The Uzbekistan cough syrup scandal was a series of poisonings that resulted in the deaths of 18 children in Samarkand and two more children elsewhere in Uzbekistan in December 2022 and January 2023. It was caused by the toxic levels of diethylene glycol and ethylene glycol in cold medicines produced by the Indian company Marion Biotech, such as the Dok-1 Max brand. Subsequently, the Indian government investigated Marion Biotech's manufacturing processes, while Uzbek authorities opened a criminal case against members of the health system that had contributed to the children's deaths, such as regulatory officials and pharmacy administrators.
On December 22, the sale and distribution of Dok-1 Max was temporarily suspended in Uzbekistan, followed by the complete ban of Marion-produced cough syrups one week later. Uzbek customs officials prevented the distribution of 60,000 boxes of Dok-1 Max in response to the new regulations. In late December, the Indian government also ordered the company's manufacturing plant in Noida, Uttar Pradesh to shutdown production and on January 10, 2023, it suspended Marion's license to conduct business.
Shavkat Mirziyoyev, the current President of Uzbekistan, removed Sardor Kariyev from directing the Ministry of Health's Agency for the Development of the Pharmaceutical Network for failed regulatory oversight. The World Health Organization is continuing to investigate the poisonings.
Background
Dok-1 Max is a combination drug produced in syrup and tablet forms, used to resolve symptoms of acute respiratory diseases. It is mainly used in cases of whooping cough, runny nose, wet cough, sore throat, angina, headache, body aches, and fever. Despite the packaging indicating that the syrup can be safely used for children aged 2 and over, other companies only recommend use among those over 12 years of age. Each 10 ml dose of the drug contains paracetamol (500 mg), guaifenesin (200 mg), phenylephrine hydrochloride (10 mg), and minor amounts of sorbitol, propylene glycol, sodium benzoate, citric acid monohydrate, sodium saccharin, sucralose, glycerol, caramel coloring, ice lemon flavoring, menthol, and purified water.
The drug was available in Uzbekistan from 2012 to 2022 and imported under the limited liability company Quramax Medical.
Toxicity
The Uzbek Ministry of Health's toxicology studies identified substitution of the cough syrup's propylene glycol with diethylene glycol and ethylene glycol, toxic substances that can cause vomiting, seizures, syncope, acute renal failure, and cardiovascular disease. Marion Biotech allowed adultation with diethylene glycol and ethylene glycol at approximately 300 times higher than regulatory limits.
Incidents
An official letter from the head of the Children's Multidisciplinary Medical Center of the Samarkand region, Mamatkul Azizov, to the head of the Health Department of the regional government, Davronbek Jumaniozov, on December 15, describes the tragic circumstances related to Dok-1 Max to have happened "in the last 2 months".
Oltinoy Esanova, the deputy head of the Syrdarya Region health department, reported that the drug had a negative effect on seven children. 3 of the patients are in the intensive care unit, and 4 have recovered. The information advised parents to refer children under 6 years of age who have received Dok-1 Max to family hospitals, even if there are no side effects.
Abduqayum Tokhtaqulov, the head of the health department of Fergana region, reported to the National News Agency that a 3-year-old boy was poisoned. In his message, he noted that the condition of the patient from the city of Kuvasoy was serious and that he was currently being treated on the basis of specially approved standards. Tokhtakulov also told parents that they should keep their children away from such drugs and not to give them to their children.
There were also reports that 9 children were poisoned in Tashkent region. According to the report of the regional administration, until now there had been no cases of death in the region due to the drug. It was reported in the media that five of the children in the region recovered, and the condition of four was stable.
Akmal Askarov, deputy minister of Karakalpakstan, told the state television channel that two children were poisoned by the Dok-1 Max and were sent to Tashkent for specialized treatment. Spokesman of the Ministry S. Ziyayev noted that the condition of the children was average, with renal toxicity being observed.
Deaths
Cases of death in young children were recorded in Samarkand (18), Kashkadarya (1) and Namangan (1) regions.