Decision taken after national review

NEW DELHI: Two medicines used widely – antibiotic doxycycline and thyroid drug carbimazole – will soon carry stronger safety warnings, following a national review of adverse drug reaction reports.After examining patient-level safety data, regulators have flagged possible mental health symptoms linked to doxycycline and a rare but potentially life-threatening blood disorder associated with carbimazole. In separate communications issued this month, Central Drugs Standard Control Organisation (CDSCO) and Drugs Controller General of India (DCGI) directed all State and Union territory licensing authorities to ensure manufacturers update prescribing information and package inserts for both medicines and report compliance.For doxycycline – commonly prescribed for respiratory infections, acne, sexually transmitted infections, urinary tract infection and numerous vector-borne diseases – the authorities have asked that specific central nervous system side effects be explicitly mentioned. These include restlessness, anxiety, irritability, nervousness and dizziness.The decision follows an assessment by Pharmacovigilance Programme of India, which reviewed adverse reaction reports and individual case safety data. The issue was examined at a Signal Review Panel meeting in March 2025 and later discussed by Subject Expert Committee (SEC) on antimicrobial and antiparasitic drugs in Jan 2026, which endorsed updating the official prescribing documents.While gastrointestinal discomfort and photosensitivity were already known side effects of doxycycline, the latest directive formally adds neuropsychiatric symptoms to the safety profile. Regulators have directed manufacturers of carbimazole – prescribed for hyperthyroidism, including Graves’ disease – to prominently warn about agranulocytosis, a rare but serious condition marked by a sharp fall in white blood cells.Agranulocytosis can leave patients vulnerable to severe infections. Early warning signs include fever, sore throat and unexplained infections. The recommendation emerged from the 26th Signal Review Panel meeting and was subsequently reviewed by SEC on endocrinology and metabolism before being approved for inclusion in prescribing information leaflet.Dr Rommel Tickoo, director of Internal Medicine at Max Hospital, Saket, said the move reflects a maturing safety system. “CDSCO’s decision on for doxycycline and carbimazole reflects a proactive and responsible pharmacovigilance system. While the medicines remain safe and effective when used appropriately, clearer warnings help both doctors and patients recognise rare but important side effects early. In the case of carbimazole, prompt attention to symptoms like fever or sore throat can be life-saving. Such regulatory steps strengthen patient safety without creating unnecessary alarm,” he said.For patients, the updated leaflets mean clearer information on risks. For clinicians, the advisory reinforces the need to counsel patients on warning symptoms and monitor use appropriately.