WHO finds ‘lethal’ substance in cough syrups

The World Health Organisation (WHO) has found toxic ‘levomethorphan’ in the raw material imported from an Indian manufacturer Kenduskar and used in cough syrups in Pakistan which killed more than 50 people, causing another blow to the already fragile Indo-Pakistan trade ties, Pakistan Today has learnt. In its preliminary findings shared with the Punjab Health Department, WHO authorities maintained that the raw material used in the cough syrups Tyno and Dextromethorphan includes 22 percent and 11 percent “lethal” levomethorphan content respectively.
The matter surfaced after around 20 people died after allegedly consuming Tyno syrup (manufactured by Reko Pharmaceuticals) in Lahore. Days later the incident was repeated in Gujranwala where more than 30 people lost their lives after consuming another cough syrup Dextromethorphan (Ethical Pharmaceuticals). They confiscated the stock of Tyno and Dextromethorphan from the distributors and retailers, bringing into the legal loop the distributors and the manufacturers as well. The government formed a special committee in this regard. The Drug Testing Laboratory (DTL) found out that there was something “wrong” with the raw material. However, the drug regulation authority of the federal government gave a clean chit after conducting tests. WHO was then involved to decide the matter, while the drug samples were sent to the Medicines and Healthcare Products Regulatory Agency (MHRA) in the UK. The preliminary report shared by WHO is based on MHRA tests.
A drug expert said the salt Dextromethorphan is used in the raw material and even 1 percent of levomethorphan is toxic. “Overdose [of syrup with levomethorphan] can be fatal in a normal person, while normal dose can prove deadly to drug addicts,” the expert said, adding that to cover their incompetence the police had not gathered data of the deceased whether they were addicts or normal individuals.
Seeking anonymity, a Health Department official said WHO was in touch with the health authorities throughout the process. “A few weeks back, they asked us [Health Department] if levomethorphan was a registered drug to which we replied in negative. A detailed conversation on Skype was also held with the health secretary and WHO representatives abroad to discuss the matter,” he said. Recently, WHO authorities visited the manufacturing factories after confiscation and dumping of the entire stock. Another senior official said the issue has the potential to deliver a deadly blow to the already fragile ties between the two countries. WHO authorities have traced the entire chain, contacting not only the Indian manufacturer Kenduskar, but also the importers of the same raw material in Egypt, Ghana and Kenya. The official said the matter goes beyond the ambit of the Punjab government, as the DRAP will have to involve the Foreign Office to highlight the matter on the international level with the Indian authorities.
A senior WHO official, seeking anonymity, said the fault lied with the DRAP authorities and the two firms imported the raw material without performing the requisite tests. “If the raw material was coming from a new vendor, the authorities should have made sure about its quality before allowing its import, but the authorities showed sheer negligence,” the official said, adding that the ultimate responsibility “of course lies on the original manufacturer”.
Health Secretary Captain (r) Arif Nadeem was not available for comment. However, Additional Secretary (tech) Dr Anwer Janjua said WHO had shared the preliminary findings and “we have dumped the entire stock from the market”. “The import and export of drugs comes under the purview of the federal government and one cannot blame any department before a few reports which are yet to come,” he added. According to details, the two countries have yet to sign the memorandum of understanding on the most favourite nation (MFN) status.
“At present only a few anti-cancer drugs are coming from India while the trade will increase only after the MoU is signed between the two countries,” he said. The matter has been further hampered by the recent tension between the two countries. The report will prove another blow to the fragile relationship if made public.