Killer cough syrup

The past words Afsana Khan heard from her son, Usaid, were the lines of a nursery rhyme — “Anaar ka meetha daana (The saccharine effect of the pomegranate).” A drowsy and anemic Usaid had tried to recite the rhyme arsenic helium laic successful a infirmary furniture astatine New Health City Hospital successful Nagpur, Maharashtra.

“I was trying to cheer him up. He had started going to nursery schoolhouse conscionable 2 months ago, truthful I asked him to recite the rhyme. He fell unconscious aft saying these lines and ne'er woke up,” says Khan, sitting successful her two-room location successful Parasia municipality successful Chhindwara territory of Madhya Pradesh (M.P.), astir 150 km away.

On September 13, 2025, Usaid died owed to kidney failure, aft 3 sessions of dialysis. He would person turned 4 connected October 10, 2025.

Khan’s younger son, 2-year-old Yamaan, is excessively young to recognize the tragedy. As Khan speaks, Yamaan crawls nether a seat and grabs an bare vessel of cough syrup. Khan rapidly snatches it from him. “You enactment distant from this,” she snaps. Hours later, a squad from the State Health Department arrives to prehend the bottle.

The 60-millilitre vessel of the cough syrup, Coldrif, has been linked to an unfolding calamity successful M.P. Since September, 24 children from the State person died. Most of them were from Chhindwara, portion immoderate were from the neighbouring Betul and Pandhurna districts. Three much children stay successful a captious information successful Nagpur. The find of contamination successful the cough syrup points to a larger, unsafe occupation — India’s mediocre regulatory system.

A unsafe prescription  

All the 24 children had 1 happening successful communal — they developed a fever and cold, and received attraction successful Parasia, a bustling municipality 30 km from the territory headquarters.

Parasia is surrounded by the scenic Satpura upland ranges and ember mines and is lined with rows of hospitals, clinics, and pharmacies. Among them is the infirmary of Dr. Praveen Soni, a fashionable paediatrician successful the area. According to galore parents, Dr. Soni prescribed the Coldrif syrup, on with different medicines, for respective sick children. Other doctors successful town, including Dr. Amit Thakur and Dr. Aman Siddiqui, besides allegedly prescribed the aforesaid syrup for immoderate different children who reported akin symptoms.

The parents bought the prescribed medicines and went home. They began to interest erstwhile their children complained of a tummy ache aft drinking the syrup. Soon, interest turned into panic: the children began vomiting and became drowsy. Their tiny bodies swelled up. Finally, incapable to urinate, the children suffered terrible kidney harm and died.

Suresh Pipri, a 40-year-old husbandman from Parasia’s Sethiya village, recalls the past fewer days of his 5-year-old daughter’s life. “Rishika was diagnosed with fever connected August 25 and received attraction from Dr. Thakur,” says Pipri. “She was prescribed 5 ml of syrup doubly a day. When we gave her the archetypal dose, she began vomiting greenish fluid. She vomited aggregate times done the nighttime and complained of a tummy ache. The adjacent day, she stopped talking and recognising anyone.”

Pipri took her again to Dr. Thakur, who referred her to a backstage infirmary successful Chhindwara city. Despite 3 days of attraction astatine the hospital, Rishika’s information worsened and she was not capable to urinate astatine all, helium says.

“On September 2, the doc conducted a sonography and immoderate different kidney-related tests. The results were not good. Her creatinine levels were highly high. The doc referred her to a backstage infirmary successful Nagpur,” helium says. There, Rishika underwent 9 sessions of dialysis. When her information worsened, she was enactment connected a ventilator for 4-5 days. She died connected September 16.

Pipri stares astatine Rishika’s creation videos connected his telephone and her drawings. “We did everything we could, but we could not prevention her,” helium says.

A period of deaths and confusion

While astir of the children successful M.P. had been prescribed the syrup from mid-August onwards, the archetypal death, of 3-year-old Divyansh, occurred connected September 2 successful a backstage infirmary successful Nagpur. More deaths of children were reported connected September 4, 7, and 9, but authorities successful Parasia and Chhindwara were unaware of the horror.

“Since the children had been referred to backstage hospitals and had died there, the section wellness section had nary grounds of them,” says Dr. Ankit Sahlam, Block Medical Officer (BMO), Parasia.

On September 16, aft 5 children had died, wellness authorities successful Nagpur wrote to the Chhindwara territory hospital, informing them that children hailing from Parasia, oregon children who had been referred to hospitals from Parasia block, had died successful Nagpur owed to kidney failure.

“This is erstwhile we started tracing the cause,” says Dr. Sahlam. “Our absorption was connected uncovering sources of corruption from water, food, oregon animals. When we recovered that the children had been treated by section doctors first, we told those doctors to transportation each the children with akin symptoms to the Civil Hospital successful Chhindwara.”

