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Filmdragerad tablett 400 mg
(Rosa, oval tablett, märkt med "227" på ena sidan)

Antivirala läkemedel för systemiskt bruk, övriga antivirala medel.

Aktiv substans:
ATC-kod: J05AX08
Läkemedel från MSD omfattas av Läkemedelsförsäkringen.
  • Vad är miljöinformation?




Miljörisk: Användning av raltegravir har bedömts medföra försumbar risk för miljöpåverkan.
Nedbrytning: Raltegravir är potentiellt persistent.
Bioackumulering: Raltegravir har låg potential att bioackumuleras.

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Detaljerad miljöinformation

Environmental Risk Classification

Predicted Environmental Concentration (PEC)

PEC is calculated according to the following formula:

PEC (μg/L) = (A*109*(100-R))/(365*P*V*D*100) = 1.5*10-6*A(100-R)

PEC = 0.01 μg/L


A = 98 kg (total sold amount API in Sweden year 2018, data from IQVIA) (Ref. I)

R = 0 % removal rate (worst case assumption)

P = number of inhabitants in Sweden = 9 *106

V (L/day) = volume of wastewater per capita and day = 200 (ECHA default) (Ref. II)

D = factor for dilution of waste water by surface water flow = 10 (ECHA default) (Ref. II)

Predicted No Effect Concentration (PNEC)

Ecotoxicological studies

Green Algae (Selenastrum capricornutum) (OECD 201) (Ref. III):

EC50 96 h (growth rate) = 66 mg/L

NOEC 96 h (growth rate) = 3.8 mg/L

Crustacean, water flea (Daphnia magna):

Acute toxicity (OECD 202) (Ref. IV)

LC50 48 h (mortality) > 100 mg/L

Non-toxic up to highest concentration tested

Chronic toxicity (OECD 211) (Ref. V)

NOEC 21 day (reproduction) = 9.5 mg/L

Non-toxic up to highest concentration tested

Fish, fathead minnow (Pimephales promelas):

Acute toxicity (OECD 203) (Ref.VI)

LC50 96 h (mortality) > 100 mg/L

Non-toxic up to highest concentration tested

Chronic toxicity (OECD 210) (Ref. VII)

NOEC 33 days = 9.3 mg/L

Non-toxic up to highest concentration tested

Fish, sheepshead minnow (Cyprinodon variegatus): (OECD 203) (Ref.VIII)

Acute toxicity

LC50 96 h (mortality) > 100 mg/L

Non-toxic up to highest concentration tested

PNEC = 380 µg/L (3.8 mg/L / 10) based on the chronic NOEC for the algae (growth rate) and an assessment factor (AF) of 10)

Environmental risk classification (PEC/PNEC ratio)

PEC/PNEC = 0.01/380 = 3.9E-05, i.e. PEC/PNEC ≤ .1 which justifies the phrase "Use of raltegravir has been considered to result in insignificant environmental risk."


Biotic degradation

Biodegradation Simulation Screening (OECD 314) (Ref. IX)

75% biodegradation by Day 28

8% to CO2 after 28 days

67% to transformation products

DT50 = 9 days

Sediment Transformation (OECD 308) (Ref. X):

DT50 (water) = 6 days

3 - 7% to CO2 after 100 days

A GLP transformation study was conducted to assess the potential biodegradation of raltegravir in aerobic and anaerobic aquatic sediment systems. Two sediments and their associated waters were utilized in both the aerobic and anaerobic segments of the study. Test systems were dosed with 14C-labeled test material at a nominal test concentration of 0.75 mg/L in the aqueous layer and incubated at approximately 20ºC for up to 100 days. Treated sediment-water systems were maintained under a gentle stream of compressed air (aerobic conditions) or nitrogen gas (anaerobic conditions). Effluent gases were passed through a sorbent material to trap organic volatiles, followed by a strong alkali solution to trap evolved CO2 (carbon dioxide). Duplicate incubation chambers of each sediment-water type and condition were sacrificed on Days 0, 14, 28, 49, 70 and 100. Water and sediment samples were analyzed separately for total 14C-radioactivity, parent test substance and radiolabeled metabolites. Analogous anaerobic sediment-water test chambers were also established to assess 14C-methane evolution at regular sampling intervals using a specialized mineralization apparatus and were sacrificed on Day 100 for analysis of total radioactivity and potential metabolites. Untreated test chambers and solvent control chambers were utilized to characterize the sediment-water systems during the study.

