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Emergency Message for U.S. Citizens: Islamabad (Pakistan), Drug Advisory

South Central Asia > Pakistan > Islamabad

As recent press reports have indicated, a harmful drug contamination has caused around 120 deaths and hundreds of hospitalizations in Pakistan.  According to reliable reports, independent professional analysis has identified Isotab (isosorbide mononitrate) 20 mg tablets as having been contaminated with a drug called pyrimethamine, a common anti-malarial drug also manufactured by Efroze, a Pakistani pharmaceutical manufacturer.  

 Pyrimethamine taken in the quantities present in the contaminated batch of Isotab can be associated with significant adverse effects consistent with those seen in the patients under investigation, including hematologic abnormalities of low blood counts (anemia), thrombocytopenia (causing bleeding), skin lesions including a diffuse body rash, and gastrointestinal symptoms.

There is currently no evidence that other drugs by the same manufacturer or those produced by other Pakistani manufacturers are affected.  However, the World Health Organization (WHO) Pakistan has suspended all Efroze products from the list of WHO drug suppliers until test results confirm these medications are not contaminated. 

The U.S. Embassy in Islamabad has recommended to all its employees that products from Efroze not be purchased or consumed until the WHO advises that health concerns have been addressed by the manufacturer.  Efroze products have been widely available at most pharmacies throughout Pakistan.  An attached list of medications produced by Efroze follows.

The U.S. Embassy in Islamabad has advised its employees that any person taking Isotab 20mg tablets made by Efroze Batch J093 should immediately stop doing so and see their health care provider. 

The Embassy further recommends that U.S. citizens follow WHO recommendations and consult their health care provider if they have further concerns.

List of Medications Produced by Efroze

BRAND

INGREDIENTS

ACORET

Ethambutol (HCl) [300 mg], Isoniazid [75 mg], Rifampicin [150 mg]

ACORET-P

Ethambutol (HCl) [225 mg], Isoniazid [60 mg], Pyrazinamide [300 mg], Rifampicin [120 mg]

ALGAPHAN

Dextropropoxyphene [32.5 mg], Paracetamol [325 mg]

ALGAPHAN

Dextropropoxyphene [32.5 mg], Paracetamol [325 mg]

ALPAX

Alprazolam [0.25 mg]

ALPAX

Alprazolam [0.5 mg]

ANGIOTAN

Valsartan [160 mg]

ANGIOTAN

Valsartan [80 mg]

ANGIOTAN H

Hydrochlorothiazide [0 ], Valsartan [0 ]

ARTEDOXIN

Artesunate [0 ], Pyrimethamine [0 ], Sulfadoxine [0 ]

ARTEDOXIN P

Artesunate [0 ], Pyrimethamine [0 ], Sulfadoxine [0 ]

ASILEZ

Aliskiren [150 mg]

ASILEZ

Aliskiren [300 mg]

BRECARE

Montelukast [5 mg]

BRECARE

Montelukast [10 mg]

CALZEM

Diltiazem (HCl) [30 mg]

CALZEM

Diltiazem (HCl) [60 mg]

CAPRIL

Captopril [50 mg]

CAPRIL

Captopril [12.5 mg]

CAPRIL

Captopril [25 mg]

CAPRIL

Captopril [25 mg]

CORBIS

Bisoprolol (Fumarate) [2.5 mg]

CORBIS

Bisoprolol (Fumarate) [5 mg]

CORBIS

Bisoprolol (Fumarate) [10 mg]

CORBIS-H

Bisoprolol (Fumarate) [0 ], Hydrochlorothiazide [0 ]

CORBIS-H

Bisoprolol (Fumarate) [0 ], Hydrochlorothiazide [0 ]

DECLOT

Clopidogrel [75 mg]

DELAWARE

Carvedilol [12.5 mg]

DELAWARE

Carvedilol [12.5 mg]

DELAWARE

Carvedilol [3.125 mg]

