Pharmaceutical Waste Management in Pharmacies in Zagreb

Aim The main goal was to study pharmaceutical waste (drugs that were unsold, as of their expiration date, and drugs disposed by patients in pharmacies) disposal by using data from pharmacies in the City of Zagreb, Republic of Croatia. Subsequently, we also tried to determine which drugs and their therapeutical groups were disposed of, the amount of prescription drugs and OTC (Over the Counter) drugs disposed, and the cost of their disposal. Methods The research included 51 of the overall 208 pharmacies in Zagreb (Agency for Medicinal Products and Medicinal Devices of Croatia, Publication. 2014.), which had a population of 795.505 inhabitants, almost a quarter of the whole population of Croatia (Croatian Bureau of Statistics – Republic of Croatia, Publication. 2014.). Pharmaceutical waste was collected in pharmacies from April 14 to May 14, 2014. After collection, the drugs were sorted using Anatomical Therapeutic Chemical Classification (ATC) into different therapeutical groups, noting them in an electronic formular for waste recording in each pharmacy (). We also used Register of Medicines as a source for prices of medicines (Lejla Bencaric, Register of Medicines in Croatia. Zagreb. 2014.) as well as internal data from companies whose core business was pharmaceutical waste disposal as the source for cost of its disposal. Results During the research, pharmacies collected 291.56 kilograms of pharmaceutical waste, containing 6289 medicine packings, including tablets and other formulations of drugs. 4549 (72.3%) of them were prescription drugs and 1740 (27.7%) were OTC drugs. Of all the pharmaceutical units, there were more prescribed medicines than OTCs (). The majority of the pharmaceutical waste drugs included Cardiovascular system (17.8%), Alimentary tract and metabolism (14.5%) and Nervous system (12.4%) according to ATC (). In the first group, the most prevalent drugs were the antihypertensives atenolol and amlodipine. In the second group, the leading drug was ranitidine, followed by insuline and metmorphine. Among the antibiotic drugs, amoxiciline in combination with clavulonic acid was the most reported. Among OTCs, acetylsalicylic acid was the most often evidented substance. Overall, results showed a strong correlation between drugs mostly prescribed by physicians and those evidented in pharmaceutical waste. We estimated the total cost of managing pharmaceutical waste to be 132,194 €. Conclusion Although the practice of disposing medicines through pharmacies is well regulated, its cost is high, especially when we know that most of it is consisted of prescribed drugs. This reflects patients’ non‐compliance or misunderstanding of directions in regard to drug use, showing us that the level of cooperation in drug treatment between patients and their physicians has room for improvement. Support or Funding Information This research had support from “Gradska ljekarna Zagreb”. Number of packages of prescription medicines (Rx) and OTCs per each pharmaceutical unit Unit Rx OTC 1 53 44 2 34 6 3 23 11 4 51 32 5 87 46 6 94 48 7 53 15 8 25 7 9 89 27 10 215 103 11 98 45 12 43 22 13 31 28 14 25 5 15 78 47 16 42 20 17 81 16 18 262 69 19 146 46 20 50 17 21 62 39 22 70 25 23 64 22 24 31 9 25 87 54 26 248 71 27 177 71 28 42 16 29 26 7 30 26 11 31 217 92 32 35 28 33 29 6 34 137 108 35 92 38 36 68 33 37 185 105 38 40 3 39 66 4 40 23 6 41 186 46 42 49 8 43 89 13 44 83 28 45 129 69 46 151 16 47 126 51 48 186 53 49 101 20 50 66 13 51 78 21 Total Rx or OTC 4549 1740 Total Rx+OTC 6289 Number of packages of collected medicines sorted according to Anatomical Therapeutic Chemical Classification Code Anatomical main group Number of packages A Alimentary tract and metabolism 913 B Blood and blood foaming organs 273 C Cardiovascular system 1120 D Dermatological 563 G Genito‐urinary system and sex hormones 184 H Systemic hormonal preparations, excluding sex hormones and insulins 94 J Antiinfectives for systemic use 512 L Antineoplastic and immunomodulating agents 15 M Musculo‐skeletal system 651 N Nervous system 780 P Antiparasitic products, insecticides and repellents 0 R Respiratory system 592 S Sensory organs 496 V Various 96 Total number of packages 6289