Investigating the presence, distribution and risk of pharmaceutically active compounds (PhACs) in wastewater treatment plants, river sediments and fish.

The increasing consumption of medicines and the lack of efficient technologies in wastewater treatment plants (WWTPs) can release pharmaceutically active compounds (PhACs) into any given river with the subsequent risk to the environment and human health. To assess the occurrence and transfer pathways of PhACs through the river ecosystem, 22 PhACs and one metabolite were analyzed in WWTPs, river sediments and fish collected alongside the Tagus River basin between 2020 and 2022. All the matrices presented at least two drugs being azithromycin the only one quantified in all of them. Analgesics, anti-inflammatories, antihypertensives, antidepressants and beta-blockers were the main PhACs in influents, with median concentrations up to 19 μg/L. In effluents, antihypertensives and antidepressants were the PhACs with the highest contribution. For acetaminophen, ibuprofen, ketoprofen, naproxen, atorvastatin, azithromycin, clarithromycin, sulfamethoxazole, trimethoprim, and valsartan WWTPs treatments reached removal efficiencies above 75%. Compounds with a high tendency to bind to organic matter were retained in sludge (clotrimazole, 96 ng/g before digester, 100%). However, results showed that applied treatments were not effective in removing PhACs from this matrix. Although the total mass balance revealed a high removal rate of some PhACs, many of them were still present in the effluent and their release into rivers became the main source of PhAC pollution of the aquatic ecosystem. The most hydrophobic ones (irbesartan, 24 ng/g, 61%), positively charged (o-desmethylvenlafaxine, 95 ng/g, 68%) and those with affinity to organic matter (clotrimazole, 21 ng/g, 61%) reached sediment samples. Only clotrimazole (7.8 ng/g) and azithromycin (160 ng/g) were found in fish samples. Risk assessment revealed a high risk for (i) acetaminophen, clarithromycin, erythromycin A, and venlafaxine in phototrophic organisms and (ii) acetaminophen and venlafaxine in fish.