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The safety of drinking water is a global concern. N-nitrosamines (NAs), nitrogen-containing disinfection by-products (N-DBPs), are commonly found as mixtures in drinking water worldwide. Studies have demonstrated that individual NAs exhibit strong teratogenic, carcinogenic, and genotoxic effects at high concentrations. However, the health risks of NAs at environmental levels (concentrations in drinking water) remain unclear. Therefore, research is needed on the potential health risks of environmentally related NA exposure in drinking water. This review examines the formation and transformation of NA chlorination disinfection by-products (DBPs) in drinking water. It also explores the cytotoxicity, genotoxicity, and carcinogenicity of these by-products at environmental levels and delves into their toxic mechanisms. Additionally, it delves into the mechanisms underlying the toxic effects of these compounds. The findings aim to inform improvements in chlorination disinfection processes, thereby reducing the generation of DBPs, ensuring safer and cleaner drinking water, and providing scientific evidence regarding the potential health impacts of low-dose mixed NAs in drinking water.

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  • Toxicity study: Examines low-dose mixed N-nitrosamines (NAs) in drinking water, filling research gaps.

  • Formation mechanisms: Explores NA by-products in chlorination, aiding process improvement.

  • Health risks: Assesses carcinogenicity, cytotoxicity, and genotoxicity of low-dose mixed NAs.

disinfection by-products, drinking water, low-dose mixed exposure, nitrosamines, toxicity
© 2025 The Authors
This is an Open Access article distributed under the terms of the Creative Commons Attribution Licence (CC BY 4.0), which permits copying, adaptation and redistribution, provided the original work is properly cited (http://creativecommons.org/licenses/by/4.0/).

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