“I'm not great at the advice. Can I interest you in a sarcastic comment?”

This is what ‘Friends’ actor Matthew Perry’s character Chandler Bing was known for. He was known for being funny. However, he had his own struggles in his personal life and those struggles were acute depression. He was treating it with ketamine infusion therapy which is legal in the US and the UK.

What is Ketamine infusion therapy?

Ketamine is an anaesthetic used to treat depression, anxiety and pain under supervised and controlled medical settings. However, it does have its side effects, which can lead to distortion of sight, sound and time. It can also produce calming and relaxing effects.

Ketamine increases a person’s heart rate and blood pressure. If overdosed, it can leave users confused and agitated and can cause them to hurt themselves without even realising it. It can also lead to liver damage and bladder problems.

However, when used in moderation and under the supervision of medical doctors, it can treat depression where traditional antidepressants have failed.

Prof Rupert McShane, a University of Oxford psychiatrist who runs an NHS ketamine treatment clinic told BBC that ketamine “probably turns off the area of the brain that is involved in disappointment.”

Can Ketamine Infusion Therapy Kill Someone?

In simple terms, it cannot, be if the dosage is given in a controlled setting and as prescribed. Ketamine infusion therapy uses drugs in small doses than those used for anaesthesia. It acts faster than traditional anti-depressants, but the effects also wear off way quickly. Which is why it is important to monitor patients’ mental state for relapsing back into depression and discouraging them from overdosing on it.

There are ways of giving people ketamine. One of the ways is through “infusing”, which means to use an IV drip. However, injections, nasal sprays and capsules are also methods used to give people ketamine.

Since the dosage of ketamine used in the infusion treatment is small, it being the reason of actor Perry’s death was ruled out. The medical examiner also noted that Perry’s last ketamine infusion therapy session happened more than a week before his death, which means by the time he had died, it must have worn off.

So, What Happened To Perry?

Though Perry’s last session was more than a week before, his post-mortem showed that his blood contained a high concentration of ketamine. He had died of the “acute effects” of ketamine.

If it was not his session, then how did he get ketamine?

Prosecutors alleged that his assistant gave him at least 27 shots of ketamine in four days before his death, reported BBC.

Perry has been open about his personal struggles and this is what the doctors and dealers used against him. Martin Estrada, the US attorney for California’s Central District told the BBC that people took advantage of his condition. They charged him 165 times more than what vials of ketamine cost.

Names that have come up include Dr Salvador Plasencia, drug dealers “Ketamine Queen” aka Jasveen Sangha and Eric Fleming, and Perry’s live-in assistant Kenneth Iwamasa.

Who Are These Names And What Did They Do?

Ketamine Queen or Sangha supplied drugs that led to Perry’s death. Her home was a “drug-selling emporium,” said Estrada. More than 80 vials of ketamine, and thousands of pills including methamphetamine, cocaine and Xanax were allegedly found in her house known as the “Sangha Stash House.”

Sangha is known to deal with high-end celebs and was a “major source of supply for ketamine to others as well as Perry,” said Estrada.

Dr Plasencia called Perry a “moron” while charging him $2,000 for vials that cost only $12. He sold Perry 20 vials of ketamine between September and October 2023, costing $55,000.

He was the one who taught Iwamasa, who had no medical knowledge to inject the drug. This is after he knew that “Perry’s ketamine addiction was spiralling out of control,” as per what the investigators told the BBC.

Another dealer Fleming was told by Sangha to “delete all our messages.” While Fleming pleaded guilty to conspiring to distribute drugs unlawfully, he also allegedly messaged Sangha: “Please call...Got more info and want to bounce ideas off you. I’m 90% sure everyone is protected. I never dealt with [Perry] only his assistant. So the assistant was the enabler.”

The court documents also revealed that he asked Sangha on whether the ketamine stays in your system or “is it immediately flushed out.”

Dr Pepper, Bots, Cans

The people who allegedly exploited Perry used coded language for ketamine and called it “Dr Pepper”, “bots”, or “cans.”

Selling overpriced drugs, taking advantage of Perry’s mental condition and falsifying medical records to make the drugs given to him look legitimate by Dr Plasencia is what took Perry’s life.

