Thursday, November 5, 2026

Patient Safety vs. Automatic Suspension: Is the Proposed Drugs Amendment 2026 Too Harsh on India's Pharmaceutical Industry?

An independent pharmaceutical consultant's perspective on the proposed amendments to Rules 85 and 122O of the Drugs Rules, 1945

By Rajesh Kapoor | Independent Pharmaceutical Consultant | 28+ Years of Pharmaceutical Industry Experience

The Indian pharmaceutical industry has made tremendous progress over the years in strengthening manufacturing standards, improving quality systems and establishing itself as a globally recognised supplier of medicines. However, this progress also brings with it an enormous responsibility: ensuring that every medicine reaching a patient meets the prescribed standards of quality, safety and efficacy.

Having spent over 28 years in the pharmaceutical industry, including leadership responsibilities in Quality and Regulatory Affairs and now working as an independent pharmaceutical consultant, I have consistently advocated stronger GMP compliance, improved manufacturing practices, robust Quality Management Systems and continuous upgradation of pharmaceutical facilities.

I have always believed that there should be no compromise when it comes to patient safety.

However, after reviewing the recently published Draft Drugs (Amendment) Rules, 2026, vide G.S.R. 956(E), dated 28 October 2026, I believe that certain proposed provisions deserve serious reconsideration before they are finalised.

My concern is not about strengthening pharmaceutical regulation. On the contrary, I strongly support it.

My concern is about the proposed mechanism of enforcement, particularly the provision for immediate suspension of the manufacturing licence granted for the particular drug upon receipt of a Government Analyst's report declaring that drug Not of Standard Quality (NSQ).

Can we strengthen patient safety without creating disproportionate consequences for pharmaceutical manufacturers? I believe we can, and we should.

1. What Exactly Is the Government Proposing?

The Ministry of Health and Family Welfare has proposed amendments to Rules 85 and 122O of the Drugs Rules, 1945.

The proposed Rule 85(2A) and Rule 122O(1A) introduce provisions requiring the Central Licensing Approving Authority or State Licensing Authority, as applicable, to immediately suspend the manufacturing licence granted for the particular drug upon receipt of a Government Analyst's report declaring that drug Not of Standard Quality.

Under proposed Rule 85(2A), the specified parameters include:

  • Assay

  • Dissolution

  • Related substances

  • Impurities

  • Sterility

The proposed Rule 122O(1A) provides a broader provision relating to drugs declared NSQ.

The suspension would continue until the manufacturer conducts an effective root cause analysis and implements Corrective and Preventive Actions (CAPA) to the satisfaction of the licensing authority.

The suspension would be revoked only after implementation and verification of CAPA.

An important clarification: The proposed provisions refer to the manufacturing licence granted for the particular drug concerned. They do not expressly propose automatic suspension of all manufacturing permissions held by the company or closure of the entire manufacturing facility.

This distinction must be clearly understood while evaluating the proposed amendment.

Nevertheless, suspension of permission to manufacture even a single product can have significant consequences, particularly when that product represents a substantial portion of the manufacturer's business, serves an important therapeutic segment or has limited alternative manufacturing sources.

At first glance, the proposed measure may appear to be a strong and decisive step towards preventing substandard medicines from reaching patients.

However, the implications of making suspension an immediate and mandatory consequence of an analytical report need to be examined carefully.

2. A Laboratory Failure and a Manufacturing System Failure Are Not Necessarily the Same

This is an important distinction that deserves attention.

A Not of Standard Quality result is a serious matter and must never be ignored. Every NSQ result should trigger a documented investigation, scientific assessment and appropriate regulatory response.

However, not every NSQ result necessarily establishes that the entire manufacturing system has failed.

Consider a few examples:

  • A batch failing assay specifications.

  • A dissolution result falling outside the prescribed limits.

  • An isolated impurity exceeding its specified acceptance criterion.

  • A sterility failure.

  • A result potentially influenced by sampling, transportation, storage or analytical variables.

These situations are not scientifically identical.

A sterility failure, for instance, can represent an immediate and potentially serious patient-safety risk. An assay or dissolution failure may require a different level of investigation depending on the magnitude, nature and possible cause of the failure.

