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Fake Pills for Lethal Infection

Counterfeit malaria pills may contain no active ingredients or only small amounts of them, plus other chemicals.

Production of fake antimalarial pills has increased since the late 1990s, especially in Southeast Asia. Artesunate, a key component of falciparum malaria treatment in many areas, has become a target for particularly sophisticated counterfeiters. Researchers recently collected genuine and fake artesunate tablets for analysis by liquid chromography coupled with mass spectrometry. They quantified the amount of active ingredient and identified inappropriate ingredients.

Among the genuine tablets, with one exception, the mean artesunate content was 55 mg (range, 51–59 mg; expected content, 50 mg). Of 34 counterfeit tablets that were labeled as artesunate manufactured by Guilin Pharmaceutical Co., Ltd., 23 (68%) did not contain artesunate; 8 (35%) of these tablets had wrong active ingredients (erythromycin, acetaminophen), and 9 (39%) had calcium carbonate.

Comment: The authors and others have identified 14 different types of fake artesunate tablets, many in packages with a hologram that imitates the genuine hologram used by Guilin Pharmaceutical Co. Eight of the 12 major antimalarial drugs now have been targeted by counterfeiters. In other studies, fake artesunate has been found to contain such active ingredients as sulfonamides and chloramphenicol, which can be associated with allergic and other adverse events. In addition to problems with counterfeiting, drugs can also be substandard in tropical climates because of inadequate storage conditions. Use of fake or substandard pills can lead to deaths from falciparum malaria, a treatable infection.

Counterfeiters have become increasingly sophisticated; some even add small amounts of artesunate to foil use of rapid colorimetric tests designed to detect fake pills. Identification of fakes in multiple different countries suggests that counterfeiters have wide distribution networks.

— Mary E. Wilson, MD

Published in Journal Watch Infectious Diseases December 13, 2006

Citation(s):

Hall KA et al. Characterization of counterfeit artesunate antimalarial tablets from Southeast Asia. Am J Trop Med Hyg 2006 Nov; 75:804-11.

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