Pharmaceutical Waste Management in Pharmacies in Zagreb
Authors: Bosnjak Marija , Bosnjak Ivan , Drmic Domagoj 
Published: November 2023

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 (Figure 1). 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 (Table 1).

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 (Table 2). 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