Explained: The Toxic Truth Behind India's Cough Syrup Deaths

In Madhya Pradesh, the death toll of children who died after consuming contaminated cough syrup has climbed to 20.

The death toll of children who died after consuming contaminated cough syrup in Madhya Pradesh has climbed to 20, the state's Deputy Chief Minister Rajendra Shukla confirmed on Tuesday, 7 October. This number is expected to rise further.

The children began experiencing symptoms such as vomiting and difficulty urinating after taking a cough syrup branded Coldrif, and their condition soon deteriorated rapidly.

Laboratory tests have confirmed the presence of Diethylene Glycol (DEG), a toxic industrial solvent known to cause acute kidney failure when ingested, in the syrup.

The tragedy has sent local authorities into overdrive with inspections and quality checks being carried out across manufacturing units in several states.

Weeks after the news first broke, G Ranganathan, the owner of Sresan Pharmaceuticals, the manufacturer of Coldrif cough syrup, was arrested, officials announced on Thursday, 9 October.

However, these efforts appear superficial when viewed against India’s long history of contaminated cough syrups leading to fatalities.

Why does this keep happening, and where does the buck stop?

India's Long History of DEG Poisoning

As grim as it sounds, India is all too familiar with children dying from DEG poisoning caused by contaminated cough syrups.

In fact, it makes headlines every few years, with familiar themes: cough syrup, DEG poisoning, Indian manufacturer, regulatory lapses, and children dead.

It was first reported in India in 1986 when 14 patients died at Mumbai’s JJ Hospital after being given glycerol contaminated with 18.5 percent DEG.

More than three decades later, in 2020, the death of 12 children in Jammu & Kashmir was liked to cough syrups contaminated with DEG. This time, authorities in Himachal Pradesh (where it was manufactured) suspended the license of Digital Vision Pharmaceuticals, and an FIR was filed.

But just a couple of years later, in 2022, the deadliest DEG tragedy struck when four cough syrup brands produced by Haryana-based Maiden Pharmaceuticals were linked to DEG and Ethylene Glycol (EG) poisoning that killed nearly 70 children in Gambia.

This time, the tragedy made international headlines, prompting the World Health Organisation (WHO) to take notice. Although the WHO confirmed the link through laboratory tests, India’s Central Drugs Standard Control Organisation (CDSCO) at the time denied that the Indian-made cough syrup was responsible for the deaths in The Gambia.

Later that same year, 20 children in Uzbekistan died after taking Dok-1 Max cough syrup made by another Indian company, Marion Biotech, which too was found to contain DEG.

How exactly does DEG get into cough syrups? To put it simply, cough syrups commonly use pharmaceutical-grade solvents such as glycerin or propylene glycol to dissolve other ingredients.

However, to cut costs, some manufacturers may use cheaper substitutes often sourced from unreliable suppliers, which can be contaminated with DEG or EG. DEG itself is chemically very similar to glycerin, making it hard to trace withouth proper testing.

The Blame Game Continues

Each tragedy triggers brief outrage, investigations, and promises of reform, yet the pattern keeps repeating. Regulatory lapses persist, accountability remains elusive, and children continue to pay the price for a system that seems to learn nothing from its own failures.

The latest tragedy is no different.

When the first casualty linked to the Coldrif cough syrup came to light in September, the Madhya Pradesh government initially dismissed any connection between the cough syrup and the deaths.

This allowed the contaminated cough syrup to continue being prescribed and given to children in the meantime. It was only several days later, after more deaths were reported, that a laboratory in Tamil Nadu conducted tests and, on 3 October, confirmed the syrup contained 48.6 percent DEG, a fatally high concentration.

Now, as the case shapes up to be one of the worst tragedies of its kind in the state, the Madhya Pradesh government has responded with seemingly knee-jerk actions—arresting one doctor, Praveen Soni, a government paediatrician in Chhindwara’s Parasia, who prescribed the medicine, and booking the manufacturer Sresan Pharma. They have also announced a Special Investigation Team to probe the case further.

The Indian Medical Association (IMA) has objected to Dr Soni’s arrest.

In a statement issued on Monday, 6 October, the IMA said this was clearly a case involving a spurious drug, and that ensuring its quality falls within the responsibility of the drug regulatory system, and not the doctor.

Subsequently, in a notice issued on 7 October, the CDSCO acknowledged that several pharmaceutical companies have failed to conduct due diligence in testing raw materials before using them to manufacture drug formulations. However, the country’s apex drug regulator has not made any direct statement regarding Coldrif or its manufacturer, Sresan Pharma.

The Rot Runs Deep

India is a huge producer and market for cough syrups. According to Market Research Future, the domestic market for cough syrups was valued at $0.26 billion in 2024. This figure is projected to grow to $0.74 billion by 2035, reflecting a compound annual growth rate (CAGR) of around 9.92 percent.

But, pull back the curtains, and you'll find that the production and sales of cough syrups in India is a messy affair that's not always evidence-based.

Several combinations of drugs, all sold under the umbrella term of ‘cough syrups’ are widely advertised and sold over-the-counter here.

According to experts, the root cause of such quality lapses time and time again is a result of serious oversight by the regulatory system charged with enforcing them.

“Firstly, Indian pharmaceutical companies often skip testing raw materials and finished products before marketing them, despite such testing being mandated under the Good Manufacturing Practices (GMP) prescribed by the Drugs and Cosmetics Act, 1940,” Shreya Shrivastava, Senior Resident Fellow at the Vidhi Centre for Legal Policy, told The Quint in a previous interview.

Secondly, drug regulators often fail to investigate the root cause of such incidents. Tracing and publicly disclosing the source of contaminated industrial solvents could help prevent future cases.

In the Jammu case, the regulator treated the contaminated cough syrup as an isolated issue, without probing the origin of the Propylene Glycol (PG), a likely source of contamination across multiple syrups produced by Digital Vision.

Speaking to The Quint when the Gambia incident happened, public health activist and co-author of The Truth Pill: The Myth of Drug Regulation in India, Dinesh Thakur, stated that the repeated occurrence of such incidents without corrective action suggests "we either don't care, or that the people who are accountable to the citizens of India are not doing their job."

Why Are Cough Syrups Still being Prescribed?

But here’s the real kicker. There’s no evidence that cough syrups actually help treat colds or coughs. Experts have reiterated this time and again.

In fact, the WHO has repeatedly advised against the use of cough and cold medicines in children.

"I have spent decades of my career trying to convince parents that their child does not need cough syrups. But it seldom works," said Dr Vandana Prasad, a community paediatrician and public health professional, in an earlier interview with The Quint.

Amitava Guha, national co-covener of Jan Swasthya Abhiyan (People's Health Mission), further explained, "Sometimes both cough expectorants and suppressants are combined in one cough syrup. These combinations are contradicting, and don't make any sense."

Some of these combinations are also known to cause dangerous, and even fatal outcomes.

"Many of these are sedatives, which in children is not a good thing. Cough suppressing cough syrups could inhibit respiratory function, especially in kids with lung issues."

Dr Vandana Prasad

“As far as government regulations for approving medicines are concerned, there is complete anomie,” said Dr Guha, who believes the most effective solution to the OTC cough syrup crisis would be to ban these syrups altogether.

However, experts say such a ban is unlikely, especially if major pharmaceutical companies have a say.