Lahore, Pakistan: About 120 dead from "bad" medication - Pyrimethamine contamination suspected

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Re: Lahore, Pakistan: About 100 dead from "bad" medication - undetermined contamination suspected

Re: Lahore, Pakistan: About 100 dead from "bad" medication - undetermined contamination suspected

http://tribune.com.pk/story/327654/free-medicine-case-punjab-govt-caught-unaware/

?The Punjab Institute of Cardiology caters to as many as 600,000 people annually. Of these, 50,000 people are registered for free medicines for various cardiac diseases,? Dr Saeed Elahi, parliamentary health secretary, said. ?The substandard medicines were distributed to 28,000 patients and 450 of them were affected. One hundred patients have died while 222 are undergoing treatment and 22 of them are in critical condition. However, those in serious condition are not responding to medicines.?


[snip]

Secondly, he said, samples of suspected drugs have been sent for analysis and investigation to domestic and foreign laboratories. In Pakistan, samples have been sent to the National Institute of Health, Islamabad, while one man has gone to a lab in London and is expecting a report in 48 hours. Samples have also been dispatched to labs in Belgium and the US.

 

[Emily]

Re: Lahore, Pakistan: About 100 dead from "bad" medication - undetermined contamination suspected

Re: Lahore, Pakistan: About 100 dead from "bad" medication - undetermined contamination suspected

http://tribune.com.pk/story/327412/tainted-drugs-compensation-payments-begin-as-three-more-die-2/

The Express Tribune
Tainted drugs: Compensation payments begin as three more die
By Our Correspondent
Published: January 26, 2012
[snip]
?The Punjab government established a Punjab Healthcare Commission in 2010 to regulate, register and monitor private hospitals and clinics, but no such authority has been established to monitor and regulate pharmaceutical companies and factories. There are around 600 non-registered factories producing medicines in Punjab while the companies which have been registered by the federal government are not under the control of the provincial government either. There is no mechanism to ensure a control on the quality and prices of medicine,? said a statement issued by PMA officials on Wednesday....

Death benefit: http://coinmill.com/PKR_calculator.html#PKR=500000

Surviving patient benefit: http://coinmill.com/PKR_calculator.html#PKR=200000

 

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Re: Lahore, Pakistan: About 100 dead from "bad" medication - undetermined contamination suspected

Re: Lahore, Pakistan: About 100 dead from "bad" medication - undetermined contamination suspected

http://www.nation.com.pk/pakistan-n...medicine-reaction-takes-toll-to-106-in-punjab

The number of people killed by contaminated heart medicines in Punjab reached 106 as another patient lost his life at Mayo Hospital in Lahore on Friday. The victim was identified as Muhammad Gulab.

On the other hand, Punjab government has launched a house-to-house campaign to retrieve free medicine given at Punjab Institute of Cardiology (PIC) during last month. In addition, Punjab Health Department has removed doubtful medicine from stores. The government has set up a fund in this regard.

 

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Re: Lahore, Pakistan: About 100 dead from "bad" medication - undetermined contamination suspected

Re: Lahore, Pakistan: About 100 dead from "bad" medication - undetermined contamination suspected

http://www.nation.com.pk/pakistan-n...2012/no-respite-from-drug-reaction-2-more-die

[snip]

According to the spokesman of Health Department, as many as 33 patients affected by PIC medicines have recovered and discharged from various hospitals during the last 24 hours, increasing number of recovered patients till today to 274. So far 191 have been discharged from Services Hospital, 32 from Jinnah Hospital, 25 from Mayo Hospital, 23 from Sir Ganga Ram Hospital and 03 from Lahore General Hospital.

At present, 254 patients are still under treatment at various hospitals of Lahore including 90 in Services Hospital, 76 at Mayo Hospital, 52 at Jinnah Hospital, 19 at Sir Ganga Ram Hospital, 11 at LGH, 04 at Shaikh Zayed Hospital and one at Ghurki Trust Hospital. Moreover, two patients are under treatment at Allied Hospital Faisalabad.

