Pharmaceuticals and Microplastics in Aquatic Environments: A Comprehensive Review of Pathways and Distribution, Toxicological and Ecological Effects

Pharmaceuticals and microplastics are persistent emerging contaminants that pose significant risks to aquatic ecosystems and ecological health. Although extensively reviewed individually, a comprehensive, integrated assessment of their environmental pathways, bioaccumulation dynamics, and toxicological impacts remains limited. This review synthesizes current research on the environmental fate and impact of pharmaceuticals and microplastics, emphasizing their combined influence on aquatic organisms and ecosystems. This review provides a thorough and comprehensive examination of their predominant pathways, sources, and distribution, highlighting wastewater disposal, agricultural runoff, and atmospheric deposition. Studies indicate that pharmaceuticals, such as antibiotics and painkillers, are detected in concentrations ranging from ng/L to μg/L in surface waters, while MPs are found in densities up to 106 particles/m 3 in some marine and freshwater systems. The toxicological effects of these pollutants on aquatic organisms, particularly fish, are discussed, with emphasis on bioaccumulation and biomagnification in the food chain, physiological effects including effects on growth, reproduction, immune system performance, and behavioral changes. The ecological consequences, including disruptions to trophic dynamics and ecosystem stability, are also addressed. Although valuable efforts, mitigation and remediation strategies remain inadequate, and further research is needed because they do not capture the scale and complexity of these hazards. This review highlights the urgent need to advance treatment technologies, establish comprehensive regulatory frameworks, and organize intensive research on long-term ecological impacts to address the environmental threats posed by pharmaceuticals and microplastics.