Overview of the NSQ Alert and DEG Concerns
In a developing public health story, Telangana’s drug control administration (DCA) and national regulators are scrutinizing several cough syrups after a Madhya Pradesh (MP) lab raised red flags. Relife cough syrup, among the four products identified as not of standard quality (NSQ) earlier this year, was flagged by MP’s drug testing lab for potential adulteration with the highly toxic diethylene glycol (DEG) and later flagged for labeling issues in Telangana. DEG is a toxic industrial chemical implicated in tragic fatalities in MP and Rajasthan, prompting urgent regulatory action to prevent a recurrence.
While the MP lab warned about DEG in Relife, the Central Drugs Standard Control Organisation (CDSCO) found no DEG in the particular Relife batch tested in Telangana. However, the labeling deficiencies—specifically the failure to disclose the official or common name of the color additive used in the medicine—were deemed a serious lapse. Color additives can trigger allergic reactions or other adverse effects in some patients, and precise labeling helps clinicians and patients make safer choices.
What the Investigations Revealed
The NSQ findings followed a coast-to-coast effort by Telangana’s drug regulators as part of monthly CDSCO inspections. In Relife’s case, authorities noted:
- The batch did not contain detectable DEG, but labeling gaps raised safety concerns.
- Two other NSQ findings involved mislabeling or misleading marketing as cough syrups, and another involved incorrect composition.
- Experts emphasize that accurate labeling of color additives is not cosmetic; it informs risk assessments and potential cross-sensitivities, especially for children.
Senior drug inspectors in Telangana underscored the seriousness of label accuracy: “Knowing the exact color helps doctors and patients avoid harmful ingredients,” one official said. The immediate regulatory response was to recall the NSQ batch and to instruct field teams to withdraw the product from wholesalers and retailers. Officials also stated that Relife is no longer circulating in Telangana.
Other NSQ Cases and Implications for Labeling
Beyond Relife, the NSQ wave in Telangana this year encompassed three other cough syrups with concerning quality or labeling issues:
- Ambroxol Hydrochloride syrup also failed to reveal the correct name of its color additive, mirroring Relife’s labeling shortcomings.
- Ambrodil and Mucolite were flagged for mislabeling, with missing information about levosalbutamol, an asthma-related active ingredient. The labeling requirement — “levosalbutamol sulphate IP equivalent to levosalbutamol” — is intended to ensure dosing clarity and patient safety, particularly for children and those with airway conditions.
Pharmacology experts stress that clear labels also inform clinicians about the potential for adverse reactions and ensure proper dosing, reducing the risk of misuse or dosing errors in vulnerable populations.
Coldrif Contamination: A National Concern
The broader safety concern centers on Coldrif syrup contamination. Following MP and Rajasthan incidents, Telangana’s DCA has intensified statewide checks to prevent Coldrif from entering the market. Although Telangana typically sources cough syrups from states such as Himachal Pradesh, Uttarakhand, and Sikkim, the implicated Coldrif batch reportedly originated from a Tamil Nadu facility (Sresan Pharma) and had distribution across several states. A senior DCA official confirmed no contaminated stocks have been detected in Telangana to date, and authorities are actively tracking suppliers from HP, UK, and Sikkim to ensure no further shipments contain DEG or similar toxins.
Preventive Measures and Public Health Messaging
Regulators emphasize rapid recalls, robust supplier audits, and comprehensive labeling standards as critical lines of defense against NSQ medicines reaching patients, especially children. The current actions reflect a precautionary approach: identify labeling flaws, rectify them, and remove potentially dangerous products from commerce swiftly. Public health officials advise clinicians and caregivers to remain vigilant for warnings and to report any adverse events promptly.
The NSQ alerts serve as early warnings to protect vulnerable groups. While the exact DEG-related fatalities highlighted in MP and Rajasthan have intensified scrutiny, the Telangana experience demonstrates that ongoing, transparent enforcement is essential to maintaining drug safety and public trust.
What Consumers Should Do
For caregivers and patients, the takeaway is prudence and prompt reporting. If a cough syrup or similar pediatric medicine is suspected of substandard quality, consult a healthcare professional, verify product labeling, and check regulatory updates from CDSCO and state DCA portals. Returning suspected NSQ products to retailers and participating in recall drives help curb potential harm.
Conclusion
As regulators widen their net to prevent DEG-adulterated or mislabelled medicines from reaching households, the emphasis remains on stringent labeling, accountable manufacturing practices, and swift regulatory action. The recent NSQ findings in Telangana underscore the ongoing vigilance required to safeguard children and other patients from unsafe drug products.