Iwamasa is said to have administered more than 20 shots of ketamine and three on the day Perry died. Whereas ketamine is only administered by a physician. Authorities also found that weeks before Perry’s death, Dr Plasencia allegedly bought 10 vials of ketamine and intended to sell to Perry.

He also injected Perry with a large dose, two days later. This caused him to “freeze up” and spiked his blood pressure.

When I Die, I Want Helping Others To Be The First Thing That’s Mentioned

Perry had always been open about his drug addictions, struggles with alcohol and his depression. He said that his openness would help others who are also struggling and wanted to be remembered by his quote which also is on the homepage of the Mattew Perry Foundation that helps others struggling with the disease of addiction: “When I die, I want helping others to be the first thing that’s mentioned.”

Five arrests have been made in the case so far.

The US Food and Drug Administration (FDA) has approved a drug therapy to address neurologic symptoms of a rare genetic disorder — Hunter syndrome.

The X-chromosome-linked disease, occurring predominantly in males, has an estimated 2,000 affected individuals worldwide.

The drug Avlayah, developed by pharma company Denali Therapeutics, targets certain individuals with Hunter syndrome (Mucopolysaccharidosis type II or MPS II).

It is the first therapy to address the neurologic complications of Hunter Syndrome, such as

• progressive cognitive decline,
• behavioral problems,
• hydrocephalus,
• spinal cord compression,
• seizures,
• carpal tunnel syndrome.

“Today is a milestone day for children and their families battling Hunter syndrome,” said FDA Commissioner Marty Makary, in a statement.

“Avlayah is the first product approved to address neurologic complications of Hunter Syndrome, a very rare and often severe X-linked disorder in children, affecting about 500 people in the US, almost exclusively males,” added Acting CDER Director Dr. Tracy Beth Hoeg.

The FDA noted that Avlayah, the once-weekly drug given via IV infusion, must begin in presymptomatic or symptomatic pediatric patients weighing at least 5 kg before advanced neurologic impairment.

What Is Hunter Syndrome?

Hunter syndrome is a rare inherited lysosomal disorder in which sugar molecules called glycosaminoglycans build up within the cells’ lysosomes.

The condition affects physical and mental development and causes abnormalities in the skeleton, heart, respiratory system, brain, and other organs.

Hunter syndrome is a rare congenital metabolic disease. It was first reported in 1917 by a Canadian physician, Charles Hunter, in two brothers in a family.

The brothers presented typical signs, such as

• short stature,
• inguinal hernia,
• macroglossia,
• enlarged skull,
• decreased hearing,
• coarse facial features,
• protruded abdomen with hepatosplenomegaly,
• umbilical hernia,
• skeletal deformities.

The younger brother had symptoms of Central Nervous System (CNS), including seizures and cognitive decline, while the older brother did not have CNS involvement.

The estimated incidence is 1 in 162,000 live male births.

How The FDA Approved Avlayah

The FDA approval came after Avlayah showed promise in reducing cerebrospinal fluid heparan sulfate — one of the glycosaminoglycans that accumulates in the body in this disorder and is linked to the organ damage that occurs in early childhood.

The phase 1/2 multi-cohort, single-arm, open-label trial enrolled 47 pediatric patients with Hunter syndrome aged 3 months to 13 years.

Of these, 44 patients with measurements at had a 91 percent average decrease from baseline in CSF.

Denali is now conducting a randomized clinical trial that is more than 95 percent enrolled to evaluate the clinical benefit of this product.

"In the meantime, families with young children with Hunter Syndrome will have access to a product that may favorably alter the course of the disease at the crucial time in life when there is the greatest potential for benefit," Hoeg said.

Are There Any Side Effects?

Avlayah’s labeling includes a boxed warning for allergic reactions, including anaphylaxis, associated with the drug.

The FDA recommended that patients start therapy in a health care setting with appropriate medical monitoring and support measures.

The common side effects of Avlayah include

• upper respiratory tract infection,
• ear infection,
• fever,
• anemia,
• cough,
• vomiting,
• diarrhea,
• rash,
• COVID-19,
• runny nose,
• nasal congestion,
• fall,
• headache,
• skin abrasion,
• hives.

