Cough Syrup Safety: A Warning Pakistan Cannot Ignore

When 23 children died in India’s Madhya Pradesh after consuming contaminated cough syrup in September, the tragedy barely made headlines in Pakistan. Yet the incident strikes dangerously close to home, where syrup bottles are household staples and self-medication is widespread.

The Indian case revealed syrup laced with diethylene glycol (DEG) — a toxic solvent found at 500 times the permissible limit. Investigations showed the manufacturer had sourced industrial-grade chemicals from paint dealers instead of certified pharmaceutical suppliers. With no qualified chemist overseeing production, the syrup went untested — and deadly.

This was not an isolated incident. In 2022, Indian-made syrups caused the deaths of at least 70 children in The Gambia and 18 in Uzbekistan. Similar tragedies have occurred in Kashmir, underscoring systemic weaknesses in drug oversight.

Pakistan’s Vulnerability

In Pakistan, cough syrups — often called sherbet — are viewed as harmless cures. Parents expect them in prescriptions, and families often share bottles without medical advice. Doctors warn that syrups do little to treat infections, often making children drowsy or irritable.

Karachi’s hospitals are already overwhelmed this flu season, with up to 70% of child patients presenting respiratory infections. Despite medical advice against syrups for under-fives, parents continue to administer them, reinforcing a culture of casual self-medication.

Weak Oversight and Risks

Experts caution that Pakistan’s weak enforcement and easy access to medicines make the system vulnerable. Thousands of unqualified practitioners sell syrups freely, while pharmacies rarely demand prescriptions.

The Drug Regulatory Authority of Pakistan (Drap) admits that most raw materials for syrups are imported from India and China. While contaminated batches have not entered Pakistan, the risk remains. Drap has since mandated pre-testing of additives like glycerin and propylene glycol, strengthened vendor checks, and expanded sampling of raw materials and finished syrups.

Since November 2023, Drap has recalled 63 contaminated products, identified 44 impurities, and issued 13 alerts about unsafe raw materials. Training programs for pharma companies across South Asia now include rapid detection methods like Thin Layer Chromatography to spot contamination early.

A Global Reputation at Stake

Pakistan’s pharmaceutical industry, with 700–800 companies, is eager to expand into global markets. Yet experts warn that scandals over unsafe medicines could jeopardize international ambitions. Only about 300 companies are members of the Pakistan Pharmaceutical Manufacturers Association, leaving much of the sector operating with limited oversight.

Professor Mishal Khan of the London School of Hygiene and Tropical Medicine cautions that weak regulation hurts everyone — doctors, pharma companies, and patients alike. Her 2024 study found that 40% of Karachi doctors accepted incentives to prescribe medicines from a fake pharmaceutical company without verifying quality standards.

The Way Forward

As flu season drives demand for syrups, Pakistan faces a critical choice: strengthen oversight or risk repeating tragedies seen abroad. Regulators are stepping up, but enforcement gaps remain. Public awareness, stricter pharmacy controls, and accountability across the supply chain are essential to prevent disaster.

For families in Pakistan, a sweet bottle of syrup may seem harmless. But as recent tragedies show, without vigilance, it can carry irreversible consequences.