DELAWARE

Carvedilol [0 mg]

DELAWARE

Carvedilol [25 mg]

DESLET

Desloratadine [2.5 mg/5ml]

DIAZEPAM

Diazepam [2 mg]

DIAZEPAM

Diazepam [5 mg]

DINEMIC

Trimetazidine (Di HCl) [20 mg]

DINEMIC

Trimetazidine (Di HCl) [20 mg]

ECIN

Erythromycin [250 mg]

EFOME

Omeprazole [20 mg]

EFRODOL

Caffeine [0 ], Mepyramine [0 ], Paracetamol [0 ]

EFROQUINE

Chloroquine [250 mg]

EFROQUINE

Chloroquine [250 mg]

EFTRAN

Sulphamethoxazole [400 mg], Trimethoprim [80 mg]

EFTRAN DS

Sulphamethoxazole [800 mg], Trimethoprim [160 mg]

EMOD

Loperamide (HCl) [2 mg]

ERIZOLE

Mebendazole [100 mg/5ml]

ERIZOLE

Mebendazole [500 mg]

ERIZOLE

Mebendazole [100 mg]

EZ-FLOW

Lactulose [0 ]

FAMITINE

Famotidine [20 mg]

FAMITINE

Famotidine [40 mg]

FAMTINE

Famotidine [40 mg]

FAMTINE

Famotidine [20 mg]

Feboric

Febuxostat [40 mg]

Feboric

Febuxostat [80 mg]

FLOXER

Levofloxacin [250 mg]

FLOXER

Levofloxacin [500 mg]

FOSFOMYCIN

Fosfomycin [250 mg]

GASTROLON

Metoclopramide (HCl) [10 mg]

GASTROLON

Metoclopramide (HCl) [10 mg]

GLICON

Glibenclamide [5 mg]

GLYPER

Glimepiride [1 mg]

GLYPER

Glimepiride [2 mg]

GLYPER

Glimepiride [3 mg]

GLYPER

Glimepiride [4 mg]

GYNAECOSID

Methyloestradiol [0.3 mg], Methyloestrenolone [5 mg]

ISDIN

Isosorbide (Dinitrate) [10 mg]

ISOTAB

Isosorbide 5-Mononitrate [20 mg]

ISOTAB

Isosorbide 5-Mononitrate [40 mg]

ISOTAB

Isosorbide 5-Mononitrate [60 mg]

ISOTAB-XR

Isosorbide 5-Mononitrate [60 mg]

KLABID

Clarithromycin [125 mg/5ml]

KLABID

Clarithromycin [250 mg]

KLABID

Clarithromycin [500 mg]

KONTAB

Bromelains [50 mg], Trypsin (Protease) [1 mg]

LIPOCOR

Bezafibrate [200 mg]

LIPOTRIM

Atorvastatin [10 mg]

LIPOTRIM

Atorvastatin [20 mg]

LIPOTRIM

Atorvastatin [40 mg]

LOSAAN

Losartan (K) [50 mg]

LOSAAN-H

Hydrochlorothiazide [12.5 mg], Losartan (K) [50 mg]

MALADAR

Pyrimethamine [25 mg/5ml], Sulfadoxine [500 mg/5ml]

MALADAR

Pyrimethamine [25 mg], Sulfadoxine [500 mg]

MALADAR

Pyrimethamine [25 mg], Sulfadoxine [500 mg]

MEFNAC

Mefenamic Acid [500 mg]

MEFNAC

Mefenamic Acid [50 mg/5ml]

MEFNAC

Mefenamic Acid [250 mg]

MEFNAC

Mefenamic Acid [250 mg]

METCON

Glibenclamide [2.5 mg], Metformin (HCl) [500 mg]

METCON PLUS

Glibenclamide [5 mg], Metformin (HCl) [500 mg]

METPHAGE

Metformin (HCl) [850 mg]

METPHAGE

Metformin (HCl) [500 mg]

