Preserving planetary health through pharmacology: A call to action on eco-pharmacovigilance and green medicines

INTRODUCTION

Pharmacology today faces a dual responsibility: Preserving human health and protecting the environment. The unchecked release of pharmaceuticals into ecosystems has emerged as a silent crisis, demanding urgent intervention from pharmacologists.

Facing the hazardous consequences produced by pharmaceutical pollution as depicted in Figure 1, it is essential to evaluate every stage of a medicine’s life, from synthesis and packaging to safe disposal. Expired, unused or damaged drugs constitute pharmaceutical waste, and improper disposal can cause irreversible environmental and public health damage. ^[1-3]

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Figure 1:

Hazardous consequences produced by pharmaceutical pollution.

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As editors and pharmacologists, we emphasise that the success of our discipline ^[4,5] should reflect not only therapeutic outcomes but also ecological stewardship. This editorial is a collective call for integrating EPV and green pharmaceutical practices as professional imperatives [Figure 2].

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Figure 2:

The pharmacologist’s role in eco-pharmacovigilance.

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CONCERNS: PHARMACEUTICALS AS ENVIRONMENTAL POLLUTANTS

Pharmaceutical compounds have been detected in water bodies and agricultural runoff worldwide.^[6] Residues of antibiotics, antidepressants and analgesics alter aquatic ecosystems ^[7] and fuel antimicrobial resistance (AMR). For example, fluoxetine changes fish behaviour, while tramadol disrupts migratory species. Wastewater plants fail to remove many drug residues, and surveys from India show alarming contamination levels in rivers.

Biomagnification of diclofenac in vultures^[8] led to population collapse due to eggshell thinning. Surveys in India have found higher concentrations of pharmaceuticals in rivers^[9] illustrating how human medicines affect biodiversity.

An additional critical concern is pharmaceutical packaging, which predominantly consists of blister packs, multilayer laminates, and plastic containers, the majority of which are nonbiodegradable and contribute substantially to environmental waste. These materials pollute landfills and oceans, fragment into microplastics, and infiltrate the food chain. Addressing packaging waste is critical for comprehensive sustainability.

THE PROMISE OF ECO-PHARMACOVIGILANCE (EPV)

EPV is not theoretical–it is applied science. It builds on pharmacovigilance principles to detect, evaluate and prevent environmental harm caused by drugs.^[10] EPV promotes:^[11]

• Environmental sustainability

• Rational medicine consumption

• Safe disposal of unused drugs

• Minimisation of manufacturing residues.

However, EPV cannot succeed without public participation. Awareness campaigns and responsible disposal practices are essential to secure its long-term impact.^[12]

THE SHIFT TOWARD GREEN PHARMACEUTICALS

Global focus is shifting toward green pharmaceutical practices^[13] which aim to reduce environmental impact without compromising efficacy. Figure 3 illustrates a three-pronged approach to greener pharmaceuticals. The European Federation of Pharmaceutical Industries and Associations advocates:^[14]

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Figure 3:

Greener pharmaceuticals: A three-pronged approach.

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• Reducing greenhouse gas emissions

• Investing in renewable energy and clean technology

• Enhancing resource efficiency and circular economy models

• Promoting collaboration and knowledge sharing

• Minimising environmental impact while ensuring therapeutic effectiveness.

Sustainable packaging is integral to this transition. Paper-based blister packs, recyclable plastics, compostable laminates and bulk dispensing systems represent promising solutions.

REGULATORY MOMENTUM: A GLOBAL PERSPECTIVE

A lot of regulations are also being put into place in relation to EPV. The World Health Organisation in 2024 published the first-ever guidance on antibiotic pollution from manufacturing. This step of wastewater and solid waste management for antibiotic manufacturing underlines a neglected aspect contributing to antibiotic resistance.^[15]

In the European Union, an environmental risk assessment (ERA) is mandatory before a drug is launched in the market.^[11]

Unfortunately, in India, the concept of EPV is still at a very nascent stage. The issue of the environmental effects of drug utilisation has not yet been given its due importance. This situation needs to change with immediate effect, especially with the launch of the ‘One Health’ concept, which took centre stage in the G20 summit that was in New Delhi (2023). The concept was applied to address the issue of AMR.^[16]

OVERCOMING BARRIERS

Despite the growing recognition of EPV, its implementation continues to be hampered by three persistent challenges. First, there is a significant lack of long-term, multidisciplinary data on the environmental impact of pharmaceuticals. Most existing research focuses on human safety, leaving substantial knowledge gaps about the ecological consequences of drug residues on biodiversity, food chains and soil health. Second, our current wastewater treatment infrastructure is not equipped to remove many pharmaceutical compounds, especially in low- and middle-income countries. Technologies that can break down or capture active pharmaceutical ingredients (APIs) remain expensive, underdeveloped or inaccessible at scale. Third, there is a glaring deficiency in public awareness. Many consumers remain unaware of the consequences of flushing unused medicines or discarding them improperly. These issues demand a concerted, forward-looking response. We call for the establishment of national and international research consortia to deepen our understanding of pharmaceutical ecotoxicology. At the same time, public and private investment must be mobilised to upgrade wastewater treatment systems using advanced, environmentally safe technologies. Finally, targeted public education campaigns and professional development initiatives must be rolled out to equip healthcare providers, pharmacists and the general population with the knowledge and motivation to engage in responsible pharmaceutical practices.

RECOMMENDATIONS: PATHWAYS TO SUSTAINABILITY

To mitigate these concerns, a multi-pronged strategy is needed that focuses on pharmaceutical products in their entirety, beyond the environmental, social and governance framework. Our recommendations include:

• Incorporating ERAs into early drug development.

• Promoting green chemistry principles and biodegradable API design.

• Developing sustainable packaging solutions such as recyclable plastics, paper-based blister packs and compostable alternatives.

• Investing in advanced wastewater treatment and green manufacturing technologies.

• Integrating EPV into pharmacology curricula and professional training.

• Launching public awareness campaigns on safe medicine disposal and responsible prescribing.

• Encouraging interdisciplinary collaborations between pharmacologists, packaging technologists, environmental scientists and policymakers.

THE PHARMACOLOGIST’S ROLE: LEADING FROM THE FRONT

Pharmacologists can no longer afford to remain passive observers in the conversation on pharmaceutical sustainability; we must lead from the front. As scientists trained in the mechanisms of drug action and metabolism, we are uniquely positioned to champion environmental stewardship in medicine. This includes active involvement in drug design, manufacturing and packaging innovations to minimise environmental footprints.

It is time to redefine our identity, expanding our role beyond the laboratory and the clinic to include planetary guardianship. Academic pharmacology departments should also engage in research on eco-friendly packaging solutions and collaborate with industry to bring them to market.

CONCLUSION: FROM HEALING HUMANS TO HEALING SYSTEMS

In the face of escalating environmental threats, pharmacology must evolve into a discipline that balances therapeutic advancement with environmental responsibility. EPV is not a theoretical concept but an urgent necessity, and green pharmaceutical practices – including sustainable packaging – are central to this transformation. By embedding ecological consciousness into every phase of the pharmaceutical life cycle – from synthesis and formulation to packaging, prescribing and disposal – we ensure that the benefits of modern medicine do not come at the expense of planetary health. Let pharmacology emerge not only as a science of medicines but also as a science of sustainable healing – for people and the planet alike.