The investigation may identify a manufacturing process problem, an analytical issue, a raw-material variation, an equipment-related problem or another contributing factor.

The regulatory response should therefore consider the nature of the failure, its severity and its potential impact on patients.

Should an isolated batch-level failure automatically result in suspension of the manufacturing permission for that particular product without first assessing the circumstances and extent of the failure?

I believe this question deserves serious consideration.

3. Does the Proposed Mechanism Adequately Protect Statutory Rights Under the Drugs and Cosmetics Act, 1940?

One of my major concerns relates to the existing statutory mechanism under Section 25 of the Drugs and Cosmetics Act, 1940.

Section 25(3) provides a statutory opportunity to dispute the findings of a Government Analyst within 28 days of receiving the report by giving written notice of the intention to adduce evidence in controversion.

Section 25(4) provides for examination of the sample through the Central Drugs Laboratory in the circumstances specified therein, with the Director's report having the statutory evidentiary status provided under that section.

This is an important safeguard within the existing legislative framework.

The Supreme Court of India, in M/s Medicamen Biotech Ltd. & Anr. v. Rubina Bose, Drug Inspector, Criminal Appeal No. 483 of 2008, decided on 13 March 2008, recognised the importance of the manufacturer's statutory rights under Sections 25(3) and 25(4).

The judgment highlighted the serious consequences of procedural delays when a manufacturer seeks re-analysis and the drug sample approaches the end of its shelf life.

My concern is that the proposed amendments do not expressly explain how these statutory rights will be protected when an NSQ report is disputed.

What happens if a manufacturer receives an NSQ report, disputes the analytical findings within the statutory period and seeks examination through the Central Drugs Laboratory?

Will the product-specific manufacturing permission remain suspended regardless of the outcome of that statutory challenge?

What happens if the subsequent examination does not support the original Government Analyst's finding?

These questions should be addressed explicitly in the amended rules.

I am not suggesting that a manufacturer should be allowed to continue distributing a potentially unsafe product merely because it has disputed a test result. Patient protection must always take priority.

However, an appropriate mechanism must exist to protect the manufacturer's statutory right to challenge an analytical finding while allowing regulators to take necessary interim action wherever justified.

4. Product-Specific Suspension: Is an Automatic Decision Always Justified?

I would like to clarify that the proposed amendment is not about automatically suspending the entire manufacturing licence of a pharmaceutical company.

The language of the proposed Rule 85(2A) and Rule 122O(1A) refers to suspension of the manufacturing licence granted to manufacture the particular drug concerned.

Therefore, if a company manufactures several products, an NSQ finding against one product would trigger the proposed suspension mechanism in relation to the manufacturing permission for that particular drug, rather than automatically stopping the manufacture of every other product.

This is an important distinction, and the impact of the proposed amendment should be evaluated accordingly.

However, even a product-specific suspension can have substantial consequences.

Consider a manufacturer producing several pharmaceutical formulations, with one particular product contributing significantly to its business or catering to a critical therapeutic requirement.

Suspension of permission to manufacture that product could result in:

  • Disruption of production and supply commitments for that particular product.

  • Financial losses arising from blocked production and inventory.

  • Contractual difficulties with marketing companies and distributors.

  • Disruption of supply to patients who depend on that medicine.

  • Additional regulatory and operational costs associated with investigations and CAPA.

  • Loss of confidence among customers and business partners.

More importantly, the suspension could continue even when the manufacturer is disputing the analytical findings through the statutory procedure.

The fundamental question is not whether a product-specific suspension can be imposed. It is whether making that suspension automatic, without expressly addressing the circumstances of the case and the statutory challenge mechanism, is the most appropriate regulatory approach.

A product-specific NSQ finding should certainly invite stringent scrutiny of the affected product and its manufacturing process.

However, the regulatory response should also consider the nature of the failure, the associated risk, the manufacturer's quality history and the findings of the investigation.

5. CAPA Is a Scientific Process, Not Merely an Administrative Formality

Every pharmaceutical professional understands the importance of root cause analysis and CAPA.

In fact, I have spent a substantial part of my professional career implementing and improving pharmaceutical Quality Management Systems, strengthening CAPA procedures and preparing organisations for regulatory inspections.

