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AstraZeneca

Filmdragerad tablett 5 mg/850 mg
(Bruna, bikonvexa, 9,5 x 20 mm ovala, filmdragerade tabletter med ”5/850” präglat på ena sidan och ”1067” präglat på andra sidan)

Diabetesmedel, Perorala blodglukossänkande medel, kombinationer

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2019-01-21: Viktig säkerhetsinformation
Vid misstanke om den sällsynta men livshotande infektionen Fourniers gangrän (nekrotiserande fasciit i perineum) ska SGLT2-hämmare sättas ut och akut behandling påbörjas.
  • Vad är miljöinformation?

Miljöpåverkan (Läs mer om miljöpåverkan)

Dapagliflozin

Miljörisk: Användning av dapagliflozin har bedömts medföra försumbar risk för miljöpåverkan.
Nedbrytning: Dapagliflozin bryts ned långsamt i miljön.
Bioackumulering: Dapagliflozin har låg potential att bioackumuleras.


Läs mer

Detaljerad miljöinformation


PEC/PNEC = 0.0041/100 = 4.1 x 10-5

PEC/PNEC ≤ 0.1


Environmental Risk Classification


Predicted Environmental Concentration (PEC)


PEC is based on following data and calculated using the equation outlined in the fass.se guidance (Ref 1):


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


PEC (µg/L) = 1.5*10-6*A*(100-R)


A (kg/year) = 27.1 kg, total sold amount API in Sweden year 2016, data from QuintilesIMS Health.

R (%) = removal rate (due to loss by adsorption to sludge particles, by volatilization,

hydrolysis or biodegradation) R = 0.

P = number of inhabitants in Sweden = 9 *106

V (L/day) = volume of wastewater per capita and day = 200 (default, Ref 1)

D = factor for dilution of waste water by surface water flow = 10 (default, Ref 1)

(Note: The factor 109 converts the quantity used from kg to μg).


PEC = 1.5 * 10-6 * 27.1 * (100-0) = 0.0041  μg/L


(Note: Whilst dapagliflozin is metabolised in humans, little is known about the ecotoxicity of the metabolites. Hence, as a worst case, for the purpose of this calculation, it is assumed that 100% of excreted metabolites have the same ecotoxicity as parent dapagliflozin).


Metabolism

Dapagliflozin is rapidly adsorbed and extensively metabolised. Dapagliflozin and its related metabolites are primarily eliminated via urinary excretion with less than 2% as unchanged dapagliflozin (Ref 2). After administration of a 50 mg [14C]-dapagliflozin dose, 96% was recovered, 75% in urine and 21% in faeces. In faeces, approximately 15% of the dose was excreted as parent drug (Ref 3). Therefore, the patient use of dapagliflozin is likely to result mainly in metabolites and, to a lesser extent, the active moiety entering the environment.


Ecotoxicity data

Study Type

Method

Result

Ref

Activated sludge, respiration inhibition test

OECD209

3 h EC50 >200 mg/L

3 h NOEC = 200 mg/L

4

Toxicity to green algae, Pseudokirchinella subcapitata, growth inhibition test

OECD201

72 hour NOECgrowth rate = 37 mg/L

72 hour LOECgrowth rate = 67 mg/L

72 hour EC50growth rate = 120 mg/L

72 hour NOECbiomass = 21 mg/L

72 hour LOECbiomass = 37 mg/L

72 hour EC50biomass = 48 mg/L

5

Acute toxicity to the giant water flea (crustacean) Daphnia magna

OECD202

48 hour EC50 >120 mg/L
48 hour NOEC = 120 mg/L

6

Fish early-life stage toxicity with fathead minnow, Pimephales promelas

OECD210

32 day NOEC = 1.0 mg/L

32 day LOEC > 1.0 mg/L based on hatch, survival, standard length, and dry weight

7

Long-term toxicity to Daphnia magna

OECD211

21 day NOAEC = 10 mg/L based on reproduction and length

8

Long-term toxicity to the sediment dwelling midge, Chironomus riparius 

OECD218

28 day NOEC = 150 mg/kg dry sediment

28 day LOEC > 150 mg/kg dry sediment, based on emergence, development rate and sex ratio

9

EC50 the concentration of the test substance that results in a 50% effect

NOEC no observed effect concentration

NOAEC no observed adverse effect concentration

LOEC lowest observed effect concentration


PNEC (Predicted No Effect Concentration)


Long-term tests have been undertaken for species from three trophic levels, based on internationally accepted guidelines. Therefore, the PNEC is based on the results from the chronic toxicity to fathead minnow (Pimephales promelas), the most sensitive species, and an assessment factor of 10 is applied, in accordance with ECHA guidance (Ref. 10).


