Sresan Pharmaceuticals: Why is their 'Coldrif' cough syrup banned? How can parents exercise caution?

After Tamil Nadu, the Madhya Pradesh government recently banned 'Coldrif,' a cough syrup produced by Sresan Pharmaceuticals based in Kancheepuram. On Saturday, Kerala Health Minister Veena George said the sale and distribution of the cough syrup is suspended here, following reports from other states. Telangana has also issued a public alert to stop the usage of the medicine, on Saturday. Gujarat has ordered an investigation into the presence of harmful ingredients in cough syrups, too. On Friday, the Union Health Ministry issued an advisory to all States and Union Territories that cold and cough medications shouldn't be prescribed to kids under the age of 2. 

The ban, advisories and warnings followed after the death of 14 children in Chhindwara near Bhopal, following suspected renal failure. Earlier, two children had died in Rajasthan, reportedly following the use of the cough syrup. As per reports, the samples of the cough syrup, which were supplied in Puducherry, Madhya Pradesh and Rajasthan, apparently had toxic substances. A few days ago, the Tamil Nadu drug control authorities said that the Coldrif syrup sample (Batch no. SR-13, manufactured in May this year with expiry in April 2027) is adulterated due to the presence of 'Diethylene Glycol,' a toxic substance. 

What is Diethylene Glycol?
Diethylene Glycol or DEG is an industrial solvent used in paints, plastics, antifreeze and brake fluids. According to the National Institutes of Health, it is a colourless liquid that is denser than water. Apparently, contact with it can also irritate eyes, mucous membranes, and skin, and ingestion can be slightly toxic, as it can break down into harmful compounds. The World Health Organisation says that even when taken in small amounts, Diethylene Glycol can be poisonous, especially in children. 

Why is it used in cough syrups if it's toxic?
According to the Journal of Ethics of the American Medical Association, DEG is sometimes used by pharmacies as an 'illegal adulterant' in place of its non-toxic, more costly alternative, glycerin. Glycerin is a substance commonly used in liquid medicines to provide a soothing effect, often found in cough medicines. Often, DEG gets added to medicines through intentional adulteration by manufacturers for higher profits or accidental contamination. In fact, DEG is the most common contaminant found in glycerin. Similar to glycerin, DEC has soothing, thickening properties, but its ingestion can lead to permanent disability, renal failure or even death. The journal notes that cases of DEG contamination underscore the importance of ensuring the quality of medicine in a complex supply chain. 

What can patients do?
According to Dr Rajeev Jayadevan of the Indian Medical Association, Cochin, and Dr M Narayanan, Paediatrics and Neonatology Consultant of Ernakulam Medical Centre, here are some precautions parents can take to ensure they are giving the right cough syrups to their children.
1. Understand that there are many kinds of cough syrups for various types of coughs. Do not buy a random cough syrup from pharmacies based on past prescriptions. Additionally, it is not always a qualified pharmacist who prescribes drugs at a pharmacy. 
2. To make sure that your child gets the right medicine, go to a paediatrician and get the correct prescription. Depending on the type of cough, they can prescribe the right syrup, steam inhalation or other remedies. 
3. If any medicine is labelled 'Cough Suppressant,' do not use it without proper advice from doctors. Often, they can have dangerous impurities. 
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