However, an effective CAPA is not always something that can be completed within a few days.

Depending on the nature of the problem, it may require:

  • Detailed investigation of manufacturing and testing records.

  • Review of process parameters and critical quality attributes.

  • Equipment maintenance, modification and requalification.

  • Process revalidation.

  • Analytical method investigation and verification.

  • Supplier and raw-material investigations.

  • Stability evaluation.

  • Training and competency reassessment.

  • Effectiveness verification over subsequent batches.

Some corrective actions can be completed immediately, while preventive actions and effectiveness verification may require a longer period.

If suspension continues until every aspect of CAPA is completed to the satisfaction of the licensing authority, without a defined review mechanism or reasonable regulatory timeline, manufacturers could face prolonged uncertainty.

The draft should therefore distinguish between immediate corrective measures required to control the identified risk and longer-term CAPA effectiveness verification.

It should also provide a transparent mechanism for review and restoration of manufacturing permissions when the immediate risk has been adequately addressed.

6. The Wider Consequences for the Pharmaceutical Industry

India is one of the world's major pharmaceutical manufacturing and supply centres.

The industry comprises large pharmaceutical companies, mid-sized manufacturers, small-scale manufacturers, loan licensees and contract manufacturing organisations.

These companies operate with substantial investments in infrastructure, machinery, quality-control laboratories, trained manpower and regulatory compliance.

Although the proposed suspension is product-specific, its consequences can extend beyond the affected batch.

Impact on manufacturing operations: Production schedules and supply commitments relating to the affected product can be disrupted.

Impact on employees: Personnel directly involved in manufacturing, quality assurance, quality control, warehousing and related activities for the affected product may be impacted.

Impact on medicine availability: Products with limited alternative sources may face supply disruptions.

Impact on business sustainability: Manufacturers may experience financial losses, particularly where the affected product contributes significantly to their business.

Impact on India's pharmaceutical competitiveness: Uncertainty in regulatory enforcement can affect manufacturing investments, contract manufacturing relationships and confidence among international customers.

None of these consequences should be used as an excuse for poor-quality manufacturing.

But a balanced regulatory framework must consider the overall public interest, which includes both the quality of medicines and their continued availability.

7. Is the Proposed Amendment Consistent with the Existing Regulatory Framework?

The existing Rule 85 and Rule 122O provide for suspension or cancellation of licences through prescribed procedures, including an opportunity to show cause and a written order stating the reasons.

The proposed provisions introduce an overriding mechanism through the expression "Notwithstanding anything contained in sub-rule (1) and (2)" under Rule 85 and "Notwithstanding anything contained in sub-rule (1)" under Rule 122O.

This creates an important regulatory and legal question.

The Drugs and Cosmetics Act, 1940, empowers the Central Government to frame rules. However, rules made under a parent legislation must operate consistently with the Act and its statutory framework.

In my view, the proposed amendments require closer examination regarding their interaction with:

  • The statutory rights under Section 25.

  • The existing procedural safeguards under Rules 85 and 122O.

  • The principles of natural justice.

  • The proportionality of regulatory action.

  • The distinction between precautionary action and final adverse action.

The objective of protecting public health is unquestionably legitimate. However, the manner in which that objective is pursued must also be legally sustainable.

There is also an apparent drafting inconsistency in proposed Rule 122O(1AA), which refers to suspension under sub-rule (2A), although the corresponding new provision is numbered (1A). This should be corrected before finalisation.

These concerns warrant detailed legal examination rather than a premature conclusion that the proposed provisions are necessarily invalid.

8. What Would Be a More Balanced Regulatory Approach?

I strongly believe that India needs stringent and effective pharmaceutical regulation. However, I would suggest the following improvements before these amendments are finalised.

1. Risk-based regulatory action

The response should depend on the nature, severity and potential patient-safety implications of the NSQ finding.

2. Immediate batch-level protection

Where there is a potential public-health risk, the authorities should have the ability to immediately restrict distribution, order recall or take other necessary precautionary measures.

3. Protection of statutory retesting rights

The procedure under Section 25(3) and Section 25(4) should be expressly preserved, with prompt communication and preservation of samples under appropriate conditions.

