PIC medicine disaster: Isotab is the killer pill

London lab report says excess of anti-malarial chemical in drug caused deaths.

LAHORE:

A London laboratory has determined that Isotab, a medicine manufactured by Efroze Chemical Industries, caused the reaction that has so far cost 120 lives.

At a press conference on Wednesday, Chief Minister Shahbaz Sharif revealed that Isotab tablets, which are meant for heart patients, had been contaminated with an anti-malarial chemical, which resulted in fatalities to patients who used it daily. The medicine was given free of cost to patients of the Punjab Institute of Cardiology (PIC).

A doctor familiar with the investigation, who did not want to be named, told The Express Tribune that there were dangerous quantities of the chemical, Pyrimethamine, in Isotab.

Explaining the reaction to the body, the doctor said: “Pyrimenthamine is found in Fansidar, an anti-malarial drug. This chemical reduces folic acid, which is responsible for production of blood. Isotab is given to heart patients twice daily to lessen the burden on their heart. The chemical found in Isotab, however, was equal to 10 tablets of Fansidar, which means those who used this medicine twice a day were effectively taking 20 tablets of Fansidar, which suppressed the bone marrow, disturbed blood production, and ultimately caused death.”

The doctor said that the other four medicines under suspicion – Cardiovestin, Alfagril, Concort and Soloprin – were manufactured by lesser-known pharmaceutical companies. “We didn’t expect Isotab to be contaminated because it’s manufactured by Efroze Chemical Industries, who have around 80 registered medicines in Pakistan. We suspected the above four medicines, but Isotab has turned out to be the one with faults,” he said. He added that drug testing laboratories in Pakistan had previously cleared Isotab.

At the press conference, Shahbaz was in no mood to accept responsibility, claiming that the circulation of the faulty medicine was a conspiracy against Punjab.

“A high-ranking person in Islamabad is responsible for this,” he said, adding that official letters had been written to the federal government with these allegations. Referring to the treatment of patients, the chief minister said that folic acid was being used as an antidote.

Shahbaz also announced that the London laboratory’s report would be forwarded to the World Health Organisation.

Meanwhile, Governor Sardar Latif Khan Khosa took a different view to the chief minister. He announced that the federal government would compensate the families of those who died of the drug reaction. “This is an extreme form of criminal negligence. The Punjab government should accept its negligence. By raising fingers toward President House in Islamabad, the provincial government cannot beguile people,” the governor said.

The owner of Efroze Chemical Industries did admit on Wednesday that the batch of Isotab produced for the PIC containted Pyrimethamine. However, the owner told Express News that his factory should not be closed down, as it had been producing drugs for 35 years and exported them to over 20 countries.

Terming the disaster a ‘conspiracy’ to malign the factory’s name, the owner said that in September last year, some material was stolen from their warehouse, and this might have been used in adulterating the batch of medicines. He said that only this particular batch was spurious and that the rest of the medicines produced by the factory did not have any issues.

The Federal Investigation Agency, meanwhile, has closed the factory after inspecting the premises and meeting staff on Wednesday. The three pharmaceutical laboratories in Lahore which were originally suspected of foul play have been cleared of any criminal offence. However, a medicine called Alfagril, produced by one of the laboratories, has been declared substandard – though not spurious – a source with ties to the FIA said.

It’s obviously more serious for Isotab, which has been taken off the shelves in Pakistan and banned across the world.

(Read: Medicine crisis - who is to blame?)

(With additional reporting by Asad Kharal)

Published in The Express Tribune, February 2^nd, 2012.