The Chhindwara authorities failed to hint the origin of the problem. “On September 22, the doctors astatine the Government Medical College, Nagpur, told america that the kidney harm could person been caused by immoderate medicine,” says the Chief Medical and Health Officer of Chhindwara, Dr. Naresh Gonnade. The doctors besides sent the prescriptions issued to the 5 children successful Parasia.

“The Health Commissioner successful Bhopal and different State authorities instructed america to motorboat a run to find the medicine that had caused the deaths,” Dr. Gonnade says. The hunt led to 2 communal cough syrups successful the prescriptions — Coldrif and Nastro-DS. Dr. Gonnade says the Drug Inspector of Chhindwara was asked to commencement collecting samples of the 2 syrups from pharmacy stores arsenic a precautionary measure.

On September 24, teams of the National Centre for Disease Control, the Central Drugs Standard Control Organisation (CDSCO), and the State surveillance portion of the National Health Mission successful M.P. arrived successful Chhindwara to analyse the deaths and cod samples.

According to a papers of the M.P. Health Department, seen by The Hindu, the teams collected assorted samples to cheque for infections and diseases, including Leptospirosis, Chandipura, and Japanese Encephalitis. Tests ruled these out. Finally, the biopsy tests of the kidneys of 4 of the 5 children confirmed Acute Tubular Necrosis, an acute kidney injury.

Dr. Sahlam, the BMO of Parasia, says that it was lone connected September 26 that the authorities suspected Coldrif to beryllium a imaginable cause. The authorities seized batches from pharmacies and instructed doctors not to prescribe the syrup.

On October 1, the past Controller of the Food and Drug Administration, Dinesh Kumar Maurya, wrote to the cause power authorities successful Tamil Nadu and Himachal Pradesh, asking them to instrumentality enactment successful the matter. While Coldrif had been manufactured by Sresan Pharmaceuticals successful Kancheepuram successful Tamil Nadu, Nastro-DS had been manufactured by Aqunova Pharma, successful Himachal’s Solan district. Nastro-DS has since been cleared pursuing tests by the M.P. Food and Drugs Administration (MPFDA).

A precocious grade of toxicity

With the decease toll climbing, the State Health Ministry and the Union Health Ministry sent samples of assorted medicines for testing.

The Tamil Nadu authorities ordered inspection and investigating of samples arsenic well. It recovered that 1 illustration of the cough syrup tested showed diethylene glycol (DEG) contamination astatine a level of 48.6% weight/volume. The authorities issued a ‘stop production’ bid to Sresan Pharma connected October 3 and the CDSCO recommended that the company’s manufacturing licence beryllium cancelled.

On October 4, the Ministry of Health and Family Welfare said, “Nineteen medicine samples which had been consumed by children were collected from backstage practitioners and adjacent retail stores... Out of the archetypal 10 samples analysed successful the archetypal batch, 9 met prime standards. However, 1 of them, viz. cough syrup Coldrif, contained DEG beyond permissible limits.’’

DEG is simply a toxic chemic substance typically utilized successful antifreeze solutions for air-conditioners, fridges, and freezers, and arsenic a solvent for products, including cosmetics, astatine precise debased concentrations.

According to the CDSCO, DEG replaces pharmaceutical-grade solvents, specified arsenic propylene glycol and glycerin, required for harmless quality consumption. “DEG is cheaper and has a colourless, syrupy consistency and saccharine sensation similar glycerin. It is utilized by manufacturers to chopped costs,’’ says a elder authoritative astatine CDSCO.

Upon further investigation, the CDSCO identified 3 products which had been contaminated — Coldrif from Sresan Pharma (Tamil Nadu) showing 48.6% DEG; Respifresh TR from Rednex Pharma (Gujarat) showing 1.342% DEG; and ReLife from Shape Pharma (Gujarat) showing 0.616% of DEG.

In its authoritative statement, the Tamil Nadu Drugs Control Department said the inspection squad recovered respective non-compliances astatine Sresan Pharma. They noticed 39 captious observations and 325 large observations. “It was recovered that the alleged batch was manufactured utilizing non-pharmacopoeial people Propylene Glycol arsenic an excipient, which mightiness person been contaminated with DEG and Ethylene Glycol (EG), which are known nephrotoxic and poisonous substances,” it said.

In India, portion the Drugs and Cosmetics Act, 1940, and the associated Drugs and Cosmetics Rules, 1945, bash not explicitly database DEG by name, they prohibit the usage of immoderate substance considered “adulterated” oregon “substandard”.

Who is responsible?

Contaminated, Indian-made cough syrup is simply a recurring wellness hazard. In 1986, astatine slightest 14 patients, including a child, died of acute renal nonaccomplishment aft being administered glycerol syrup laced with DEG astatine Mumbai’s J.J. Hospital. In 2022, a fig of countries reported that over-the-counter cough syrups for children had been contaminated with DEG and EG. These resulted successful the deaths of much than 300 children successful Gambia, Indonesia, and Uzbekistan. A laboratory investigation successful Gambia revealed that the merchandise samples contained unacceptable amounts of DEG and EG and that the bottles of syrup had been imported from India. Yet, the occupation persists.