4. Opportunity for a reasoned regulatory decision

Except where an immediate emergency measure is demonstrably necessary, the manufacturer should receive a reasonable opportunity to explain the findings and present its investigation.

5. Differentiation between batch failure and systemic failure

Suspension of the manufacturing permission for a particular product should not be an automatic consequence of every isolated batch-level NSQ result without consideration of its cause and wider implications.

6. Defined timelines for regulatory review

The licensing authority should review the suspension and the manufacturer's response within specified timelines.

7. Clear CAPA closure requirements

The regulatory authority should distinguish between immediate risk-control actions, corrective actions and long-term effectiveness verification.

8. A mechanism for review and restoration

Where subsequent statutory examination or a scientific investigation does not substantiate the original finding, there should be a clear mechanism for reconsidering and, where appropriate, revoking the suspension.

These measures would strengthen enforcement without unnecessarily compromising the rights of manufacturers or disrupting the pharmaceutical supply chain.

9. My Message to the Pharmaceutical Industry

I would also like to make one thing absolutely clear.

This article is not an argument in favour of manufacturers who neglect quality systems, ignore repeated deviations, manipulate analytical results or release products that do not meet prescribed standards.

Such practices must attract strict regulatory action.

Every pharmaceutical manufacturer must take ownership of its quality systems. GMP compliance should not be treated as a documentation exercise or something to be implemented only before an inspection.

Quality must be built into every stage of pharmaceutical manufacturing.

However, regulatory enforcement should distinguish between deliberate non-compliance, systemic quality failures, isolated batch defects and genuine analytical or procedural disputes.

A regulatory framework that is scientifically informed, transparent and proportionate will encourage better compliance and greater confidence among all stakeholders.

The pharmaceutical industry should also use this opportunity constructively by submitting well-reasoned suggestions and technical representations to the Ministry within the prescribed consultation period.

Silence should not be mistaken for agreement when an important regulatory change has far-reaching implications.

10. My Concluding Perspective: Stronger Regulation, But With Balance

After more than 28 years in this industry, I have seen how pharmaceutical manufacturing has evolved and how much effort companies have invested in upgrading facilities, strengthening quality systems and aligning with international GMP expectations.

I have always supported improvements. I continue to advocate higher standards, better compliance and stronger accountability.

But I also believe that good regulation must achieve a balance between patient safety, scientific evidence, statutory rights and the practical realities of pharmaceutical manufacturing.

A medicine that does not meet quality standards must never be allowed to compromise patient safety. Equally, a manufacturer's product-specific manufacturing permission should not be suspended without a fair, scientifically justified and legally sustainable assessment of the circumstances.

The objective should not be to make regulation less stringent.

The objective should be to make regulation more effective, more transparent and more balanced.

I sincerely hope the Ministry of Health and Family Welfare will reconsider the proposed provisions in consultation with pharmaceutical manufacturers, regulatory experts, pharmacists, quality professionals and legal experts before finalising the amendments.

India needs a pharmaceutical regulatory framework that protects patients, strengthens the industry and reinforces the global credibility of Indian medicines.

Patient safety and a sustainable pharmaceutical industry are not opposing objectives. With the right regulatory framework, both can and must go hand in hand.


About the Author

Rajesh Kapoor is an independent pharmaceutical consultant and founder of PharmaHealth Insights, with over 28 years of experience in the pharmaceutical industry.

His professional experience spans Quality Assurance, Quality Control, Regulatory Affairs, cGMP compliance, pharmaceutical manufacturing, Quality Management Systems, regulatory inspections and facility upgradation.

Through PharmaHealth Insights, he works with pharmaceutical manufacturers to strengthen quality systems, improve regulatory compliance, implement GMP requirements and build sustainable quality practices.

Disclaimer: This article represents the author's independent professional opinion based on the proposed draft rules and his pharmaceutical industry experience. The legal issues discussed are intended to encourage regulatory and industry discussion and do not constitute a formal legal opinion.

References

  1. Ministry of Health and Family Welfare, Government of India. G.S.R. 956(E), dated 28 October 2026 – Draft Drugs (Amendment) Rules, 2026.