PNEC = 1000/10 µg/L = 100 µg/L


Environmental risk classification (PEC/PNEC ratio)

PEC = 0.0041 µg/L

PNEC = 100 µg/L


PEC/PNEC = 4.1 x 10-5


The PEC/PNEC ratio is < 0.1  which justifies the phrase: ‘Use of dapagliflozin has been considered to result in insignificant environmental risk’.


In Swedish: “Användning av dapagliflozin har bedömts medföra försumbar risk för miljöpåverkan” under the heading “Miljörisk”.


Environmental Fate Data

Study Type

Method

Result

Ref

Aerobic biodegradation

OECD301F

11% after 28 days.

Not readily biodegradable

11

Adsorption/desorption to sludge

OPPTS guideline 835.1110

Kd(ads) = 51 L/Kg

Koc = 138 L/Kg

12

Aerobic transformation in aquatic sediment systems

OECD308

  • Mass balance 83-120% of applied radioactivity

  • The half-lives (DT50) in the water 6.0 – 8.7 days

  • The half-lives (DT50) in the sediment ranged 95 - 128 days 

  • Extensive mineralisation (14CO2 formation) observed in both high and low organic matter vessels with 35 and 68% of the applied radioactivity after 99 days

  • Kdsediment = 12 kg/L, based on measured partitioning at 8 days


13

Kd Distribution coefficient for adsorption

Koc Organic carbon normalized adsorption coefficient


Biotic degradation

Dapagliflozin is not readily biodegraded as measured in an OECD 301F study (Ref 11), but based on the Aerobic Transformation in Aquatic Sediment System OECD 308 (Ref 12), dapagliflozin slowly degrades in the environment.


The degradation of dapagliflozin in aquatic sediment systems was assessed according to the OECD 308 Test Guideline. In this test two different sediments were used, one with high organic matter (HOM) and one with low organic matter content (LOM). Radiolabelled test substance was dosed into the overlying water and the subsequent dissipation from the water phase, and partitioning and/or degradation in the sediment, was observed over a 99 day test period. Since mineralisation was very strong the test vessels were kept to monitor CO2 production over 148 days.


The partitioning of dapagliflozin in aquatic sediment systems appears to stop at Day 8 and no further significant amounts of radioactivity moved into the sediment. Afterwards degradation and mineralisation took place, apparently in the water phase.


Transformation of dapagliflozin into a possible seven transformation products was rapid as was partitioning to the sediment. Extensive mineralisation was seen in both the high and low organic matter sediment vessels with 35 and 68%, respectively of the applied radioactivity produced as CO2 after 99 days.


Following extensive sediment extration, using a variety of organic solvents of varying polarity, a significant proportion of the applied radioactivity, 44% in the high organic matter system and 24% in the low organic matter system, on Day 99, remained as non-extractable residue (NER). At Day 99 the amount of applied radioactivity removed from the total system as 14CO2 and NER, accounted for 79 and 92% in the high and low organic matter sediment vessels, respectively. Accordingly the half life of dapagliflozin in both aquatic sediment systems is <120 days.


Based on the data above dapagliflozin has been assigned the risk phrase: ‘Dapagliflozin is slowly degraded in the environment.’


In Swedish: “Dapagliflozin bryts ned långsamt i miljön.” under the heading “Nedbrytning”.


Bioaccumulation

Dapagliflozin is not ionisable within the environmentally relevant pH range (estimated pKa = 12.6). The octanol-water partition coefficient was 2.34, measured at pH 7.4. Since Log POW < 4, dapagliflozin has low potential to bioaccumulate and the phrase “Dapagliflozin has low potential for bioaccumulation” is assigned.


