Background
On 24 January 2013, WHO Medical Product Alert N1/2013 was published following the discovery in Pakistan of two types of locally produced cough syrups containing the contaminated active pharmaceutical ingredient (API) Dextromethorphan.
This led to the death of approximately 50 persons in Pakistan, all with a history of drug addiction, who had been abusing dextromethorphan-containing syrups for many years without any reported unexpected adverse reactions.
The subsequent investigation identified that both manufacturers in Pakistan were obtaining Dextromethorphan API from Konduskar Laboratories in India.
More information is available here.
Update
On 26 September 2013, WHO HQ was notified of suspected drug intoxications involving 11 paediatric patients in Paraguay. All of the patients were experiencing influenza-like symptoms and had consumed medical products produced by a local manufacturer (INDUFAR C.S.I.A.) containing Dextromethorphan. The children were aged between 2-9 years and serious adverse reactions included altered consciousness, cyanosis, respiratory distress, and seizures. The onset of symptoms occurred between 2-7 hours after ingesting the Dextromethorphan. Since then the number of patients experiencing adverse reactions has risen to 44 confirmed cases, ranging in age from 5 months to 48 years. There has been one fatality that may be linked to this event.
The Paraguayan Ministry of Health has issued warnings concerning the medicines thought to be connected to this incident.
More details on this update are available here.
For any further information concerning this Alert, or if you have imported Dextromethorphan from
Konduskar Laboratories, India please, contact rapidalert@who.int.