Izza Shahid  ( Ziauddin Medical College, Karachi, Pakistan. )
Emaan Amin  ( Dow University of Health Sciences (DUHS), Karachi, Pakistan. )
Muhammad Mustafa Memon  ( Dow University of Health Sciences (DUHS), Karachi, Pakistan. )

Over-the-counter (OTC) medications are used by 25-75% of the population in Asia.^1,2 Recently, a commonly prescribed OTC cough syrup named \'Sancos\' was recalled from the pharmacies of Pakistan.³ This decision came after
the discovery that the syrup contained an increased percentage of sympathomimetic amine pseudoephedrine. Pseudoephedrine is a readily available OTC nasal decongestant which alleviates symptoms of nasal congestion via vasoconstriction of nasal blood vessels.⁴ However, if used in greater dosages, it can result in psychomotor stimulation within the central nervous system owing to its structural similarity with psychostimulant amphetamine.⁴ We discuss implications
of this recall on the drug situation in Pakistan. An alarmingly high percentage of individuals (84.8%) selfmedicate in Karachi alone and use OTC medications, primarily painkillers, antipyretics and anti-tussives, with a total of 14% males and females self-medicating with cough syrups.⁵ Furthermore, the failure of the Drug Regulatory Authority of Pakistan to successfully recall Sancos (7 out of 1.15 million litres recalled) following the ruling underscores the dire threat which the citizens of Pakistan still face.³ In addition, the pharmaceutical industry goes largely unchecked, precipitating the manufacture of substandard and counterfeit drugs which are known to be both ineffective for treatment and detrimental to
health.⁶ The United States implemented the Combat Methamphetamine Epidemic Act in 2005, whereby the amount of pseudoephedrine sold per person was restricted and presentation of identification details was made mandatory at the time of purchase.⁷ In a similar fashion, Pakistan can adopt policies at a national level to regulate pseudoephedrine not only in cough preparations but also other commonly marketed medications. Moreover, pseudoephedrine containing drugs should be made behind-the-counter and prescriptions should becompulsory for purchase. Lastly, patient awareness is also vital to ensure that the sale of hazardous drugs comes to a halt.

Disclaimer: None to declare.
Conflict of Interest: None to declare.
Funding Sources: None to declare.

References

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