COLDRIF COST SYRAP TRAGEDI has once again exposed gaps in India’s drug security system. Dr. Lancelot Pinto, Consultant Respirologist at PD Hinduja National Hospital, Explains why such pollution is fatal and when cough syrup is really neededCooling rich Cough syrup, linked to deaths of at least 14 children in Madhya Pradesh, Rajasthan and Kerala, were found to contain 48.6% dietylene glycol, almost 500 times the safe limit. Can you explain how intake of such toxic chemical affects children?Dietylene glycol should not be present, in any amount, in a medication. Dietylene glycol (dough) and ethylene glycol (eg) are industrial solvents used in antifreeze, colors, brake fluids and not intended for consumption. Because they are cheap solvents, unscrupulous manufacturers use them as replacement for more expensive, secure and approved auxiliary substances such as glycerol. Such a substitution is harmful to people, especially to children, in which the low body weight, and limited capacity to metabolize and secrete the chemical makes exposure more potent per ml intake. A “allowed limit” is allowed only because track pollution is often inevitable and such track pollution that is usually below the detection level (usually 0.1% or less) is considered harmless. Admitting dough in high doses can cause the kidneys to fail within a day, neurological manifestations such as seizures, liver failure and pancreas and the acidic environment in the blood can cause multiple organs, such as the heart and lungs, to fail. Although the child survives, they are likely to have lifelong complications, especially if the dose is high.There have been protests against the arrest of the doctor who prescribed the syrup. Where is the main responsibility – with the doctor, manufacturer or regulatory authorities?As far as I know, Coldrif was not a forbidden syrup. If it was legally manufactured and marketed, it must have been subjected to legislation approvals. The combination of medications used in the syrup is not toxic when prescribed as stated, and the deaths were the result of forgery, not the drugs themselves. Doctors cannot be blamed for this.
Do general doctors today have a tendency to overwrite cough syrup? In 2024, revenue on the market for cold and coughing agents in India amounted to $ 1.49 billion (revenue per person in India was $ 1.03 2024). There is definitely an overuse of cough syrup, both as a result of overwriting and use without disk. A significant proportion of cough is self -limiting, and an equal proportion needs treatment of the cause (reflux, asthma, drops after naser are often guilty) rather than syrup.Many cough syrup are available over the counter in India. How dangerous is it when they are purchased without considering the right age group? The best coughing agents are often opioids or opioidderivated. These have abuse potential and are often abused. Antihistamines found in cough syrup can cause drowsiness, difficulties in concentration, in addition to affecting cognition, and can cause serious injuries and cases, especially at both ends of the age spectrum. It is very easy to make mistakes when it comes to taking the right dose, and the difference between the right dose and a dangerous dose can be a few ml in children.What does research say about the efficiency of cough syrup?Bronchodilators such as terbutaline in cough syrup can help with cough associated with bronchospasm (inhalers are superior and safer but tend to be more expensive). Opioids work well in some types of cough but should be completely avoided in children and the elderly. Cough syrup can have a calming effect due to their viscosity, which occupies the nerve in the throat which can cause irritating cough. But honey, chocolate and even suction of non-medicated lozenges have been shown to have a similar effect.What is your strategy for integrating it into the overall treatment plan? A cough is a protective defense mechanism that helps clear mucus, often secreted in response to an irritant or an infection. When it is acute and associated with an infection, it is often self -limiting and does not guarantee any specific treatment. Cough that lasts longer than 4-6 weeks must be examined and the underlying cause is treated. Asthma, reflux and drip after nasal tend to be the most common causes in children and adults. In some refractory cough (such as those associated with diseases such as pulmonary fibrosis), opioid cough syrup has a definitive role, but this is for a small minority of all cough. Cough syrup should be avoided in children, especially those under 5, as the low body weight makes dosage uncertain, and the risk-to-use ratio is therefore high.The market has many herbal syrup. Can they also pose health risks?The words “herbal” or “natural” should not be assumed to be synonymous with “safe”. I would be very careful about using any medicine that has not undergone rigorous scientific testing.
