any leftover medicines.

Further information: Environmentally friendly disposal of leftover drugs

Environmental aspects of different methods of administration of pharmaceuticals

The forms of administration and their different dosages influence how much active pharmaceuticals are released into the environment.

Source: CC-BY 4.0 German Environment Agency, Ecologic Institute 2023

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Diclofenac: Influence of pharmaceutical form and wastewater treatment on the discharge into the envi

Comparison: transdermal patch – tablet – gel (with/without wiping hands)

Source: CC-BY 4.0 German Environment Agency, CAU Kiel, Ecologic Institute 2024

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Diclofenac: Influence of the pharmaceutical form and wastewater treatment on the discharge into 2/2

Data values [mg] with references

Source: CC-BY 4.0 German Environment Agency, CAU Kiel, Ecologic Institute 2024

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Using pharmaceutical substances that degrade more effectively in sewage treatment plants and the environment or have lower environmental toxicity is another important approach. From an environmental perspective, it would be beneficial if doctors prioritised more environmentally friendly medicines whenever possible.

A publicly accessible environmental information and classification system for pharmaceuticals could support this effort. In Sweden, the "Kloka Listan" (in Swedish) and the Janusinfo portal (in English) serve this purpose. These platforms help doctors identify environmentally friendlier pharmaceutical alternatives and access information on the environmental impact of specific medicines.

Currently, Germany lacks such a database. But in a recent project the feasibility analysis for the implementation of an environmental information and classification system in Germany („Arzneimittelindex Umwelt“) was investigated. However, environmental risk assessments for certain pharmaceuticals can be found in the professional drug information available through medical practice software. Specifically, sections 5.3 (Preclinical Safety Data) and 6.6 (Disposal Information) indicate whether a pharmaceutical has been classified as environmentally harmful.

Additionally, exchange among medical and pharmaceutical professionals regarding the environmental relevance of prescribed medicines, application forms, and packaging sizes is an important step toward more conscious prescribing. Through discussion and knowledge-sharing, doctors and pharmacists can benefit from each other’s expertise and improve the consideration of environmental factors when prescribing and dispensing medicines.

Further information: Prescribing Drugs: Environmental aspects

Toxicity of active substances to aquatic organisms (02.2025)

The toxicity of active substances in a group varies.

Source: CC BY 4.0 German Environment Agency 2025

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