Are PFAS Hiding in Your Prescription Drugs?

While I’m not a big fan of prescription drugs, mainly because of what I see as the problems of overprescribing and drug side effects, when I read an article about PFAS and pharmaceuticals, that got my attention!

PFAS is shorthand for what are commonly called “forever chemicals.”

So, when you think about PFAS, what comes to mind? Nonstick cookware, water-resistant clothing, stain-resistant carpets, food packaging, or perhaps contaminated drinking water?

But prescription drugs? Uh?

I recently came across research showing that fluorinated chemicals are used in a surprisingly large number of pharmaceutical drugs, and that some fluorinated pharmaceuticals can actually fall under certain scientific definitions of PFAS. Fluorinated chemicals are also used in parts of the pharmaceutical manufacturing process.

So...I decided to take a closer look at what the research actually says.

First...What Exactly Is PFAS?

PFAS stands for per- and polyfluoroalkyl substances. They are a large family of man-made chemicals that have been widely used because they resist heat, water, oil, and chemical breakdown.

That can be a benefit, but it can also be a problem. Many PFAS are extremely persistent in the environment, which is why they are often called “forever chemicals.”

Research has associated exposure to certain PFAS with health concerns including increased cholesterol, changes in immune response, changes in liver enzymes, pregnancy-induced hypertension and preeclampsia, reduced birth weight, and certain cancers. However, these effects vary considerably depending on the specific PFAS chemical, the amount of exposure, and how long someone was exposed.

Here's Where It Gets Interesting

Fluorine is used extensively in modern drug design. Adding fluorine to a drug molecule can change the way that drug behaves in the body, including its metabolic stability, absorption, and other pharmacological properties.

In fact, roughly 20% of commercialized medications contain fluorine.

Some familiar examples include:

·         Statins: Atorvastatin, Rosuvastatin

·         Antidepressants: Fluoxetine, Escitalopram

·         Acid Reflux / PPIs: Pantoprazole

·         NSAIDs & Anti-inflammatories: Celecoxib

·         Steroids: Fluticasone

So...does that mean all of these drugs are “forever chemicals”?

It turns out the answer is no. A drug containing fluorine is not automatically a PFAS.

And this is where things get really interesting. Researchers examined 360 fluorinated pharmaceuticals using nine different definitions of PFAS and found that the definitions classified anywhere from 1% to 100% of those drugs as PFAS. In other words, how you define PFAS makes a huge difference.

So, we shouldn't simply see the letter “F” in a chemical formula and immediately jump to the conclusion that we are taking a dangerous forever chemical.

At this point, I’d be looking at the specific drug, its known side effects, and exactly what chemicals are actually in the formulation.

But Should You Be Worried?

I wouldn't panic, but I also wouldn't ignore the issue.

PFAS exposure in our environment is a legitimate health concern, but research on environmental PFAS contamination cannot automatically be applied to every fluorinated prescription drug you take. The fact that a molecule contains fluorine doesn't tell us by itself whether that particular drug presents the same risks associated with environmental PFAS exposure.

And many fluorinated medications serve important medical purposes. I certainly would not recommend stopping a prescription simply because it contains a fluorine atom. Doing so could create a much bigger and more immediate health problem than the exposure you are trying to avoid.

Instead, I think the smarter approach is to find out exactly what you're taking and whether a reasonable alternative exists.

Here's What You Can Do

If you want to take a proactive look at your medications, here is a practical step-by-step approach.

1. Check Your Labels: Look up your medication on DailyMed, the National Library of Medicine's database of drug labeling, and review both the active and inactive ingredients. You can also check the FDA's Inactive Ingredient Database, which is updated quarterly.

2. Ask Your Pharmacist a Specific Question: Instead of simply asking, “Does this drug contain fluorine?” ask, “Does this particular manufacturer and formulation contain any ingredients that meet a current scientific definition of PFAS?” That's a much more targeted question.

3. Explore Formulation Differences: Two manufacturers can make the same medication using different inactive ingredients, such as fillers, coatings, or binders. So, if an inactive ingredient is the concern, another manufacturer or formulation may provide an alternative.

4. Talk With Your Doctor: If the active drug itself is the source of your concern, ask your doctor whether another medication could treat the same condition without that particular chemical structure. But remember, never stop or switch a prescription medication on your own!

My Take

Looking at natural health and wellness research over the years has taught me that sometimes the biggest problem isn't the information we receive. It's the oversimplification of that information!

PFAS are a legitimate concern, and I think it makes complete sense to reduce unnecessary exposure where we reasonably can. But when it comes to prescription medications, we shouldn't throw the baby out with the bathwater.

A fluorinated drug isn't automatically a dangerous “forever chemical,” just as the presence of PFAS in a particular product doesn't automatically tell us what the actual health risk is. We need to look at the specific chemical, the amount of exposure, and the available research.

So...know what you're taking. Check the active ingredients, check the inactive ingredients, review the known side effects, and talk with your pharmacist and doctor about whether a medically appropriate alternative is available.

The goal isn't to eliminate every single molecule containing fluorine from your life. The goal is to reduce unnecessary chemical exposure and unnecessary side effects while still getting the medical treatment you need.

And I think that's a pretty reasonable goal!

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References

·         Agency for Toxic Substances and Disease Registry (ATSDR). “How PFAS Impacts Your Health.”

·         Hammel, S. C., Webster, T. F., Gurney, R., & Heiger-Bernays, W. (2022). “Implications of PFAS definitions using fluorinated pharmaceuticals.” iScience, 25(4), 104020.

·         “Chemistry and Pharmacology of Fluorinated Drugs Approved by the FDA (2016–2022).” PMC.

·         “Contribution of Organofluorine Compounds to Pharmaceuticals.” PMC.

·         U.S. Food and Drug Administration. “Inactive Ingredient Database.”

·         DailyMed. U.S. National Library of Medicine.