 

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Re: Lahore, Pakistan: About 100 dead from "bad" medication - undetermined contamination suspected

Re: Lahore, Pakistan: About 100 dead from "bad" medication - undetermined contamination suspected

http://www.brecorder.com/top-news/1...dulterated-medicines-reach-at-least-113-.html

Deaths from adulterated medicines reach at least 113

Saturday, 28 January 2012 16:10

KARACHI: The number of deaths from spurious drugs has risen to 113 at the Punjab Institute of Cardiology (PIC) it was reported by the media on Saturday.

According to the media, the Federal Investigation Agency (FIA) has ordered arrest of the individuals involved in supplying the false medicines.

Earlier, Punjab Chief Minister Shahbaz Sharif said his team was investigating the unfortunate incident at the PIC.

It was also learnt that the government has sent samples of the drugs toBelgium,France,Britainand US for analysis in more sophisticated labs.

 

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Re: Lahore, Pakistan: About 100 dead from "bad" medication - undetermined contamination suspected

Re: Lahore, Pakistan: About 100 dead from "bad" medication - undetermined contamination suspected

Now what contaminant would cause these symptoms? A couple of these are new.

There has been speculation of radiation poisoning in some of the comments in previous articles, which would be consistent with disease in the bone (say strontium-90, for example) but one might think that would have been detected by now. I also don't see any evidence for an infectious contaminant such as CCHF or H5N1 due to the lack of secondary cases.

http://pakobserver.net/detailnews.asp?id=137842

Death toll reaches 112
Punjab Govt to request LHC for judicial inquiry
Salim Ahmed


Lahore—The death toll due to the Pakistan Institute of Cardiology (PIC) fake medicine reached 112 on Sunday as three more people lost their lives, sources said.

Both the deaths took place in Lahore.

The official death toll remains 89, but Punjab Chief Minister Shahbaz Sharif, talking to the media, had confirmed more than 100 deaths.

The medicine triggered an unknown disease that is said to get deposited in the bone marrow and ultimately ends the body’s resistance. The generation of white blood cells stops in the body and a severe chest infection also takes place.

The symptoms of the disease include a change in complexion, low platelet count, vomiting blood and a severe chest infection.


[snip]

 

[Emily]

Re: Lahore, Pakistan: About 100 dead from "bad" medication - undetermined contamination suspected

Re: Lahore, Pakistan: About 100 dead from "bad" medication - undetermined contamination suspected

I haven't seen any progress on figuring out what was wrong with these medicines. You'd think heavy metal contamination would be easy to find, but this article says animal trials are being planned.

http://www.fiercepharmamanufacturing.com/story/pakistan-suspects-heart-drug-contamination-patient-deaths-seals-plant/2012-01-23

 

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Re: Lahore, Pakistan: About 100 dead from "bad" medication - undetermined contamination suspected

Re: Lahore, Pakistan: About 100 dead from "bad" medication - undetermined contamination suspected

Emily, I'm pretty sure it's not heavy metal now. Heavy metal would have explained the blood counts and hemorrhages, but wouldn't explain the aplastic anemia, immune destruction, or chest infection.

My best guess now would be a radioactive contaminant (perhaps something intended for use in cancer treatment?).

http://tribune.com.pk/story/329793/...be-submitted-on-feb-6-death-toll-reaches-117/

PIC suo motu: With 117 dead, interim report to be submitted Feb 6


By Asad Kharal / Web Desk
Published: January 31, 2012
ISLAMABAD / LAHORE: Advocate General of Punjab Ashtar Ausaf, during a suo motu hearing of the Punjab Institute of Cardiology (PIC) free medicine case on Tuesday, told the Supreme Court that an interim report in the case will be submitted to the court on February 6.

Ausaf informed the court that samples of the drugs were sent out to Switzerland, Belgium and England for tests and the results are awaited.

He said that this step was taken because there was no laboratory in Pakistan which could clearly determine the cause of the deaths by examining the samples.

Ausaf told the court that so far, nothing concrete has surfaced in the investigation and an autopsy of the victims’ bodies will be required to determine the actual cause of the deaths.

