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Combined Effects of Pharmaceutical Compounds and Microplastics on Fish Health: a Review of Exposure, Toxicity, and Ecological Risks
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This review pulls together existing research on what happens when fish are exposed to both microplastics and pharmaceutical pollution (like drugs washed into rivers and oceans) at the same time, and finds their combined effects on fish gut and liver health can be worse, better, or about the same as either pollutant alone, depending on conditions. This matters because most lab studies use unrealistic, "squeaky clean" plastic particles and pollution levels far higher than what's actually in our waterways, meaning we still don't have a clear picture of real-world risks to aquatic life, or, by extension, the seafood many people eat.
Pharmaceutical compounds and microplastics are ubiquitous aquatic pollutants that frequently co-exist in aquatic environments; however, their combined effects on fish cannot be accurately predicted from studies investigating each pollutant individually. Pharmaceutical compounds can disrupt conserved molecular targets even at low concentrations, whereas microplastics are particulate materials that also act as surfaces capable of sorbing, transporting, and releasing chemical contaminants. This review synthesizes current knowledge on the co-exposure of fish to pharmaceuticals and microplastics, with a particular focus on toxicokinetics, organ toxicity, and associated ecological risks. Findings from direct co-exposure studies indicate that interactions range from synergistic and additive to antagonistic, depending on factors such as particle size, polymer composition, plastic aging, biofilm formation, water chemistry, exposure sequence, pharmaceutical properties, and tissue-specific uptake. The intestine and the gut–liver axis have emerged as particularly vulnerable targets, while the plastisphere may harbor increased abundances of antibiotic resistance genes and exert stronger selective pressure under antibiotic co-exposure. However, most available studies have employed pristine spherical polystyrene microplastics, short exposure durations, and concentrations exceeding environmentally relevant levels. Furthermore, only a limited number of studies have incorporated mixture toxicity models or investigated sub-organismal mechanisms to predict population-level effects. Current evidence suggests that, under environmentally realistic conditions, microplastics should not generally be regarded as vectors of pharmaceutical contaminants but rather as carriers, sinks, sources, and independent stressors. Future risk assessments should prioritize environmentally aged microplastics, realistic pharmaceutical mixtures, time-dependent internal exposure, species-specific sensitivity, and adverse outcome pathways to improve ecological risk predictions.
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Pharmaceuticals and Microplastics in Aquatic Environments: A Comprehensive Review of Pathways and Distribution, Toxicological and Ecological Effects
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This review examines how pharmaceuticals and microplastics travel through the environment and accumulate in aquatic food chains, with drug residues found at measurable levels in surface waters and microplastics reaching densities of up to a million particles per cubic meter in some water systems. When aquatic organisms absorb these combined pollutants, the contaminants can biomagnify up the food chain to humans, affecting growth, reproduction, and immune function.
Rainbow trout (Oncorhynchus mykiss) physiological response to microplastics and enrofloxacin: Novel pathways to investigate microplastic synergistic effects on pharmaceuticals
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Scientists studied how microplastics interact with the antibiotic enrofloxacin in rainbow trout and found that the combination increased toxicity beyond what either pollutant caused alone. The microplastics appeared to change how the antibiotic was absorbed and processed in the fish, leading to greater liver damage and immune system disruption. Since fish are exposed to both pollutants in real waterways, this synergistic toxicity could affect seafood safety and the health of people who consume contaminated fish.
Combined Effects of Microplastics and Heavy Metals, Pesticides, and Antibiotics in Zebrafish ( Danio rerio ): A Critical Review
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This review of 86 zebrafish studies found that most research on microplastics mixed with metals, pesticides, or antibiotics lacks strong evidence to prove whether these combos make toxic effects worse or better. Microplastics can carry chemicals into the body or release them, but scientists still can't reliably predict which effect wins, meaning real-world health risks from combined exposures remain uncertain.
Impacts of Combined Microplastics and Heavy Metal Pollution on Aquatic Ecological Health: Insights from Trophic Levels
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This review looked at how microplastics and heavy metals interact in water, fish, and other wildlife, since both pollutants often show up together. It found that microplastics can sometimes change how metals move and get absorbed by living things, but there's not yet enough solid evidence to say this combo makes metal exposure or health problems worse in humans.
Combined Effects of Microplastics and Mercury on Growth, Hematology, Tissue Morphology, GH/IGF Axis, and Antioxidant-Immune Responses in Nile Tilapia.
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Scientists found that fish exposed to both microplastics and mercury together—two pollutants increasingly common in waterways—suffered much worse health effects than fish exposed to either one alone, including organ damage, weaker immune function, and stunted growth. This matters because it shows how pollutants can team up to cause more harm than we'd expect from studying them separately, which raises questions about the combined effects of everyday contaminants on the seafood we eat and on our own bodies, since humans are also routinely exposed to both microplastics and trace mercury.
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