Environmental sustainability—an essential component of rational use of medicines.

This article focuses on the environmental impact of human-use medicines on surface water and proposes a comprehensive decision-making flowchart to mitigate this issue within a sustainability framework. It highlights how pharmaceutical residues enter surface waters throughout the medicines’ life cycle—from manufacturing and consumption to disposal—affecting aquatic ecosystems and potentially human and animal health. The paper emphasizes integrating environmental considerations into the rational use of medicines, guided by the One Health approach, which links human, animal, and environmental health. It reviews existing regulatory measures, such as Environmental Risk Assessments by the European Medicines Agency and the U.S. Food and Drug Administration, and advocates for upstream actions like legislation, education, and green pharmaceutical innovation, alongside downstream measures including advanced wastewater treatment and proper disposal practices. The article underscores the need for coordinated efforts among stakeholders to promote sustainable medicine use while ensuring patient safety.