In Swedish: ”Dapagliflozin har låg potential att bioackumuleras” under the heading “Bioackumulering”.


Physical Chemistry Data

Study Type

Method

Result

Ref

Octanol-water distribution coefficient

OECD107, Shake flask

log Pow = 2.34 at pH 7

14

Water solubility

OECD105, Shake flask

pH 5 = 720 mg/L

pH 7 = 538 mg/L

pH 9 = 946 mg/L

15

Hydrolysis

OECD111

<10% after 5 days at 50°C (pH 5 & 7)

11.5 % after 5 days at 50°C (pH 9)

at 25°C ≥ 1 year

16

 

References


  1. Environmental Classification of Pharmaceuticals in www.fass.se – Guidance for Pharmaceutical Companies. (2012). https://www.fass.se/pdf/Environmental_classification_of_pharmaceuticals-120816.pdf 

  2. Kasichayanula, S., Liu, X., LaCreta, F. et al. 2014. Clinical Pharmacokinetics and Pharmacodynamics of Dapagliflozin, a Selective Inhibitor of Sodium-Glucose Co-transporter Type 2. Clin Pharmacokinet 53: 17-27

  3. Mass balance and metabolism of [14C]BMS-512148 in healthy male subjects. Bristol-Myers Squibb, Princeton, New Jersey 08543, USA. Protocol Number MB102006. November 2006

  4. Dapagliflozin: Effect on the respiration rate of activated sludge. BLS8577/B. Brixham Environmental Laboratory, Brixham, UK. October 2008.

  5. Dapagliflozin: Toxicity to the green alga Pseudokirchneriella subcapitata. BL8587/B. Brixham Environmental Laboratory, Brixham, UK. December 2008.

  6. Dapagliflozin: Acute toxicity to Daphnia magna. BL8590/B. Brixham Environmental Laboratory, Brixham, UK. September 2008.

  7. Dapagliflozin: Determination of effects on the Early-Life Stage of the fathead minnow (Pimephales promelas). BL8638/B. Brixham Environmental Laboratory, Brixham, UK. December 2008.

  8. Dapagliflozin: Chronic toxicity to Daphnia magna. BL8622/B. Brixham Environmental Laboratory, Brixham, UK. May 2009.

  9. [14C]Dapagliflozin: Effects in sediment on emergence of the midge, Chironomus riparius. BL8661/B. Brixham Environmental Laboratory, Brixham, UK. March 2009.

  10. ECHA (European Chemicals Agency) 2008. Guidance on information requirements and chemical safety assessment. Chapter R.10: Characterisation of dose [concentration]-response for environment http://guidance.echa.europa.eu/docs/guidance_document/information_requirements_en.htm

  11. Dapagliflozin: Determination of 28 day ready biodegradability. Report No. BL8586/B. Brixham Environmental Laboratory, Brixham, UK. July 2008.

  12. Dapagliflozin: Activated sludge sorption isotherm. Report No. BL8614/B. Brixham Environmental Laboratory, Brixham, UK. August 2008.

  13. Dapagliflozin: Aerobic transformation in aquatic sediment systems. BL8594/B. Brixham Environmental Laboratory, Brixham, UK. February 2009.

  14. Dapagliflozin: Determination of 1-octanol/water partition coefficient. Report No. BL8585/B. Brixham Environmental Laboratory, Brixham, UK. June 2008.

  15. Dapagliflozin: Determination of Water Solubility Shake Flask Method. Report No. BLS3433/B. Brixham Environmental Laboratory, Brixham, UK. June 2008.

  16. Dapagliflozin: Hydrolysis as a function of pH - preliminary study results summary. BLS3434/B. Brixham Environmental Laboratory, Brixham, UK. July 2008.



Metformin

Miljörisk: Användning av metformin har bedömts medföra låg risk för miljöpåverkan.
Nedbrytning: Metformin bryts ned långsamt i miljön.
Bioackumulering: Metformin har låg potential att bioackumuleras.


