What do we know about the ecotoxicology of pharmaceutical and personal care product mixtures? A critical review
No uniform regulation for risk assessment of pharmaceutical and personal care products (PPCP) mixtures is currently available. Hence, a large diversity of strategies can be used for studying cocktail effects of PPCP, which makes difficult the task of incorporating this challenging issue into regulatory frameworks. This review provides an updated state of knowledge on the ecotoxicity of PPCP mixtures, including 194 assessments of the toxicity of mixtures from 65 articles published during 2000–2017. The misunderstandings, deficiencies and data gaps identified from those studies were critically discussed based on the models/tools used to predict/assess the joint effects and the interpretation and presentation of the effect profiles, the experimental designs used, the qualitative and quantitative composition of the PPCP mixtures and the type of bioassays performed regarding test duration, endpoints and levels of biological organization. Possible approaches pointed out in the literature to deal with the identified critical issues were also discussed. Overall, we have identified that further advances in this field of research still lack robust and consistent studies regarding the experimental design and the approaches and terminologies used to calculate, interpret and report the joint effects.