  2. Drugs and Cosmetics Act, 1940 – Section 25.

  3. Drugs Rules, 1945 – Rules 85 and 122O.

  4. M/s Medicamen Biotech Ltd. & Anr. v. Rubina Bose, Drug Inspector, Criminal Appeal No. 483 of 2008, Supreme Court of India, judgment dated 13 March 2008.

Saturday, November 15, 2025

Are Small Pharma Companies Bad? The Untold Reality Behind Schedule M, Compliance & India’s Pharma Backbone


 

The Question No One Wants to Ask Aloud

“Are small pharma companies bad?”


It’s a question that floats silently in boardrooms, audit halls, regulatory meetings, and even among healthcare professionals — yet rarely spoken openly.
Why?
Because the moment a drug recall or manufacturing issue hits the headlines, the instinctive reaction is:

“It must be a small pharma company.”

This stereotype has grown so powerful that many automatically equate “small” with “unsafe”, “unprofessional”, or “non-compliant.”
But is this stigma justified?
Or have we as an industry overlooked the complex realities, the economic struggles, the regulatory burdens, and the systemic pressure placed on India’s thousands of small and medium-scale pharmaceutical manufacturers?

This article dives deep into the truth — not the sugar-coated version, but the actual on-ground reality.
We explore the role of small pharma, their challenges, the impact of the revised Schedule M, and the difference between those who are struggling and those who are truly negligent.


1. India’s Pharmaceutical Backbone: A Giant Built on Small Foundations

India is proudly known as “The Pharmacy of the World.”
A global leader in generic medicines.
A lifeline for more than 200 countries.

Yet behind this global title lies an overlooked truth:

India has over 10,500 pharmaceutical manufacturing units — and nearly 70% are small or medium-scale.

These SMEs:

  • Are family-owned

  • Operate with lean teams

  • Run with limited budgets

  • Supply affordable medicines across India

They manufacture the everyday generics used by millions:

  • Paracetamol

  • Antibiotics

  • Antacids

  • Cough syrups

  • Pediatric formulations

  • Essential tablets and capsules

They ensure that a ₹2 strip in a city is still ₹2 in a rural clinic.

Small pharma is not the fringe — it is the foundation.

Yet it carries the worst perception.


2. The Stigma: Why Small Pharma Is Often Blamed

Let’s acknowledge the stereotype:

“Small pharma units are unsafe.”
“Small companies don’t follow GMP.”
“Small units cut corners.”

These statements are repeated often — but rarely questioned.

Why?

Because the public sees outcomes, not the circumstances.
They see deviations, not the pressures that caused them.
They see a failed batch, not the economic hardship behind it.

Small pharma is blamed because:

  • Their facilities are modest

  • Their infrastructure is aging

  • Their staff strength is limited

  • Their documentation systems are still evolving

But their intent is often far better than perceived.

Most small units are not negligent — they are overburdened, underfunded, and trying to stay afloat.


3. The Harsh Economic Reality: Compliance vs. Survival

The economic challenges faced by small pharma are enormous.

3.1 DPCO Controls: Price vs. Quality

Many essential medicines fall under DPCO.
The manufacturer’s margin may be:

  • ₹0.50 to ₹1 per strip

  • Sometimes even less

This leaves little room for:

  • Upgrades

  • Modernization

  • Hiring skilled manpower

  • Investing in documentation systems

  • Funding training programs

3.2 Raw Material Price Volatility

API and excipient costs change frequently.
Contracts are often fixed.
Losses accumulate silently.

3.3 High Utility Costs

Running HVAC, purified water systems, AHUs, and QC equipment can cost lakhs monthly.

3.4 Manpower Attrition

Trained staff often move to bigger companies for better salaries.
Small pharma must constantly train new employees.

3.5 Continuous Audits

Buyer audits, loan-license audits, and regulatory inspections lead to:

  • Downtime

  • Documentation load

  • Corrective action expenditure

Small pharma isn’t choosing shortcuts.
Small pharma is fighting for survival.


4. Revised Schedule M: The Biggest Regulatory Shift in Two Decades

The revised Schedule M is essential — no doubt.
It raises the bar for quality across India.

But it also creates major challenges for small units.