Läs mer

Detaljerad miljöinformation

PEC/PNEC = 21.0 µg/L / 100 µg/L = 0.21

PEC/PNEC ≤ 1

Environmental Risk Classification

Predicted Environmental Concentration (PEC)

The PEC is based on the following data:

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

PEC (µg/L) = 1.5*10-6*A*(100-R)

A (kg/year) =total sold amount API in Sweden year 2014, data from IMS Health.

R (%) = removal rate (due to loss by adsorption to sludge particles, by volatilization,

hydrolysis or biodegradation) = 0 if no data is available.

P = number of inhabitants in Sweden = 9 *106

V (L/day) = volume of wastewater per capita and day = 200 (ECHA default) (Ref. 1)

D = factor for dilution of waste water by surface water flow = 10 (ECHA default) (Ref. 1)

(Note: The factor 109 converts the quantity used from kg to μg).

A = 139001.95 kg.

R = 0 

PEC = 1.5 x 10-6 x 139001.95 x (100-0) = 21.0 µg/L

Metabolism

Metformin hydrochloride is excreted unchanged in the urine. No metabolites have been identified in humans (Ref. 2).

Ecotoxicity data


Endpoint

Species

Common Name

Method

Time

Result

Ref

ErC50 – Based on Growth Rate

Pseudokirchneriella subcapitata

Green Alga

OECD 201

72 h

>100 mg/L

3

NOEC – Based on

Growth Rate

100 mg/L

NOEC – Based on

Growth Rate

Note 1

Unknown

Green Alga

99.5 mg/L

4

EC50 – Based on Immobilisation

Daphnia magna

Giant Water Flea

FDA 4.08

48 h

130 mg/L

5

NOEC - Based on Immobilisation

78 mg/L

NOEC – Based on Survival, Reproduction and Growth Rate

OECD 211

21 d

67 mg/L

6

NOEC – Based on Survival, Reproduction and Growth Rate

Note 2

54.1 mg/L

4

NOEC – Based on Reproduction

Ceriodaphnia dubia

Water Flea

ISO 20665

7 d

1 mg/L

LC50

Lepomis macrochirus

Bluegill sunfish

US FDA Technical Assistance Document 4.11

96 h

>982 mg/L

7

NOEC – Based on lack of mortality and abnormal effects

982 mg/L

NOEC – Based on hatch, survival, standard length and dry weight

Pimephales promelas

Fathead Minnow 

OECD 210

32 d

10 mg/L

8

NOEC – Based on hatch, survival, standard length and dry weight

Note 3

2.2 mg/L

6

NOEC – based on hatch, survival, standard length and dry weight

Note 1

Danio rerio

Zebra fish

11.1 mg/L

NOEC - Based on emergence and development rate

Chironomus riparius

Midge

OECD 218

28 d

100 mg/kg (dry weight)

9

NOEC - Based on emergence and development rate

>100 mg/kg

(dry weight)

Microbial Inhibitory Concentartion (MIC)

Anabaena flos-aquae

Nitrogen fixing bluegreen algae

FDA 4.02

-

100 mg/L

10

NOEC – Based on growth inhibition

80 mg/L

Microbial Inhibitory Concentartion (MIC)

Azobacter chroococcum

Nitrogen fixing Bacterium

800 mg/L

NOEC – Based on growth inhibition

400 mg/L

NOEC – Based on growth inhibition

Aspergillus clavatus

Fungi

1000 mg/L

Penicillium canescens

Chaetomium globosum

Pseudomonas fluorescens

Bacterium

Bacillus megaterium

Note 1 - Geometric average (GA) of 2 data points

Note 2 - Geometric average (GA) of 4 data points

Note 3 - Geometric average (GA) of 3 data points

PNEC (Predicted No Effect Concentration)

Long-term tests have been undertaken for species from three tropic levels, based on internationally accepted guidelines. Therefore, the PNEC is based on results from the assessment of water flea (Ceriodaphnia dubia) study, NOEC = 1 mg/L, and an assessment factor of 10 is applied, in accordance with ECHA guidance (Ref. 11).

