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We modeled the ecotoxicological risks of the pharmaceutical mixtures emitted into the environment from STP effluents. The classic mixture toxicity concept of Concentration Addition was used to calculate the total expect risk of the analytically determined mixtures, compare the expected impact of seven effluent streams and pinpoint the most sensitive group of species. Single substance-based assessments underestimate the actual risks from pharmaceutical mixtures often by more than a factor of 1 000 in several of the surveyed effluent streams, clearly indicating the need to take the joint presence of pharmaceuticals into consideration in order to provide an environmentally realistic assessment for a given water body. The mixture risk quotients regularly exceed 1, indicating a potential risk for the environment, depending on the specific environmental conditions, in particular the dilution in the recipient stream. The top 10 mixture components explain more than 95% of the mixture risk in all cases. A mixture toxicity assessment cannot go beyond the underlying single substance data. The lack of data on the chronic toxicity of most pharmaceuticals as well as the very few data available for in vivo fish toxicity has to be regarded as a major knowledge gap in this context. On the other hand, ignoring Independent Action or even using the sum of individual risk quotients as a rough approximation of Concentration Addition does not have a major impact on the final risk estimate.
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