Sediment layers were extracted on the day of collection. The weights of the sediment layers, after decanting the overlying waters, were recorded. Sediment layers were quantitatively transferred from the original test vessels into 500-mL HDPE bottles using 200 mL of acidified (2% v/v acetic acid) ethyl acetate. The bottles were placed in an ultrasonic bath for at least five minutes, shaken for at least 30 minutes at 250 rpm on a gyratory shaker table, and then centrifuged at approximately 1200 rpm for five minutes to effect separation. The solvent extracts were decanted and transferred to glass bottles. The sediment layer from each sacrificed test vessel was extracted an additional two times utilizing the same procedure and 100 mL aliquots of the extraction solvent. The three extracts from each sediment layer were combined and the volume recorded. Each combined sediment extract was then transferred to a separate glass bottle and triplicate aliquots of the extracts were removed for analysis by LSC. The bottles were placed in refrigerated storage for up to 14 days before continuing with the method.

The sediment extracts were removed from refrigerated storage, and a measured portion of each extract was transferred to a round-bottom flask. The remaining sediment extracts were placed in refrigerated storage. The samples were rotary-evaporated until all solvent had been removed, and only the acidic aqueous portion remained. The concentrated extracts were transferred to graduated cylinders, and the volumes recorded. The round-bottom flasks were rinsed three times with small volumes (1 to 2 mL) of acetonitrile (ACN), and the rinses were combined with the concentrated extracts. The round-bottom flasks were then rinsed three times with small volumes (2 to 4 mL) of water. The water rinses were combined with the concentrated extracts, and the final volumes were recorded. Concentrated sediment extracts were transferred to glass vials, and triplicate aliquots were removed for LSC analysis to determine the total radioactivity associated with the concentrated samples. A portion of each extract was transferred to an auto-sampler vial for radiolabeled distribution analysis by HPLC/β-RAM. The remaining concentrated sediment extracts were placed in refrigerated storage.

The weights of the sediment solids remaining after the acidified ethyl acetate procedures were determined. Five sub-samples from each sediment were removed and weighed for combustion analyses using a PerkinElmer Model 307 Sample Oxidizer. The combusted samples were analyzed by LSC to determine total radioactivity associated with the solids and complete subsequent mass balance calculations. The remaining sediment solids were placed in refrigerated storage.

The Day 100 mass balance for the aerobic test systems is presented below (Table 1).

Table 1
Day 100 Mass Balance Results for the Aerobic Sediments
in the OECD 308 Study

Day 100 Mass Balance

Brandywine – aerobic

Choptank – aerobic

% to CO2



Aqueous Total %

- As parent

- As metabolites







Sediment Extractable Total %

- As parent

- As metabolites







Sediment Non-Extractable %



Total %



Ultimate biodegradation occurred to a limited extent in both the aerobic and anaerobic systems. The maximum percentage transformed to CO2 was 7.6% in the Choptank aerobic test system. At the completion of the OECD 308 study, the majority of the mass was found in the sediment portion (both sediment extractable and non-extractable). For the Brandywine test system, at Day 100, only 3.1% of the total radioactivity remained in the aqueous phase, all as metabolites. In the Choptank test system, a greater percentage remained in the aqueous phase (32.3%) but similarly, the majority component as a mixture of metabolites (29.8% vs. 2.5%). Based on quantification of the HPLC results, no individual metabolites were present at quantities > 10%.

