Silent threat – the ecological dangers of NSAIDs in aquatic ecosystems

Non-steroidal anti-inflammatory drugs (NSAIDs ), widely used for their analgesic and anti-inflammatory properties, are increasingly recognized as emerging contaminants in aquatic environments. Despite their therapeutic value for humans, their persistence, bioactivity, and widespread use contribute to continuous input into surface waters through wastewater effluents and agricultural runoff. This review provides a comprehensive synthesis of the current knowledge regarding the occurrence, distribution, and ecological impacts of NSAIDs in aquatic ecosystems. We examine the primary sources of emission, the physicochemical properties influencing their transport and bioaccumulation, and analyze global monitoring data on concentrations of key NSAIDs in freshwater systems. Particular attention is given to their effects on various aquatic organisms, including bacteria, phytoplankton, zooplankton, invertebrates, and vertebrates, with documented outcomes such as developmental abnormalities, physiological disruptions, and oxidative stress. Risk assessment metrics, such as risk quotients (RQ) based on predicted or measured environmental concentrations and predicted no-effect concentrations (PNECs), are evaluated to highlight zones of heightened ecological threat. Finally, we discuss the implications of current trends, forecast future risks, and suggest directions for mitigation through improved wastewater treatment technologies, regulatory measures, and public awareness. NSAIDs, often perceived as benign pharmaceuticals, represent a silent but significant ecological risk requiring urgent interdisciplinary attention.