PNEC = 1000 µg/L/10 = 100 µg/L

Environmental risk classification (PEC/PNEC ratio)

PEC/PNEC = 21.0 / 100 µg/L = 0.21 µg/L, i.e. PEC/PNEC ≤ 1 which justifies the phrase “Use of metformin hydrochloride has been considered to result in low environmental risk.”

In Swedish: ” Användning av Metforminhydroklorid har bedömts medföra låg risk för miljöpåverkan”.

Environmental Fate Data

Endpoint

Method

Test Substance Concentration

Time

Result

Ref

Percentage Aerobic Biodegradation

FDA 3.11

10 mg/L

28 d

0.6%

Not readily biodegradeable

12

Dissipation Half-life

OECD 308

1.0 mg/L (High Organic Matter Sediment)

102 d

DT50 = 6.59 days

(Total System)

13

1.0 mg/L (Low Organic Matter Sediment)

DT50 = 55.0 days

(Total System)

Hydrolysis Half-life

FDA 3.09

-

5 d

pH 5 = 0%

pH 7 & pH 9 = 1%

T1/2 = 25°C ≥ 1 year

14

Photolysis % deagradation and half -life

FDA 3.10

-

5 d

84.9 % (parent)

T1/2 28.3 days (Estimated)

15

Biodegradation

Results from the aerobic biodegradation test (Ref 12), showed that metformin hydrochloride is not readily biodegradable.

Evidence from the OECD 308 study (Ref 13) is that metfromin hydrochloride is likley to dissipate from the aqueous phase and partition into the sediment phase.

High organic matter (HOM) sediment system:

The average mass balance ranged from 93.3 – to 100.2% of applied radioactivity (AR) throughout the 102-day study. The AR declined rapidly in the water phase, by Day 14 26.3% and by Day 27 only 4.5% remained, with < 1% of the initial concentration remaining in the water phase by Day 102. At the end of the test, Day 102, 13.1% of the AR was associated with the sediment. Despite the investigation of a number of different extraction solvents (acetoniltrile: purified reagent water: concentrated hydrochloric acid), 12.8% remained non-extractable.

Metformin hydrochloride was extensively biodegraded, the cumulative amount of 14CO2 evolved was 64% of AR by Day 27. The total system half-life was 6.59 days.

In the water and the sediment combined, two degradation products were present at >10% AR at Day 14. However, these were transient degradation products and neither was detected from Day 56 onwards. These were not considered further.

Low organic matter (LOM) sediment system:

The average mass balance ranged from 93.3 – to 103.9% of AR. Dissipation of the radioactivity from the water to the sediment was slower than that observed in the HOM test vessels, with 28.8% remaining in the water phase at Day 14, and 11.2% remaining at Day 102. Very little mineralisation was observed (3.2% at Day 102). The radioactivity in the test vessel remained associated with the sediment. At Day 14, 73.6% remained associated with the sediment, of which 30.7% of the AR was extractable. At Day 102, 81.5% of the AR was associated with the sediment in the low organic matter (LOM) vessels, however the extractable fraction had decreased to 14.0% of the AR.

Extractability of metformin hydrochloride was good. The proporotion of radioactivity associated with the non-extractable residues (NER) increased throughout the study, 68% AR at Day 102. The NER are considered non-bioavailable and therefore removed in the calculation of the LOM DT50 value. The total system half-life was 55 days.

Differences in the two systems can be explained by the fact that the degradation of metformin hydrochloride is believed to depend on the specific microorganisms in the HOM matrix at the time of dosing the can use metformin hydrochloride as a carbon source and subsequently biodegrade metformin hydrochloride, whereas the microorganisms in the LOM matrix do so to a lower extent. Additionally, the HOM sediment system had a higher microbial biomass which may also contribute to a higher amount of biodegradation in the HOM systems versus the LOM system.

Based on the data above, metformin hydrochloride is not predicted to be readily biodegraded during wastewater treatment. However, there is evidence that metformin hydrochloride will degrade within the aquatic environment, both in biotic and abiotic transformation (FDA 3.10 and OECD 308).

Based on the above, the phrase “Metformin hydrochloride is slowly degraded in the environment” has been assigned.

In Swedish: “Metforminhydroklorid bryts ner långsamt i miljön” under the heading “Nedbrytning”.