METZON

Metformin (HCl) [500 mg], Pioglitazone [15 mg]

METZON

Metformin (HCl) [500 mg], Pioglitazone [15 mg]

MONTEF

Montelukast [4 mg]

MONTEF

Montelukast [5 mg]

MONTEF

Montelukast [10 mg]

MONTEF

Montelukast [4 mg]

NEOLIP

Simvastatin [20 mg]

NEOLIP

Simvastatin [10 mg]

NITRIL

Glyceryl Trinitrate [0 ]

NOMIN

Atenolol [50 mg]

NOMIN

Atenolol [100 mg]

OMEFAST

Omeprazole [0 ], Sodium Bicarbonate [0 ]

OMEFAST

Omeprazole [0 ], Sodium Bicarbonate [0 ]

PANARAM

Paracetamol [120 mg/5ml]

PANARAM

Paracetamol [500 mg]

PANGO

Ibuprofen [400 mg]

PANGO

Ibuprofen [200 mg]

PANGO

Ibuprofen [200 mg]

PANGO

Ibuprofen [400 mg]

PERAZONE

Cefoperazone [1 g]

REDUCE ACHE

Ibuprofen [0 ], Pseudoephedrine (HCl) [0 ]

REDUCE ACHE

Ibuprofen [0 ], Pseudoephedrine (HCl) [0 ]

ROXIN

Ciprofloxacin [250 mg]

ROXIN

Ciprofloxacin [500 mg]

SELOXX

Celecoxib [100 mg]

SELOXX

Celecoxib [200 mg]

SEMI GLICON

Glibenclamide [2.5 mg]

SEMI METCON

Glibenclamide [1.25 mg], Metformin (HCl) [250 mg]

SIAM

Aluminium Hydroxide, Magnesium  Hydroxides , Simethicone

TOPMATE

Topiramate [25 mg]

TOPMATE

Topiramate [50 mg]

TRAMAPAR

Paracetamol [0 ], Tramadol (HCl) [0 ]

TRISIL

Aluminium Hydroxide and Oxide [250 mg], Magnesium Trisilicate [500 mg]

TRIZYMAL

Pancreatin [150 mg]

VICOX

Rofecoxib [25 mg]

ZETRINE

Cetirizine [10 mg]

ZETRINE

Cetirizine [5 mg/5ml]

For the latest security information, U.S. citizens traveling abroad should regularly monitor the Department of State’s Internet website where Worldwide Caution, Country Specific Information for Pakistan, Travel Warnings (including the current Travel Warning for Pakistan), and Travel Alerts can be found.  You can also follow the Bureau of Consular Affairs on Twitter and on Facebook.  Up-to-date information on overseas security can also be obtained by calling 1-888-407-4747 toll-free in the United States and Canada; callers outside the United States and Canada can dial a standard toll-line at 1-202-501-4444.  These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).

U.S. citizens are advised to maintain valid travel documents and to enroll overseas travel through the State Department’s Smart Traveler Enrollment Program.

Please note the following contact information for all four U.S. diplomatic posts operating in Pakistan:

 

  • U.S. Consulate General Karachi, located at Plot No 3-5, TPX Area, Mai Kolachi Road, Karachi, provides services to U.S. citizens by appointment only.  Services can be scheduled by calling (92-21) 3527-5000 between 10:00 a.m. and 2:00 p.m., Monday-Friday; fax (92-21) 3527-5885; website http://karachi.usconsulate.gov/; email acskarachi@state.gov.

 

  • U.S. Consulate General Lahore, located at 50 Sharah-E-Abdul Hameed Bin Badees (Old Empress Road) near Shimla Hill Rotary, provides services to U.S. citizens by appointment only.  U.S. citizens requiring assistance should contact the Consular Section at (92-42) 3603-4000; fax (92-42) 3603-4200; website http://lahore.usconsulate.gov/; email acslahore@state.gov.