Over 36 people have died in the past four weeks from taking oral drugs in Punjab province, Pakistan.

The medicines were provided for free to cardiovascular patients at the government-owned Punjab Institute of Cardiology in Lahore city.

Thousands of prescriptions of these drugs were given to the patients during last month, said hospital officials.

“More than 100 patients brought to various hospitals in Lahore for suspected drug reactions have all been recently under treatment at Punjab Institute of Cardiology, and were given these drugs… We are trying to retrieve all the medicines given out at this hospital,” said Jehanzeb Khan, Punjab provincial Health Secretary.

One or more of at least four medicines taken by the patients caused their deaths.

These drugs include Alfagril (Clopidogrel), Cardiovestin (Simvastatin), Concort (Amlodipine) and Soloprin (Aspirin).

On or more drugs caused a rapid depletion of bone marrow, with a dramatic decrease in white cells and platelets counts that led to bleeding and death, Dr Javed Ikram of the Allama Iqbal Medical College told BBC.

Over 36 people have died from taking contaminated heart medicines in Punjab, Pakistan.

The presence of some bits of metal in the pills is presumed to be the cause of the symptoms.

The drugs by themselves can cause heavy bleeding if they are taken in high doses, if the patient has certain diseases (such ulcer or gastritis, renal failure) or a particular sensitivity to the substance (allergy). It is possible that the faulty pills to have had an improper dosage of the active substance.

A commission was formed by the provincial government to investigate the deaths. “Patients were coming in with symptoms similar to dengue fever. But then we realized it wasn’t that. The one thing common in all patients was heart disease, and that they were getting medicines from the Punjab Institute of Cardiology,” said Faisal Masood, member of the committee.

The owners of two local pharmaceutical firms were arrested. There have not been any comments from them.

One pharmaceutical firm has been sealed off and the drugs would be sent for testing abroad, officials said.

Pakistan Medical Association asked the government in a statement to buy life-saving drugs from other suppliers.

Pakistan’s government was accused of ineptitude and corruption, and of spending a small amount of funds on health. Apparently Pakistanis have little faith in state-run medical centers.

These oral drugs were purchased at competitive rates, said officials. Hospitals have to buy drugs from the lowest bidder, because if they do not, they can be sued by local pharmaceutical companies and even be issued with an injunction against all future purchases, hospital sources told BBC.