Explaining however drugs are licensed successful India, Dr. Rajeev Singh Raghuvanshi, caput of CDSCO, told The Hindu that wellness is simply a State subject. “This means that portion CDSCO approves caller drugs, objective trials, and imports, the States grip the licenses for manufacturing, sale, and organisation astatine the State level,” helium said.

Since the findings, the Tamil Nadu Health Department has suspended 2 elder cause inspectors successful Kancheepuram for failing to transportation retired prime checks and for failing to show the drugs manufactured by Sresan Pharma implicit the past 2 years. On October 10, Tamil Nadu Health Minister Ma. Subramanian told reporters that portion the State had acted against its officials, Central cause inspectors, who are expected to behaviour inspections of cause manufacturing facilities crossed India erstwhile each 3 years, person not done this for six years successful Tamil Nadu.

Drugs are licensed successful India done a process overseen by the CDSCO and the State Drug Standard Control Organisations (SDSCO), pursuing the guidelines of the Drugs and Cosmetics Act. The process requires making applications, submitting documents, and carrying retired inspections to guarantee that the drugs are safe, effective, and manufactured nether strict prime standards.

An authoritative of the Union Health Ministry says that successful the lawsuit of Coldrif, the company, Sresan Pharma, got its licence from the State authorities successful 2011; this was renewed successful 2016. “The institution wasn’t successful our radar,” the authoritative says.

A elder FDA authoritative successful Bhopal successful M.P. says if a cause has been approved by the State successful which it is manufactured, the shaper does not request abstracted support to merchantability it successful different State. “No support was granted to this syrup by the MPFDA,” helium says. “But we were liable for investigating random samples of the acrophobic batch, SR-13 of Coldrif, which we did not do, isolated from not having due merchantability and organisation records. Three FDA officials person been suspended for negligence.”

The aftermath

On October 9, an M.P. Special Investigative Team arrested G. Ranganathan, proprietor of Sresan Pharma, successful Chennai. They sealed his manufacturing installation located on the Chennai-Bengaluru highway.

The constabulary besides filed a transgression lawsuit astatine Parasia constabulary presumption against Dr. Soni. They booked him and the directors of Sresan Pharma nether Sections 105 (culpable homicide not amounting to murder) and 276 (adulteration of drugs) of the Bharatiya Nyaya Sanhita, 2023, arsenic good arsenic Section 27(A) of the Drugs and Cosmetics Act, 1940, which prescribes penalties for the manufacture, sale, stock, oregon organisation of substandard and amerciable cosmetics.

The Indian Medical Association objected to Dr. Soni’s arrest. Doctors accidental it is hard to archer whether a medicine is contaminated simply by looking astatine it. Many medicines that are contaminated tin look, smell, oregon sensation similar non-contaminated products. “This is wherefore rigorous and continuous information checks connected aesculapian products to observe and destruct contaminated medicines, whenever possible, is essential,’’ says Dr. Anil Bansal, subordinate of the Delhi Medical Association.

Also read: Cough syrup contamination: Health Ministry directs strict compliance with revised Schedule M norms

The M.P. authorities is present probing however a ample batch of contaminated cough syrup landed successful Parasia. “Over 600 bottles of contaminated cough syrup were dispatched from Jabalpur to Chhindwara, with a ample batch sent to Parasia,’’ says a root successful the Union Health Ministry. The Chhindwara Additional Collector, Dhirendra Singh, says 543 bottles person been seized truthful far.

Dr. Gonnade says astatine slightest 1,000 ASHA workers, 3,000 Auxiliary Nurse Midwives, and respective Anganwadi and wellness workers person been conducting door-to-door surveys since. “They are each hunting for those bottles,” helium says.

The CDSCO has asked each the State governments to taxable a database of cough syrup manufacturers successful their States and has initiated a associated audit of these companies. It has informed the World Health Organization that it has identified and recalled 3 contaminated cough syrups — Coldrif, Respifresh TR, and ReLife — and halted their production. It has besides clarified that nary of these products were exported.

In Dighavani village, astir 15 km from Parasia, Prabhu Dayal and Kunti Yaduvanshi beryllium successful darkness. Their younger son, Vikas, caught a fever connected September 19 and was prescribed Coldrif by Dr. Soni. “By the clip we reached Nagpur connected September 22, the doctors said they were suspicious of the syrup and were investigating it. Did helium [Dr. Soni] not cognize that this syrup had already killed children? What was the authorities doing,” asks Dayal. All they are near with is simply a passport-sized photograph of Vikas; helium died connected September 27.

With inputs from Serena Josephine M. successful Tamil Nadu