Upgrading to Revised Schedule M costs ₹2–5 crore, depending on:

  • HVAC zoning

  • Area classification

  • AHU upgrades

  • Cleanroom paneling

  • Epoxy flooring

  • Water system qualification

  • Modern QMS adoption

  • Equipment qualification

  • Updated validations

  • New utilities and electrical layouts

This expense is impossible for many small units without support.

So when a regulator asks:

“Why haven’t you upgraded yet?”

The honest answer is:
They want to — but they cannot afford to.

Not immediately.
Not without assistance.


🎥 Mid-Article Deep-Dive — Watch the Full Explainer

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5. Regulatory Pressure: Fear Over Guidance

Small pharma units don’t fear quality.
They fear:

  • unpredictable interpretations

  • inconsistent inspection styles

  • heavily documentation-focused audits

  • subjective expectations

One inspector may focus on HVAC.
Another on documentation accuracy.
Another on change control.
Another on trend analysis.
Another on batch record formats.

This inconsistency has created inspection anxiety, not quality culture.

Audits should inspire improvement — not fear.


6. Big Pharma’s Silent Shadow

Here’s the irony:

Small units often manufacture products for big companies under contract.

When everything goes right:

The big company gets the credit.

When something goes wrong:

The manufacturer gets the blame.

Big companies have:

  • Stronger PR teams

  • Larger legal teams

  • More influence

  • Better negotiation power

  • Greater market presence

Small pharma doesn’t.

Yet they often produce the same products under the strict SOPs of those large corporations.


7. The Unwilling Few — The Real Problem

It would be unfair to claim all small pharma units are victims.

Some are truly negligent.
These are the ones who:

  • ignore documentation

  • skip calibrations

  • reuse old batch records

  • avoid validations

  • maintain poor housekeeping

  • depend on shortcuts

These few create a negative image for everyone else.

They must be corrected, penalized, or shut down.

But they represent a small minority.


8. The Real Solution: A Graded Compliance Model

India needs a maturity model to categorize units based on their readiness and intent:

Category A — Fully Compliant

Encourage exports and expansions.

Category B — Substantially Compliant

Provide incentives for upgrades.

Category C — Non-Compliant but Willing

Offer training, mentoring, and technical support.

Category D — Persistently Unwilling

Take strict regulatory action.

This creates:

  • fairness

  • structure

  • opportunity

  • accountability


9. The Path Forward: What India MUST Do

India’s small pharma will thrive if supported through:

✔ Subsidies for modernization

✔ Soft loans for facility upgrades

✔ Digital QMS tools at affordable cost

✔ GMP Support Cells in every state

✔ Training and mentoring programs

✔ Shared QC labs in pharma clusters

✔ Recognizing improved companies

✔ Uniform interpretation of Schedule M

Support → Compliance → Better public health.


10. The Final Truth: Are Small Pharma Companies Bad?

So… are small pharma companies bad?

No.
Not even close.

Small pharma companies are:

  • the backbone of affordable healthcare

  • the first line of medicine supply in India

  • dedicated, hardworking, and essential

  • victims of financial and regulatory pressure

  • trying to maintain quality with limited resources

But yes — a small group of companies remains negligent.
They should be corrected.
Or shut down.

However, they do not represent the majority.

The majority deserve support, guidance, and recognition — not stigma.


11. A Future We Can Build — Together

Imagine an India where:

  • every small manufacturer meets WHO-GMP

  • modernization doesn’t mean closure

  • audits help instead of scare

  • documentation becomes digital and accessible

  • skilled manpower stays because the ecosystem supports them

  • state-level GMP support centres mentor SMEs

  • quality is a culture, not a compliance burden

This future is possible.
It is within reach.
And it depends on how we treat small pharma today.


12. A Message for Every Reader

If you’ve reached this point, you’re someone who cares about:

  • patient safety

  • industry fairness

  • regulatory balance

  • quality culture

So remember this:

Quality isn't built by fear. 

Compliance isn’t strengthened by intimidation. 

Industries don’t grow when we punish the willing. 

They grow when we uplift them.


🎥 Watch the Full Video — The Story Hits Harder Visually

The written article gives clarity.
The video gives emotion, visuals, and narrative depth.