For the sediment extractable portion at Day 100, 22.9% (Brandywine) and 24.8% (Choptank) of the total radioactivity remained, with the majority (20.8% and 22.2%) as parent. For the sediment non-extractable portion, 61.4% and 31.9% of total radioactivity was measured at the end of the study in Brandywine and Choptank, respectively. The decreasing amount of parent observed in the sediment extractable fraction was a function of the increase in the non-extractable residue over time. DT50 values calculated with the sediment data represent adsorption kinetics and the length of time for 50% of the applied activity to become irreversibly bound. DT50 values for this physical process were 90 days, 90 days and 182 days for Brandywine Creek anaerobic, Choptank River aerobic and Choptank River, anaerobic, respectively.

The times of disappearance of 50 percent of the parent (DT50) from the aqueous layers in the sediment-water systems were 6.4 to 6.5 days and 5.2 to 6.8 days in the aerobic and anaerobic test systems, respectively.

Abiotic degradation

Photolysis (Phototransformation of Chemicals in Water – Direct and Indirect Photolysis, OECD Guideline for Testing of Chemicals, Proposal for a New Guideline,) (Ref. XI)

Test results indicate a “definite potential for phototransformation at 295 – 800 nm” based on molar absorption.

Justification of chosen degradation phrase:

Given the total system half-life was not calculated in the Sediment Transformation study (OECD 308), the phrase raltegravir is potentially persistent was chosen.


Partitioning coefficient:

Log Dow = -0.3 at pH 7 (OECD 107). (Ref.XII)

Justification of chosen bioaccumulation phrase:

Since log Dow < 4 at pH 7, the substance has low potential for bioaccumulation.


  1. Data from IQVIA ”Consumption assessment in kg for input to environmental classification - updated 2019 (data 2018)”.

  2. ECHA, European Chemicals Agency. 2008 Guidance on information requirements and chemical safety assessment. http://guidance.echa.europa.eu/docs/guidance_document/information_requirements_en.htm

  3. Wildlife International, 2006. "MK-0518: A 96-Hour Toxicity Test with the Freshwater Alga (Pseudokirchneriella subcapitata)," Study No., 105C-111, WIL, Easton, MD, USA 04 May 2006.

  4. Toxikon, 2004. "48-Hour Acute Toxicity Test Conducted Utilizing L-000900612 on the Water Flea, Daphnia magna," Study No. 040242N4, TOXIKON, Jupiter, FL, November 2004.

  5. Wildlife International, 2007. "MK-0518: A Flow-Through Life Cycle Toxicity Test with the Cladoceran (Daphnia magna)," Study No., 105A-151, WIL, Easton, MD, USA, 02 February 2007.

  6. Toxikon, 2004. "96-Hour Acute Limit Toxicity Test Conducted Utilizing L-000900612 on the Fathead minnow, Pimephales promelas," Study No. 040242N3, TOXIKON, Jupiter, FL, November 2004.

  7. Wildlife International, 2007. "MK-0518: An Early Life-Stage Toxicity Test with the Fathead Minnow (Pimephales promelas)," Study No., 105A-152, WIL, Easton, MD, USA, 22 January 2007.

  8. Toxikon, 2004. "96-Hour Acute Limit Toxicity Test Conducted Utilizing L-000900612 on the Sheepshead minnow, Cyprinodon variegatus," Study No. 040242N5, TOXIKON, Jupiter, FL, November 2004.

  9. Wildlife International, 2007. "MK-0518: Dieaway in Activated Sludge," Study No., 105E-112, WIL, Easton, MD, USA, 02 March 2007.

  10. Wildlife International, 2007. "MK-0518: Aerobic and Anaerobic Transformation in Aquatic Sediment Systems," Study No., 105E-116, WIL, Easton, MD, USA, 23 July 2007.

  11. Wildlife International, 2006, "Phototransformation Potential of MK-0518," Study No., 105C-109, WIL, Easton, MD, USA, 13 October 2006.

  12. Wildlife International, 2012. “Determination of the n-octanol/water partition coefficient of MK-0518 by the shake flask method,” Study No. 105C-148, WIL, Easton MD, USA, 15 May 2012.