[Eco-prescription, a new major skill for healthcare professionals]

Healthcare-related carbon emissions account for about 8% of national emissions. Drugs are the primary source of emissions, contributing 9.1 Mt of CO₂ per year. The objective of this work is to better define the eco-prescription of medicines and the means of implementation to favor therapeutic strategies that are more environmentally virtuous while maintaining the quality of care. The most relevant recommendations were identified by a study of the current recommendations coupled with a bibliographical analysis. It was supplemented by an analysis of the Ecovamed® database on the carbon footprint of medicines. This study covered nine classes of common drugs. The functional unit used was the standardized Daily Defined Dose (DDD) on a monthly package. Five principles of eco-prescription have been proposed: Give preference to dry oral forms (greenhouse gas emissions divided by 2 to 130), Avoid prescribing pressurized inhalers (emissions divided by 10 to 20 when using powder inhalers), Give preference within the same therapeutic class to drugs with the lowest daily doses of active ingredient (reduction of 30% vs. the average of therapeutic class), give preference to drugs combining several active substances in the same dose (reduction of 29% vs. the 2 drugs) and Give preference to a dosage schedule with minimum administered doses (reduction of 37%). Their use by healthcare professionals is simple, with a significant effect and constant cost. However, these principles must be part of a global approach focused on the proper use and relevance of care. Eco-prescription represents a major change in our pharmaceutical and medical practices.