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Pharmaceutical Waste Reduction Strategies

Use an alternate drug or drug combination

Commonly wasted pharmaceuticals are replaced with alternative, lower-waste or less-toxic drugs or combination of drugs with equal efficacy. For example, a drug may have multiple formulations with varied minor components (excipients) which may significantly affect the drug's eco-toxicity.

Reduces Amount: Yes
Reduces Toxicity: Yes

Examples of Applying this Strategy

Generic Drug: Morphine

Conventional dosages of morphine (1-10 mg/kg) can be replaced by ultra-low dosages of morphine combined with an opioid receptor antagonist such as naltrexone (Ex. 1.0µg/kg morphine with 0.1 ng/kg naltrexone).

Proprietary Drug(s): Morphine Sulfate, Duramorph, Infumorph, Avinza, Kadian, MS-Contin, Astramorph PF
Delivery Method(s): Intravenous (IV), Injectable, Oral Tablet

For more information:

Daughton, Christian G. "Cradle-to-Cradle Stewardship of Drugs for Minimizing Their Environmental Disposition While Promoting Human Health." Environmental Health Perspectives. 2003 May; 111(5):757-774.

Christian Daughton

Phone: (702) 798-2207
Email: daughton.christian@epa.gov

Generic Drug: Fentanyl

Intravenous paracetamol infusion was effective in reducing pain as well as the incidence of intraoperative respiratory events as upper airway obstruction in high risk cardiac patients undergoing Internal Cardioverter Defibrillator insertion. Pain, respiratory events as apnea and airway obstruction in patients receiving intravenous paracetamol infusion 1g over 30min were compared with those receiving fentanyl in a total dose of 1.5¼g/kg. Insertion of Internal Cardioverter Defibrillator in high risk cardiac patients can be performed by many anesthetic techniques including local anesthesia with moderate sedation or general anesthesia. Many studies have proved that intravenous paracetamol infusion is effective in reducing narcotic requirements in many surgical procedures.

Proprietary Drug(s): Actiq, Durogesic, Sublimaze, SuFenta
Delivery Method(s): Intravenous (IV)

For more information:

Khalil, M.A., A.A.Ebade, M.D. Abdel Azeem, 2013. The role of intravenous paracetamol in conscious sedation during Internal Cardioverter Defibrillator (ICD) insertion in geriatric patients, Egyptian Journal of Anaesthesia, 29(1):41-45, Jan 2013

Mohamed A. Khalil, Faculty of Medicine, Cairo Univ

Generic Drug: Iodine povacrylex/Isopropyl alcohol

A surgeon at the University of Minnesota Medical Center - Fairview (UMMC) suggested alternatives to Duraprep such as Hibiclens, which is non-hazardous and does not require removal from the patient's skin, reducing time and material requirements as well.

Proprietary Drug(s): Duraprep
Delivery Method(s): Topical Ointment/Cream

For more information:

"Reducing Waste from the Operating Room." MnTAP, University of Minnesota, April 2011. Web. 13 June 2013.

A.J. Van den Berghe
200 Oak Street SE, Suite 350
Minneapolis, MN 55455

Phone: 612-624-4653
Email: mntap@umn.edu

Generic Drug: Epinephrine

A Minnesota surgery center is using a lidocaine/epinephrine mixture in a 3cc syringe as a local anesthetic in the field rather than diluting a 500cc epinephrine/saline mixture. For shoulder procedures, tubing is capped and changed between patients, [for] the epinephrine/saline solution. This ensures aseptic technique while reducing the 3000cc of waste that results when new solutions are diluted for each procedure. (Note: refer to AORN and/or APIC recommendations when considering implementing this strategy).

Proprietary Drug(s): Epinephrine
Delivery Method(s): Intravenous (IV)

For more information:


200 Oak Street SE, Sutie 350
Minneapolis, MN 55455-2008

Phone: (612) 624-1300
Fax: (612) 624-3370

Additional Resources

Daughton, Christian, Green Pharmacy and PharmEcovigilance: Prescribing and the Planet," Clinical Pharmacology, page 222.

Green Guide for Health Care (GGHC) Pharmaceutical Mangement Technical Brief

"In Struggle to Cut Expenses, Hospitals Eye the Pharmacy" --article from Hospital & Health Networks magazine

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