Last week in some Cardiac Hospitals and departments in Lahore, some cases of mysterious death occurred. In beginning it was believed to be a cause of some cardiac drug reaction of a specific brand. Later on, the death toll increases & a number of other drugs are considered to be involve . These cardiac drugs of some local manufacturer are Aspirin, Clopidogrel and simvastatin. 150 patients are also admitted in serious condition. A number of responsible factors are discussed by the health care authorities of Pakistan that includes.
- Default or toxic batch production with contamination of some metal
- Adverse drug reaction
- Mysterious disease
Condition of Patient after Reaction
The patients suffering from drug reaction have very low platelet count, low white blood cell count and bone marrow damage. This sudden fall in platelets and WBC causes death of patient.
Possible Reasons
1. Drug regulation system in Pakistan is not so very effective. The risks associated with some adulteration or suspicious agent in raw material during manufacturing considerably can be the main reason of this drug reaction. Some Pharma companies bought raw material of low quality that may subject to chemical changes during inappropriate storage conditions in Hospital.
2. These drug if use in regimen may interact with each other, taking non-steroidal anti-inflammatory drugs (NSAIDs) like Aspirin with clopidogrel can increase the risk of bleeding. Clopidogrel and statins also interacts and increase the anti-platelet effect that may cause bleeding. If this is the case then there is a clear cut need of a Pharmacist in Cardiac and other hospitals. it should also be noted that these interactions may also decrease the platelet count. If this is not a reason of death then combination of these medication should also be considered with precaution and proper monitoring. There are few links that may support my dissuasion.
Reference Link:
1. American Heart Association: http://circ.ahajournals.org/content/110/6/e68.full
2. http://heart-disease.emedtv.com/clopidogrel/drug-interactions-with-clopidogrel.html
3. http://circ.ahajournals.org/content/98/22/2461.full
4. http://cll.acor.org/pp%20platelets.htm
3. Some toxic material or excipient may be added during production of that batch. Principal of the Allama Iqbal Medical College/Jinnah Hospital Prof Javed Akram said that there might be chance of metal contamination that damages the platelets and bone marrow. I want to add further in it regarding production of these tablets. During processing and manufacturing of tablets different metallic equipments ( High Quality material) are used like sieves, compression machine ( Punches) and e.t.c. It is also possible that manufacturer equipments for production of tablets are not of well and good quality or may completed its optimum working period. The Metal Contamination may also comes form the raw manufacturer of excipient or active drug used.
4. If we draw attention toward a mysterious disease then this type of condition of patient indicates toward the Congo Virus infection or may be new strains of Congo virus that significantly decrease the amount of platelets or White cells without giving other symptoms. Or we can say that it is may be because of Congo virus contamination in material use in manufacturing of this cardiac medicines.