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💬 What do YOU think is the biggest challenge for small pharma today?

Comment on the YouTube video — your insight could help thousands.

If you found this article valuable:

✔ Share it in WhatsApp pharma groups
✔ Share it with QA/QC teams
✔ Share it with small pharma owners
✔ Share it with regulatory professionals
✔ Share it with your LinkedIn network

Awareness breaks stigma.

Stigma blocks progress.

Progress strengthens India.

Monday, October 6, 2025

Bitter Medicine: Cough Syrup Deaths, Regulatory Failures, and India’s Quest for Safe Pharmaceuticals

 

Introduction: A Tragedy that Shocked the Nation

India has been jolted by the deaths of at least 12 children in Madhya Pradesh and Rajasthan, linked to the consumption of contaminated cough syrup. Laboratory investigations revealed the presence of diethylene glycol (DEG), a toxic chemical used in antifreeze, in concentrations as high as 48.6%—far beyond safety limits. States responded by banning the implicated product, ordering nationwide inspections, and issuing urgent advisories. The episode reignited questions about drug safety, manufacturing practices, and regulatory failures that have long plagued the sector.


_____________________________________________________________________________________

Anatomy of a Disaster

Case Details and Timeline

In early September 2025, Chhindwara district in Madhya Pradesh began to report cases of acute kidney failure in children following administration of Coldrif syrup, manufactured by Sresan Pharma. The tragedy unfolded as follows:

Multiple children developed complications within days, with the first death occurring on September 2.
A spike in fatalities forced hospitals and authorities into action.
Laboratory analysis conclusively linked the deaths to extreme DEG contamination.
State and central governments banned Coldrif, seized stocks, and extended the prohibition to other medicines from the same manufacturer.

National Alarm and Response

  • Central Drug Standards Control Organisation (CDSCO) began risk-based inspections in six states, recognizing systemic risk.
    The Union Health Ministry issued an advisory against cough and cold syrup prescriptions for children below two.
    Compensation and medical reimbursement for affected families were announced, but outrage grew as investigations pointed to deeper failures.

_____________________________________________________________________________________

How Spurious and Adulterated Drugs Proliferate

Regulatory Gaps and Fragmentation

India’s pharmaceutical sector operates under layered, often fragmented oversight: central bodies (CDSCO), state drug controllers, and district health authorities. Key weaknesses:

Insufficiently resourced state authorities, limited lab capacity, and few trained inspectors.
Disjointed record-keeping and lack of unified databases.
Delays and gaps in post-market surveillance and recall protocols.

Economic Pressures and Ethical Lapses

  • Fierce competition and price controls drive manufacturers toward cost-cutting—sometimes substituting toxic chemicals for safer ingredients (DEG for propylene glycol).
    Weak supply chain traceability lets counterfeit and substandard drugs slip through.
    Training gaps among staff—especially in small and mid-scale plants—mean SOPs aren’t always followed.

Supply Chain Weakness and Poor Pharmacovigilance

  • Medicines pass through tens of thousands of distributors with minimal batch tracing.
    India’s pharmacovigilance programme remains poorly understood, with adverse event reporting rare and enforcement patchy.

Outdated Manufacturing Infrastructure

Many small and medium enterprises operate in decades-old facilities, lacking modern equipment, interlocks, and robust safety mechanisms—making cross-contamination and process failures common.

_____________________________________________________________________________________

The Regulatory Framework—Shortfalls and Loopholes

Drugs and Cosmetics Act and Its Limits

  • The Drugs and Cosmetics Act, 1940—amended many times—remains the sector’s legal backbone, mandating product approval, batch testing, and penalties.
    Penalties for first-time or minor violations are often tiny compared to profits, making compliance a low priority.
    Lack of harmonization across states means some regions are “soft targets” for unscrupulous manufacturers.

Recalls, Testing, and Post-Market Surveillance Failures

  • Testing is often slow and limited; recalls even slower, allowing contaminated products to remain on shelves for months.
    Inspections are infrequent, often announced in advance, and affected by staff shortages.

