Toxic cough syrup alert fails to reach doctors, IMA unaware of contamination warning

Two days had passed since Tamil Nadu's drugs control department issued an explicit warning against two contaminated cough syrups, yet most doctors in Chennai had no idea the alert existed. The Indian Medical Association, the professional body representing physicians across the state, was equally in the dark. The two products—Relife and Respifresh TR, both manufactured in Gujarat—had been found adulterated with diethylene glycol, the same chemical that had killed twenty children in Madhya Pradesh months earlier.

On October 3rd, the state's deputy director of drugs control, S Gurubharathi, issued the warning after the Madhya Pradesh drug controller determined the syrups were not of standard quality. Relife, containing Ambroxol HCl, Guaiphenesin, Terbutaline Sulphate, and Menthol, carried batch number LSL25160. Respifresh TR, a similar formulation made by a different manufacturer, bore batch number RO1GL2523 and was set to expire in December 2026. Both had been produced by pharmaceutical companies operating in Gujarat—Shape Pharma Pvt Ltd and Rednex Pharmaceuticals Pvt Ltd respectively.

When reporters contacted hospital pharmacies and private practitioners across the city, the response was consistent: they had received no notification. Dr K M Abul Hasan, former president of the Tamil Nadu branch of the Indian Medical Association, expressed the frustration plainly. "Do officials in the drug control department realise their silence can cost lives," he asked. The question cut to the heart of a systemic failure. Diethylene glycol is not an obscure substance—its dangers are well documented. It is highly toxic, capable of causing severe poisoning, kidney failure, and death. The regulatory authorities knew this. Yet the information had not reached the people who prescribe medicines daily.

Dr Subramaniam Swaminathan, an infectious diseases specialist, underscored the stakes. The chemical's toxicity was not theoretical; it had already demonstrated its lethal capacity in Madhya Pradesh. Now it was potentially in the drug supply chain of another state, and the doctors who might encounter patients harmed by it had no warning. Dr Hasan raised another concern: there was no clear channel for physicians to report adverse reactions they observed in patients who had consumed these syrups. The system had failed at multiple points—first in allowing contaminated drugs to reach the market, then in failing to communicate the danger, and finally in providing no mechanism for frontline medical professionals to feed information back to regulators.

The state health minister, Ma Subramanian, offered limited reassurance by stating that the Tamil Nadu Medical Service Corporation had not procured either product and that government hospitals were not using them. But this did not address the private sector, where most of Chennai's population seeks medical care. M Baskaran, a former drug controller, outlined what should happen next: all retailers, distributors, hospitals, and pharmacies needed to be directed to remove the contaminated batches from their shelves and report whether they had received or sold the products. But even this straightforward step had not been taken.

The most difficult challenge, Baskaran noted, lay ahead: convincing consumers who had already purchased these syrups not to use them. Those people—patients with coughs, parents with sick children—had no way of knowing what they held in their medicine cabinets. The alert had been issued. The regulatory machinery had moved. But the information had not traveled the distance it needed to travel, and the people who needed to know remained unaware.