Spot the difference
Dihydroartemisinin/Piperaquine phospate, Duo-Cotecxin®, manufactured by Zhejiang Holley Nanhu Pharmaceutical Co. Ltd, Jiaxing City, China, under licence from Holleypharm.
In the counterfeit medicine (lower image) the packet is heavier.
the tablets were thicker and significantly smaller in diameter than the genuine product
they contained sildenafil (Viagra; median [range] 10.4 [6.1–18.4] mg/tablet) in the matrix, not in the coating.
The packaging itself displays the following errors
there is ‘Franglais’ in the English section ‘Composition par tablet’ and ‘Dihydroartemisinine’/‘Pipéraquine’
it bears no hologram
the colour of the blue areas on the packet differs slightly from that on the genuine packets
Botanical analysis of both genuine and falsified samples revealed spores of the fern Cibotium, widespread in SE and south Asia, suggesting that both genuine and counterfeit manufacturers were in the same region.
Images courtesy of Paul Newton, reproduced from ‘Poor quality vital anti-malarials in Africa – an urgent neglected public health priority’ by Newton et al. (http://www.malariajournal.com/content/10/1/352).