[snip]

 

[Anne]

Re: Lahore, Pakistan: About 100 dead from "bad" medication - undetermined contamination suspected

Re: Lahore, Pakistan: About 100 dead from "bad" medication - undetermined contamination suspected

I thought it was a "disease" of the bone marrow (low platelets, low red and white ....), which explains infections and bleeding.
( aplastic anemia...)


a small quantitie of chloramphénicol for exemple, may kill some people. In vietnam, children are dying with aplastic anemia due to chloramphénicol.

http://www-sante.ujf-grenoble.fr/SANTE/corpus/disciplines/hemato/hemacell/hp6/leconimprim.pdf ( translation )
5. Etiologies of aplastic anemia
• Idiopathic +++++
• pre-existing disease:
o Paroxysmal nocturnal hemoglobinuria
o disease Fanconi
• Drugs:
o dose-dependent toxicity: chemotherapy, radiation treatment
o dose toxicity independently proven:
-irreversible:chloramphenicol
-reversible : thiophénicol, phenylbutazone, hydantoins, sulfonamides,anti thyroid, gold salt, colchicine
• Toxic Agents:
o Benzene, aromatic solvents, hair dyes
o Insecticides derived from petroleum products, and organophosphorus

• Infections: Viral hepatitis (aplastic anemia usually occurs during the
convalescent hepatitis), HIV parvovirus B19 in immunocompromised patients.

 

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Re: Lahore, Pakistan: About 100 dead from "bad" medication - undetermined contamination suspected

Re: Lahore, Pakistan: About 100 dead from "bad" medication - undetermined contamination suspected

Thank you for that list, Anne.

Consider that a good starting point for possible contaminants.

 

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Re: Lahore, Pakistan: About 100 dead from "bad" medication - undetermined contamination suspected

Re: Lahore, Pakistan: About 100 dead from "bad" medication - undetermined contamination suspected

And the name of this anti-malarial drug is? I don't see any anti-malarials in Anne's list of drug suspects.

http://www.sananews.net/english/201...ted-says-responsible-are-enemies-of-humanity/

Shahbaz says reactive drug detected; says responsible are enemies of humanity
South Asian News Agency (SANA) ⋅ February 1, 2012 ⋅ Share/Save LAHORE,(SANA): Chief Minister Punjab Mian Shahbaz Sharif has said the action against fake drug producers had been kicked off in the light of a Britain laboratory report received by the government, adding that an important personality of Islamabad had hatched the conspiracy against the Lahoriites during the dengue epidemic.

“The laboratory has revealed that anti-malaria ingredient was 14 percent higher than normal in the drugs tested by it, which caused the loss of precious lives in Punjab,” Sharif told reporters during a press conference.

He was addressing the media here on Wednesday about the spurious medicine issue. ‘The pharmaceutical has been sealed and the names of the owners of the company have been put on ECL.’

To treat the patients affected by the fake drug, an antidote has been produced which is being used in hospitals, the CM said.

A laboratory in London declared one of the cardiac drugs as contaminated with an antimalarial, which caused the deaths of more than hundred patients in Lahore.

He said the medicine, suspected to have caused the deaths of cardiac patients in Punjab, was manufactured by a pharmaceutical company in Karachi.

 

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Re: Lahore, Pakistan: About 100 dead from "bad" medication - undetermined contamination suspected

Re: Lahore, Pakistan: About 100 dead from "bad" medication - undetermined contamination suspected

http://paktribune.com/news/PIC-deat...s-Isotab-as-contaminated-medicine-247196.html

According to the report, Isotab samples were heavily contaminated with Pyrimethamine, which is commonly used as anti-malaria.

 

[Emily]

Re: Lahore, Pakistan: About 120 dead from "bad" medication - Pyrimethamine contamination suspected

So it looks like the problem has been pinpointed to one medication, rather than the group they were initially looking at. I can see why you wouldn't want Pyrimethamine as contaminant in another drug.

http://www.nejm.org/doi/full/10.1056/NEJM196906122802402

 

[Anne]

Re: Lahore, Pakistan: About 120 dead from "bad" medication - Pyrimethamine contamination suspected

perhaps it s not on the list because of different mecanism of action. ( it was a " small" list to fix ideas.)

pyrim?thamine is used against malaria, toxoplasma ( could be used in pregnant women , HIV ) and other parasits.
it s an anti folic . ( no immunoallergic mecanism ), It kills parasits by depriving them in folate.
side effects are knows, and there is an antidote ( wich is not the case with chloramph?nicol ) : wich is acid folic ( a vitamine give to pregnant women for exemple).It s a good news

question : a cardiac drug heavily contaminated with pyrimethamine : how many ? more than in anti malaria drugs ? why ?
<table class="medtable" cellpadding="5" cellspacing="0"><caption>
</caption><tbody><tr><td class="medtablecol1">
</td><td class="medtablecol2">
</td></tr></tbody></table>

 

[Emily]

Re: Lahore, Pakistan: About 120 dead from "bad" medication - Pyrimethamine contamination suspected

perhaps it s not on the list because of different mecanism of action. ( it was a " small" list to fix ideas.)

That reference I put in the post above is really old, 1969, and was the only one I saw describing bone marrow suppression by that drug. Maybe the amounts properly prescribed now are low enough that the problem wasn't seen since then.

pyrim?thamine is used against malaria, toxoplasma ( could be used in pregnant women , HIV ) and other parasits.
it s an anti folic . ( no immunoallergic mecanism ), It kills parasits by depriving them in folate.
side effects are knows, and there is an antidote ( wich is not the case with chloramph?nicol ) : wich is acid folic ( a vitamine give to pregnant women for exemple).It s a good news

question : a cardiac drug heavily contaminated with pyrimethamine : how many ? more than in anti malaria drugs ? why ?
<table class="medtable" cellpadding="5" cellspacing="0"><caption>
</caption><tbody><tr><td class="medtablecol1">
</td><td class="medtablecol2">
</td></tr></tbody></table>

That would be wonderful if they can use that as an antidote!

I can't imagine how that drug got into the heart medication. I bet that will be the focus of the investigation now.

In case you hadn't heard of this, the fake heparin drug cases that killed people in the US in 2008 went to trial just this past summer.

http://articles.chicagotribune.com/2011-06-09/business/chi-baxter-loses-first-heparin-case-20110609_1_baxter-heparin-animallike-substance-scientific-protein-laboratories

 

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Re: Lahore, Pakistan: About 120 dead from "bad" medication - Pyrimethamine contamination suspected

It is extremely good news that they can use folic acid as an antidote, and the article itelf indicates precisely that they are doing that. It will save lives.

 

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Re: Lahore, Pakistan: About 120 dead from "bad" medication - Pyrimethamine contamination suspected

http://www.dawn.com/2012/02/02/phar...entify-drug-which-caused-havoc-in-lahore.html

LAHORE: As the British Medicines and Healthcare Products Regulatory Agency (MHRA) has found one of the five suspect drugs ? Isotab ? contaminated, another report has unfolded the mystery behind the factors which have caused the death of over 100 patients.

According to sources, besides analysing Isotab samples, the MHRA and the School of Pharmacy, London, jointly worked on a case study of 30 registered patients of the Punjab Institute of Cardiology (PIC).

Each of them had consumed 1,000mg of chronic overdose of Pyrimethamine every month, which caused immediate bone marrow suppression and a terrible drop in platelet and white blood cell counts, ultimately leading to their deaths.

[snip]

He said experts of the two laboratories had traced 50mg Pyrimethamine contamination in each 20mg Isotab tablet.

Pyrimethamine is used in the treatment of complicated malaria.

It was also astonishing for them that each of the 30 cardiac patients had consumed 20mg of Isotab twice a day along with other medicines, including Alfagril and Aspirin. As the 20mg Isotab was carrying 50mg Pyrimethamine, the combination of the other two drugs acted as ?fuel to fire?.

He said the experts were stunned over the heavy contamination because the standard protocol allowed a cardiac patient to be advised 25mg of Pyrimethamine as a maximum doze once a week. Similarly, a patient can consume 500mg of Pyrimethamine for a period of three months, but under strict advice of the doctor with a combination of other drugs.

?MHRA laboratories have completed initial testing on samples of all five products. Two samples of Isotab tablets have tested positive for a significant amount of Pyrimethamine, which is anti-malarial,? MHRA Operations Enforcement Group chief Danny Lee-Frost said in his preliminary findings.

[snip]

?The approved doze of Pyrimethamine is 25mg once a week. If the contaminated products contain approximately 50mg per tablet then this would be very significant, particularly as the contaminated products would have been taken at least once a day, i.e. a minimum overdose of 14-fold over time.

?Section 4.9 of the Pyrimethamine SmPC clearly lists bone marrow toxicity as the main feature of chronic overdose, as does the National Poison Information Service (NPIS) Toxbase database.? The report said chronic Pyrimethamine toxicity would be consistent with the bone marrow toxicity seen.

[snip]

 

[Anne]

Re: Lahore, Pakistan: About 120 dead from "bad" medication - Pyrimethamine contamination suspected

Do someone know the DCI of isotab ?

http://www.nation.com.pk/pakistan-n...-2012/factory-making-isotab-sealed-in-karachi

Isotab was manufactured by a Karachi based company Efroze.

http://www.thenewstribe.com/2012/02/01/who-bans-pakistani-medicine-isotab/#.Tyrj_fm9uSo

Lahore: The World Health Organisation has banned Pakistan cardiac medicine Isotab after a medical test carried out in the presence of Punjab government representatives in Switzerland. WHO spokesman it was yet to be ascertained which badge of the medicine was substandard. The WHO also directed government to lift all sticks of the substandard drug.
The WHO has banned use of the Pakistani medicine across the globe.
It is to mention here that more than 100 people have lost their lives due to use of spurious drugs distributed by Punjab Institute of Cardiology (PIC) among poor patients.

 

[Anne]

Re: Lahore, Pakistan: About 120 dead from "bad" medication - Pyrimethamine contamination suspected

http://apps.who.int/medicinedocs/en/d/Jh2922e/2.8.1.html
WHO Model Prescribing Information: Drugs Used in Parasitic Diseases - Second Edition

( toxoplamosis )

Dosage and administration
In the schedules described below pyrimethamine must always be taken together with sulfadiazine.
Pyrimethamine has been administered alone to patients who are hypersensitive to sulfonamides at dosages some four times greater than those suggested here. However, such regimens are associated with a greater risk of bone-marrow depression.
The regimens proposed provide general guidance and are subject to modification in the light of ongoing studies. Recent experience, gained largely in pregnant women and patients with AIDS, suggests that better results can be obtained with doses larger than those previously recommended. This evidence has been taken into account for the recommendations made here.
Pregnant women: 25 mg daily for 3-4 weeks, but not before the second trimester. Recent experience suggests that alternating 3-week courses of pyrimethamine/sulfadiazine and of spiramycin 3 g daily until term may hold advantage.
Neonates without overt disease born to mothers infected during pregnancy: 1 mg/kg daily for 4 weeks, followed, if infection is subsequently confirmed, with further courses. Good results have been obtained by alternating 4-week courses of pyrimethamine/sulfadiazine with 6-week courses of spiramycin 100 mg/kg daily throughout the first year of life.
Neonates with overt disease: 1 mg/kg daily for 6 months. Treatment should then be continued, at least on an intermittent basis, throughout the first year of life. Good results have been obtained with alternating 4-week courses of pyrimethamine/sulfadiazine and of spiramycin 100 mg/kg daily.
Chorioretinitis in adults: 75 mg daily for 3 days, then 25 mg daily for 4 weeks. Unresponsive patients should receive 50 mg daily for a further 3-4 weeks. Further courses of pyrimethamine/sulfadiazine may be administered in the event of relapse.
Immunodeficient patients: 200 mg in divided doses for 1 day followed by 75-100 mg daily for at least 6 weeks, and then a suppressive dose of 25-50 mg daily.

 

[Anne]

Re: Lahore, Pakistan: About 120 dead from "bad" medication - Pyrimethamine contamination suspected

patients took 100 mg of pyrimethamine daily ?