Pharmaceutical industries produce a huge volume of emerging pollutants (EPs) that pose a threat to the aqueous environment. Biological processes have shown their inefficacy in treating many pharmaceutical products. The study assessed physicochemical parameters, EPs, heavy metals in pharmaceutical industrial wastewater, and the removal efficiency (RE) of an aerobic biological treatment plant. The study also assessed the contamination levels and risk using several indices, such as the Canadian Council of Ministers of the Environment Water Quality Index (CCME-WQI), heavy metal pollution index (HPI), heavy metal evaluation index (HEI), and risk quotients index (RQs). The study found that the treated water quality was poor, having antibiotics, nonsteroidal anti-inflammatory drugs, and others, along with several transformation products (TPs) and heavy metals, which were unsafe for consumption with high environmental risk. The analysis results showed that the RE for TSS, BOD5, COD, TDS, and EC were found to be 91.80%, 86.81%, 72.29%, 72.20%, and 65.60%, respectively, where the values of BOD5, COD, NO3−, and PO43− in the effluent were still higher than the permissible limits of the ECR (2023). However, the RE for heavy metals was in the order of Cu (84.62%) > Fe (65.04%) > Mn (63.3%) > Zn (60.58%) > Cd (53.85%) > Ni (54.12%) > Pb (42.42%) > Cr (38%), where Cr and Cd concentrations were still higher than the permissible limit of DoE (2019). The Pearson correlation and PCA suggested that EC, TDS, TSS, DO, BOD5, and COD were the most correlating and contributing variables. This study argued that metal-ligand behaviors mainly affect the removal efficiency of the treatment plant by lowering the removal rate of heavy metals and pharmaceutical products.
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