In recent days, India has been shaken by distressing reports of children, adults, and even healthcare providers, falling ill and in some cases dying after taking a particular cough syrup. NDTV reports suggest that in Madhya Pradesh and Rajasthan, clusters of acute kidney failure and other severe symptoms have been linked to consumption of the brand Coldrif (among other suspect syrups), prompting state bans, national alerts, and urgent investigations. The Health Ministry has confirmed that samples from the Tamil Nadu manufacturing unit of Coldrif contained diethylene glycol (DEG), a toxic industrial solvent implicated in past global tragedies, above permissible limits. At the same time, many samples collected in Madhya Pradesh did not detect ethylene glycol or diethylene glycol contamination, adding complexity and caution to the public narrative.
In response, the Centre has issued an advisory limiting the use of cough syrups in very young children, and state regulators are conducting widespread testing of syrup samples across multiple batches and brands. Families, doctors, and ordinary people are understandably alarmed, but it's important to know what's real, what's still under investigation, and how medicines like cough syrups actually work so that fear doesn't overwhelm reason.
What Are Ethylene Glycol And Diethylene Glycol, And Why Are They Dangerous?
Ethylene glycol (EG) and diethylene glycol (DEG) are industrial solvents commonly used in antifreeze, brake fluids, plastics, and other industrial products. They are not approved for pharmaceutical use in significant amounts.
Mechanism Of Toxicity
When ingested, EG and DEG are metabolized or broken down in the body into toxic byproducts (e.g. glycolic acid, oxalic acid, diglycolic acid) that damage organs, especially the kidneys. The dominant harm in acute poisoning is nephrotoxicity, which refers to a progression through acute tubular injury, metabolic acidosis, and ultimately acute kidney failure. Other effects of this toxicity may include neurological dysfunction, metabolic derangements, multi-organ damage.
Older Cases Of Toxic Cough Syrup Poisoning
DEG has been implicated in multiple mass poisoning events worldwide. For example, in The Gambia in 2022, contaminated Indian cough syrups were linked to around 70 child deaths. In Uzbekistan in 2023, dozens of children died after ingesting antipyretic/cough medicines with DEG contamination.
Regulations For EG And DEG Contamination
Regulatory standards across the world often require that DEG or EG contamination must remain below extremely low thresholds (for example, equal to or less than 0.1%) in components and final formulations of cough syrups. The WHO has repeatedly issued medical product alerts about DEG and EG contamination in paediatric medicines. Because even small amounts can cause severe harm, especially to children whose kidneys are more vulnerable, any suspicion of DEG or EG presence in medicines is treated as an emergency.
How Can Cough Syrup Get Contaminated?
From historic cases and global regulations, you can easily understand how and why cough syrup contamination with DEG and EG can happen. But if what you are now wondering how this can happen despite so many cautions in place, it's important to understand how cough syrups are formulated.
A cough syrup (or any liquid medicinal syrup) contains some typical components, pharmaceutically known as "excipients":
- Active pharmaceutical ingredients (API), which are basically the drug(s) that produce the therapeutic effect (e.g. dextromethorphan, ambroxol, phenylephrine, etc.).
- Vehicle (aka solvents or diluents), which are usually water, purified water, glycerine, propylene glycol, or other approved solvent base.
- Preservatives, stabilizers, sweeteners, flavouring, viscosity agents, which are used to stabilize the solution, make it palatable, prevent microbial growth, provide thickness, etc.
- Other additives, including colouring agents (if any), buffer salts, etc.
So, Where And How Does Cough Syrup Contamination Happen?
The AMA Journal of Ethics points to a number of factors that contribute to or may be responsible for cough syrup contamination:
- If a manufacturer or supplier uses industrial-grade glycerine or propylene glycol (rather than pharmaceutical grade), cheaper alternatives like DEG or EG may be substituted or inadvertently mixed.
- Poor quality control, compromised supply chain oversight, adulteration by unscrupulous actors, or cross-contamination in mixing vats can allow DEG and EG to find their way in.
- Because DEG and EG are colourless, odourless, and viscous, they can mimic legitimate solvents unless rigorous analytical tests (e.g. gas chromatography) are done.
Regulatory Detection And Safeguards For Cough Syrups
The WHO recommends that national quality control labs use screening methods like thin-layer chromatography (TLC) and confirmatory methods such as gas chromatography to detect DEG / EG in paediatric medicines. Some countries, including the U.S. FDA, require specific testing of high-risk components for DEG / EG contamination. Strengthening oversight, audits, supplier certification, and closing gaps in the supply chain are critical preventive steps.
Connecting Back To The Current India Situation: What We Know So Far
In India's case, the batch of Coldrif syrup manufactured by Sresan Pharma (Tamil Nadu) tested positive for high levels of DEG at the manufacturing site (48.6%) in one sample. That finding triggered bans in Madhya Pradesh, Tamil Nadu, and likely other states. At the same time, multiple tests of syrup samples collected from other locations (in MP, Rajasthan) have not always found EG/DEG, pointing to possible limited contamination, batch-specific issues, or sampling disparity.
This isn't the first time. India has faced scrutiny before for contaminated cough syrups exported abroad (e.g. linked to child deaths in The Gambia). So, the possibility of contaminated syrups tapping into domestic circulation understandably causes fear. But because the problem may not be universal (i.e. not all syrup batches are contaminated), we must differentiate dangerous batches vs. safe medicines.
What Indian Authorities Are Doing
Here are some clear and critical steps the Indian Health Ministry and associated agencies have taken so far:
- Banning the implicated batches and instructing recall, seizure, and suspension of sales.
- Ordering widespread testing of cough syrup samples in every district.
- Issuing central advisory to states not to prescribe cough/cold medications for children less than 2 years, and to use restraint up to 5 years.
- Forming expert panels to probe root causes, review regulatory gaps, and recommend corrective measures.
Given these developments, the public confusion is natural, and so, strengthening understanding is vital.
Safe Usage Principles: Where You Can Take Action
- Always follow the doctor's prescription or pharmacist's advice, especially regarding dose (based on weight/age) and duration.
- Use single-agent formulations where possible (rather than combinations) to minimize risk of drug interactions or overexposure.
- Avoid using expired syrups or ones with doubtful origin.
- If symptoms worsen or last beyond a few days, seek medical attention rather than increasing dosage oneself.
- Store medicines properly (as per label: temperature, humidity, etc.).
The recent Indian cough syrup tragedy is deeply distressing, especially because it combines human loss, questions of drug safety, and fear in the public psyche. While investigations are ongoing, and until final results are published, the best path is informed caution. Always use syrups under medical guidance, avoid self-medication (especially in the case of children), and trust official alerts and recalls.
Disclaimer: This content including advice provides generic information only. It is in no way a substitute for a qualified medical opinion. Always consult a specialist or your own doctor for more information. NDTV does not claim responsibility for this information.
