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Emergency Messages to U.S. Citizens

Drug Advisory

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 anufacturers are affected.  However, the World Health Organization (WHO) Pakistan has suspended all Efroze products rom 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. 

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.

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: