4 ms·

> Shouldn't we be placing the blame on people flushing meds down the toilet? Obviously, people shouldn't do that. But some antibiotics go through the body almo

> Shouldn't we be placing the blame on people flushing meds down the toilet? Obviously, people shouldn't do that. But some antibiotics go through the body almost unchanged. When penicillin was first developed they used to recycle the antibiotic from the patient's urine over and over because they had so little of it.

deleted 5y ago
[deleted]
Scoundreller 5y ago
And if you didn’t pee it out, it wouldn’t get to the right spot to treat a urinary tract or kidney infection.
- sandworm101 5y ago
  If you didn't pee it out it would remain in your system longer, limiting treatment options if it is in any way toxic. Or, if you don't pee it out it might over time break down into more toxic substances.
  - thaumasiotes 5y ago
    > if it is in any way toxic That's its whole purpose. Just look at the name "antibiotic"...
    - dgoldstein0 5y ago
      Toxic to bacteria is different than toxic to humans cells
  - Scoundreller 5y ago
    Or break down into less toxic substances, or things that are more likely to get excreted.
  - moralestapia 5y ago
    There's only one way out*, so you always pee it out somehow. * Ignoring minute traces of minerals that are lost through transpiration
gumby 5y ago
Typically > 90% of any drug taken orally is immediately discharged through the first pass metabolism (urine primarily, and breath and feces).* The body is good at disposing of substances it isn't looking for, especially when ingested. There are a lot of scare stories about the result (male fish in the Great Lakes with ovaries; therapeutic levels of antidepressants in the Edinburgh water supply, etc) but this is the first article I've seen that talks about the path. Because of this so-called "first path" effect you end up taking enough that hopefully some (and enough) "gets to the required location" and not too much gets where it's not wanted (most of what counts as "side effects"). The approval process focuses on this and ignores anything excreted, which shouldn't be surprising: with few exceptions the process is #1 safety and #2 minimal clinically effective dosing. * former pharmaceutical scientist; have designed protocols approved by the FDA.
- Scoundreller 5y ago
  Uhhh, isn’t first pass metabolism a metabolic pathway, not an excretion one? In other words, it’s the liver taking a first crack at breaking things down enzymatically at anything absorbed before it gets distributed around to post-liver bloodstream?
  - gumby 5y ago
    gut -> liver yes, but the relevant comment I was responding to was about how much dosage does not provide therapy and how it ends up in the water.
  - refurb 5y ago
    Exactly. Excretion of a drug unchanged is actually pretty rare. Most drugs get metabolized to something else before excreted.
    - gumby 5y ago
      Definitely (you can't generally pass anything through the liver without something happening to it) Unfortunately many metabolites also have some effects (as with the fish example)
idealstingray 5y ago
> Obviously, people shouldn't do that. I'm not sure this is obvious or even particularly well-publicized. The "official recommendation" in the U.S. for many meds is that they be flushed down the toilet, especially scheduled/controlled substances. The FDA maintains a "flush list" [1] of medications that you are specifically instructed to dispose of by flushing. However, even for medications not on the official flush list, it's common to be informed by reasonable authorities that you should dispose of them by flushing -- e.g. I had to sign paperwork at my doctor's office affirming that I'd responsibly dispose of my unused ADHD meds by flushing them down the toilet before my dr would write the prescription. This was seconded by the drug/alcohol training I was given as a condition of attending college, which stated that you should flush all unused medication. [1]: https://www.fda.gov/drugs/disposal-unused-medicines-what-you-should-know/drug-disposal-fdas-flush-list-certain-medicines#FlushList https://www.fda.gov/drugs/disposal-unused-medicines-what-you...
- yencabulator 5y ago
  Even more annoyingly, US pharmacies often refuse to accept leftover medicines for proper disposal. They'll hand out packets of stuff that makes opioids unusable to addicts, that's all. Back in Europe, you could just hand off your unused meds to the local pharmacy and rest assured they'll be handled more responsibly.

deleted 5y ago

[deleted]

Scoundreller 5y ago

And if you didn’t pee it out, it wouldn’t get to the right spot to treat a urinary tract or kidney infection.

sandworm101 5y ago
If you didn't pee it out it would remain in your system longer, limiting treatment options if it is in any way toxic. Or, if you don't pee it out it might over time break down into more toxic substances.
- thaumasiotes 5y ago
  > if it is in any way toxic That's its whole purpose. Just look at the name "antibiotic"...
  - dgoldstein0 5y ago
    Toxic to bacteria is different than toxic to humans cells
- Scoundreller 5y ago
  Or break down into less toxic substances, or things that are more likely to get excreted.
- moralestapia 5y ago
  There's only one way out*, so you always pee it out somehow. * Ignoring minute traces of minerals that are lost through transpiration

gumby 5y ago

Typically > 90% of any drug taken orally is immediately discharged through the first pass metabolism (urine primarily, and breath and feces).* The body is good at disposing of substances it isn't looking for, especially when ingested. There are a lot of scare stories about the result (male fish in the Great Lakes with ovaries; therapeutic levels of antidepressants in the Edinburgh water supply, etc) but this is the first article I've seen that talks about the path. Because of this so-called "first path" effect you end up taking enough that hopefully some (and enough) "gets to the required location" and not too much gets where it's not wanted (most of what counts as "side effects"). The approval process focuses on this and ignores anything excreted, which shouldn't be surprising: with few exceptions the process is #1 safety and #2 minimal clinically effective dosing. * former pharmaceutical scientist; have designed protocols approved by the FDA.

Scoundreller 5y ago
Uhhh, isn’t first pass metabolism a metabolic pathway, not an excretion one? In other words, it’s the liver taking a first crack at breaking things down enzymatically at anything absorbed before it gets distributed around to post-liver bloodstream?
- gumby 5y ago
  gut -> liver yes, but the relevant comment I was responding to was about how much dosage does not provide therapy and how it ends up in the water.
- refurb 5y ago
  Exactly. Excretion of a drug unchanged is actually pretty rare. Most drugs get metabolized to something else before excreted.
  - gumby 5y ago
    Definitely (you can't generally pass anything through the liver without something happening to it) Unfortunately many metabolites also have some effects (as with the fish example)

idealstingray 5y ago

> Obviously, people shouldn't do that. I'm not sure this is obvious or even particularly well-publicized. The "official recommendation" in the U.S. for many meds is that they be flushed down the toilet, especially scheduled/controlled substances. The FDA maintains a "flush list" [1] of medications that you are specifically instructed to dispose of by flushing. However, even for medications not on the official flush list, it's common to be informed by reasonable authorities that you should dispose of them by flushing -- e.g. I had to sign paperwork at my doctor's office affirming that I'd responsibly dispose of my unused ADHD meds by flushing them down the toilet before my dr would write the prescription. This was seconded by the drug/alcohol training I was given as a condition of attending college, which stated that you should flush all unused medication. [1]: https://www.fda.gov/drugs/disposal-unused-medicines-what-you-should-know/drug-disposal-fdas-flush-list-certain-medicines#FlushList https://www.fda.gov/drugs/disposal-unused-medicines-what-you...

yencabulator 5y ago
Even more annoyingly, US pharmacies often refuse to accept leftover medicines for proper disposal. They'll hand out packets of stuff that makes opioids unusable to addicts, that's all. Back in Europe, you could just hand off your unused meds to the local pharmacy and rest assured they'll be handled more responsibly.