Bioaccumulation

Log Kow = -1.43.

Metformin hydrochloride has has no significant bioaccumulation potential, as indicated by the log low Log Kow. Therefore the statement “Metformin hydrochloride has low potential for bioaccumulation” has been assigned.
 

In Swedish: ” Metforminhydroklorid har låg potential att bioackumuleras” under the heading ”Bioackumulering”.

Physical Chemistry Data

Endpoint

Method

Test Substance Conditions

Result

Ref.

Solubility Water 

Unknown

25oC

300.5 mg/L

16

Partition Coefficient

Octanol-Water 

Unknown

-

Log Kow = -1.43

Sorption/Desorption

FDA 3.08

Wareham activated sludge

Kd = 10.3

Koc = 32.1

17

References

  1. [ECHA] European Chemicals Agency. February 2016. Guidance on Information Requirements and Chemical Safety Assessment. Chapter R.16: Environmental exposure assessment (version 3.0)
    Link to document ECHA


  2. Summary of Product Characteristics for Komboglyze Film-Coated Tablets. Accessed 21st April 2016, and available at Link to document EMA


  3. Hoberg, J., Metformin Hydrochloride - Acute Toxicity to the Freshwater Green Alga,Pseudokirchneriella subcapitata OECD 201, Springborn Smithers Laboratories, Inc.:Report No. 12534.6219, 2007.


  4. Environmental Risk Assessment for metformin and its transformation product guanylurea in surface water. Caldwell.D, et al. SETAC Europe 24th Annual Meeting, Basle, Switzerland, May 11th–15th, 2014.


  5. Hicks, S. L.; Acute Toxicity of Metformin HCl to Daphnia magna ABC Laboratories, Inc. Report No. 41778, Jul 14, 1994.


  6. Putt, A., Metformin Hydrochloride - Full Life-Cycle Toxicity Test with Water Fleas Daphnia magna, Under Static-Renewal Conditions OECD 211, Springborn Smithers Laboratories, Inc.: Report No. 12534.6220, 2007.


  7. Sword M. Static Acute Toxicity of Metformin HCl to Bluegill (Lepomis macrochirus) ABC Laboratories, Inc. Report number 41779, July 1994.


  8. York, D., Metformin (BMS 207150) – Early Life-Stage Toxicity Test with Fathead Minnow, (Pimephales promelas), Following OECD Guideline 210. Smithers Viscient: Report No. 12534.6394, 2012.


  9. Bradley, M., Metformin Hydrochloride – Toxicity Test with Sediment-Dwelling Midges (Chironomous riparius) Under Static Conditions, Following OECD Guideline 218. Smithers Viscient: Report No. 12534.6396, 2011.


  10. Wood, J.; Microbial Growth Inhibition with Metformin HCl, ABC Laboratories, Inc. Report No. 41776, Jul 13, 1994.


  11. ECHA, European Chemicals Agency. May 2008. Guidance on Information Requirements and Chemical Safety Assessment. Chapter R.10: Characterisation of dose [concentration]-response for environment Link to document ECHA

  12. Bielefeld, T.A.; Aerobic Biodegradation of 14C-Metformin HCl in Water, ABC Laboratories, Inc. Report No. 41775, Aug 10, 1994.


  13. McKnight, C. [14C]Metformin Hydrochloride [14C](BMS 201750) – Aerobic

    Transformation in Aquatic Sediments Following OECD Guideline 308. Smithers

    Viscient: Report No. 12534.6398, 2011.


  14. Hallberg, C.; Hydrolysis of Metformin HCl as a function of pH, ABC Laboratories, Inc. Report No. 41774, Aug 10, 1994.


  15. Putman, K.; Determination of the Aqueous Photodegradation of 14C-Metformin HCl, ABC Laboratories, Inc. Report No. 41950, Aug 11, 1994.


  16. AstraZeneca Environmental Risk Assessment of Saxagliptin/Metformin Fixed Dose Combination [CV.000-594-251], June 2010.


  17. Sorption / Desorption Springborn Smithers Laboratories FDA-3.08 12534.6221. July 2007.


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