International Fallout

India’s status as a major medicine exporter means global reputation is also at stake. Recent cough syrup incidents abroad have triggered bans and lawsuits, hurting the credibility of “Made in India” medicines.

_____________________________________________________________________________________

Accountability Across the Production Chain

The Role of Analysts

  • Drug analysts serve as gatekeepers: chemically, physically, and micro-biologically testing every batch before approval.
    If analysts neglect, falsify, or ignore problems, dangerous medication enters the market.

Production Chemists and Quality Staff

  • Production chemists maintain batch integrity, check weighing and mixing, follow SOPs, and validate final release. Their documentation and sign-off are essential.
    Quality assurance staff ensure compliance, document deviations, and trigger corrective actions.

Supervisors and Regulatory Inspectors

  • Supervisors enforce day-to-day GMP compliance, inspect documentation, and train staff.
    Regulatory agencies must audit facilities, enforce standards, and order recalls/scans as needed.

Shared Responsibility

Accountability must extend to every link. Negligence, omission, or willful non-compliance at any stage can directly cause harm. Historically, legal action focuses on management, but there is an urgent need to prosecute every complicit party—from analyst to inspector.

_____________________________________________________________________________________

Penalties and Enforcement

Current Provisions

  • Drugs and Cosmetics Act: Up to life imprisonment and multi-lakh fines for manufacturing or selling adulterated drugs causing death.
    IPC Sections 274/275: Six months imprisonment or fines for adulteration/sale; but actual deterrence is weak.

The Reality of Enforcement

  • Rare prosecution of non-management staff despite clear evidence of chain accountability and negligence.
    Most regulatory actions are limited to bans, recalls, or license cancellations.
    Experts call for stronger enforcement targeting individuals across all roles.

_____________________________________________________________________________________

Schedule M—The Imperative Reform

What is Revised Schedule M?

Revised Schedule M upgrades India’s GMP standards to global levels by mandating:

Modern facilities (clean rooms, validated equipment, proper personnel/material flow)
Strict process documentation and training
Enhanced inspection protocols

The Harm of Extensions

Despite its importance, Schedule M compliance deadlines have been routinely postponed for small and medium manufacturers, now extended to December 2025.

Every extension leaves patients exposed to substandard manufacturing processes.
Delays undercut not only domestic safety but global reputation.

No More Excuses

India must enforce Revised Schedule M across all facilities, with immediate closure or penalties for non-compliance. The new law cannot remain negotiable or optional.

_____________________________________________________________________________________

Pathways to True Accountability

Immediate Action Steps

  1. Unconditional, universal Schedule M enforcement—No further extensions. Facilities must shut down if non-compliant.
    Criminal liability across all roles—prosecution, blacklisting, and license cancellation for every complicit staff member.
    Transparent compliance reporting—publicly track audit results, recalls, and enforcement actions.
    Robust pharmacovigilance—train health workers and educate the public to report adverse events; ensure timely regulatory follow-up.
    Mandatory re-training—every staff member must undergo periodic GMP and compliance updates.

Long-Term Reforms

  • Investment in inspector training, testing labs, and digital batch tracing.
    Collaboration with global regulatory bodies for harmonized best practices.
    Incentivize ethical practices by linking compliance to market access and export privileges.

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Conclusion: Lives at Stake, Reform Cannot Wait

India stands at a crossroads. The cough syrup deaths are not isolated; they are a symptom of endemic regulatory and ethical failures. Full accountability—analyst to owner, inspector to regulator—must be enforced. The Revised Schedule M offers a clear path, but only if implemented without delay, compromise, or further extensions.

India’s children deserve safe medicine—nothing less will do.

Disclaimer:
This blog expresses the author’s personal analysis, opinions, and interpretation of the recent cough syrup tragedy and pharmaceutical regulatory issues in India. The content is intended for educational and informational purposes only, and does not constitute professional medical, legal, or regulatory advice. Readers are encouraged to consult qualified professionals for specific guidance. The author and publisher disclaim any liability arising from the use or interpretation of this material. Opinions shared here reflect the author's viewpoint based on currently available information and should not be taken as official or legally binding statements.

References:

A comprehensive list of regulatory updates, news articles, expert commentaries, and official advisories from October 2025 forms the basis of this analysis.