[e-drug] Cough syrup intoxication in Lahore

e-drug
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E-DRUG: Cough syrup intoxication in Lahore
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[Dextromethorphan [DMX] has recognised abuse potential. Cases of death when abused alone used to be/are relatively rare unless taken with other substances or in very high doses. There is a report of 5 deaths from the USA (J Anal Toxicol. 2009 Mar;33(2):99-103); and also a paper on the serotonin syndrome specifically with the combination of DMX and chlorphenamine (Br J Clin Pharmacol. 2010 Dec;70(6):794-8). Metabolism polymorphisms may make some persons more susceptible to the effects. A search on PubMed will provide more articles and an internet search on abuse of DMX will also yield information. The question is perhaps why are the deaths occuring now - what is different to before? Is there a 'fad' for higher DMX abuse, coadministration with other drugs or some 'additive' in the product if the deaths are related to a specific product only - the fact that the product meets specifications does not rule out contamination. E-Druggers with more experience in this field may wish to share their thoughts either directly to Khalid or through the forum. - DB]

Dear E Druggers,

I want to draw your attention on serious intoxication incidence that has
occurred in Lahore causing loss of 16 people according to latest media
reports. Deaths are suspected due to intake of a cough syrup. The syrup was
prepared by pharmaceutical company situated in Lahore. Its formulation is
each 5 ml contains 10mg Dextromethorphan Hydrobromide and 2mg
Chlorphenamine Maleate in packing of 120ml bottle. This combination is
registered in Pakistan since many years. As per initial laboratory analysis
contamination is not present as the product fulfills API (active
pharmaceutical ingredient) qualitative and quantitative tests. The
investigation conducted so far reveals that the affected people, mostly
with history of addiction, have used this combination as part of their
addiction practices. It is being suspected that they might have mixed this
syrup with some mixture (narcotics) to increase its sedation property. Upon
intake of intoxicating cough syrup they all turned sick and almost similar
sort of symptoms that includes hypotension, constriction of pupil,
irritability of person and vomiting are being observed. Further the
possibility of DEG (Diethyl Glycol) contamination is also excluded as the
hallmark symptom of ARF (Acute Renal Failure) doesn't exist in the patients.
The further investigations by DRAP and other agencies are still in progress
including possibility of morphine derivatives.

Here I request E-Druggers to share experiences on such mixing of other precursor in OTC cough syrup for misuse and such intoxication ever witnessed.

--
Syed Khalid Saeed Bukhari
Email: skhs77@gmail.com

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E-DRUG: Cough syrup intoxication in Lahore (2)
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Colleagues

In Sri Lanka we had 5 deaths about a month ago following the ingestion of a cough syrup containing dextromethorphan. No quality issue were identified. The cases are still under investigation and we are awaiting the PM reports. All the patients were addicted to this cough syrup and were given a cocktail of the cough syrup with other drugs. Will let you know the outcome of the investigations

Rohini Fernandopulle MBBS, PhD
Clinical Pharmacologist
Telephone: +94112501217

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E-DRUG: Cough syrup intoxication in Lahore (3)
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Thanks to Dr. Rohini Fernandopulle MBBS, PhD for sharing incidence of Death in his country by cough syrup by drug addicts. All other collegues are requested to share their country experience if any of the similar nature which will be helpful in our investigation as well.

AYAZ ALI KHAN
Director Pharmacy / Drug Controller
Directorate General Health Services
Health Department
Government of the Punjab, Lahore.
Cell: 0300-8403646
Ph. Off. 042-99201145
Email: ayazalikhan@hotmail.com
ayazalikhan1@gmail.com
Skype: ayazalikhan

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E-DRUG: Re: [e-drug] Cough syrup intoxication in Lahore (4)
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Dear all,

We await the results with utmost haste and concern.I hope all care and due details will be taken into consideration in the course of the investigations bearing it in mind that human lives are involved.

It is also time that health professionals increased activities concerning the cessation of use of drugs of addiction.I feel the increase in the responsible usage of medicines should be our eternal duty as health professionals not minding the fact that people are getting more informed through the internet and other means.

Thanks

Emmanuel Afunwa
Pharmacist
Royale Pharmaceuticals
Lagos,Nigeria
234803372030

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E-DRUG: Cough syrup intoxication in Lahore (6)
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Dear Colleagues

We have not received any information from any one of the different health sectors concerning intoxication by such type of products ( dextromethorphan hydrochloride ) cough syrups. I think taking a large quantity of such types of products is the main problem so that, to save effort & time I think it better to search about the different cases of misuse other than the proper and regular use of the drug since this had been supported by so many mentioned analysis and laboratory investigations.

Shihabeldin Ali siddig Ali.
General manager of sales & distribution department
Central medical supplies
Khartoum - Sudan

[Some editing of message by moderator to improve readability]