The FDA also suggested that healthcare workers monitor

• hemoglobin levels due to the risk of anemia,
• kidney function and urine protein levels due to
• the risk of membranous nephropathy (a kidney disease).

The Central Drugs Standard Control Organisation (CDSCO) has now launched a nationwide crackdown on unapproved Fixed Dose Combination (FDCs) after 90 combination medicines that were being sold without mandatory central approval were busted last week.

CDSCO, India's apex drug regulatory body in the country, made the shocking discovery after scrutinizing drug samples uploaded on the SUGAM portal, the government’s online system for drug testing data.

Several of these samples were found to fall under the ‘new drug’ category but lacked approval from the central authority. As a result, the CDSCO wrote a letter to all states and union territory drug controllers, asking them to investigate manufacturers and marketers of these FDCs.

The letter reads: "The SUGAM lab testing data for the year 2025, a large number of drug samples (FDCs) are detected as unapproved and fall under the category of 'New Drug'. No new drug shall be manufactured for sale unless it is approved by the Licensing Authority 'as defined in Rule 3 of New Drugs and Clinical Trial Rules, 2019, Further, as per Rule 80 of New Drugs & Clinical Trial Rules 2019, a person who intends to manufacture new drug in the form of API or Pharmaceuticals formulation, as the case may be, for sale or distribution, shall make an application for grant of permission to the Central Licensing Authority in Form CT-21 along with a fee as specified in Sixth Schedule."

"The presence of unapproved drugs in the supply chain is a matter of serious concern, posing potential risks to public health and safety. It also indicates non- compliance with the provisions of the Drugs and Cosmetics Act, 1940, and rules made thereunder.

"Accordingly, please initiate appropriate investigation and regulatory action against the concerned manufacturers, marketers, and other stakeholders, as deemed fit. Kindly ensure strict monitoring and enforcement to prevent manufacture, sale, and distribution of such unapproved drugs," the letter states, on appropriate action against the sale and distribution of unapproved drugs.

FDCs are drugs that contain two or more active ingredients in a single formulation. The CDSCO has asked states to investigate and submit reports on the action taken at the earliest.

What Made It To The Unapproved List Of FDCs?

Cough And Cold Medicines

Cough and cold combination medicines have formed the single largest group. At least 14 to 16 entries show combination of ingredients found in everyday pharmacy shelves: dextromethorphan, ambroxol, guaiphenesin, chlorpheniramine, phenylephrine, terbutaline, and menthol in various permutations.

Several of these are sold as flavoured syrups for children. Budesonide-levosalbutamol inhalation suspension that is used for asthma and chronic obstructive pulmonary disease, too features in the list.

Nutritional Supplements

The next group is of the vitamins, minerals and other nutritional supplement which has roughly 18 to 20 entries. They include:

• Multivitamin capsules
• Iron-folic acid syrups
• Calcium-vitamin D3-K2 combinations
• Abapentin-methylcobalamin preparation

This group has accounted for at least 10 entries, which include antifungal creams that could lead to potential misuse and skin damage when sold without prescriptions.

Anti-Diabetic Medicines

This has accounted for six entries, and the combination includes:

• Glimepiride paired with metformin or pioglitazone

What Is India's Rule For FDCs?

Under India's New Drugs and Clinical Trial Rules of 2019, any FDC is treated as a new drug and must have the central government's approval before it could be manufactured and sold. The regulator's letter noted that there were presence of unapproved drugs in the supply chain that could pose risks to public health. This also amounts to a violation of the Drugs and Cosmetics Act, 1940.

“The presence of unapproved drugs in the supply chain is a matter of serious concern, posing potential risks to public health and safety. It also indicates non- compliance with the provisions of the Drugs and Cosmetics Act, 1940, and Rules made thereunder," it said.

DCGI urged states and UTs "to examine the unapproved FDCs in generic name as mentioned in the attached annexure". This is done to check whether any approval has been granted by the local office. "Accordingly, please initiate appropriate investigation and regulatory action against the concerned manufacturers, marketers, and other stakeholders, as deemed fit. Kindly ensure strict monitoring and enforcement to prevent the manufacture, sale, and distribution of such unapproved drugs," the letter noted.

Breakbone Fever, also known as dengue, is a mosquito-borne disease that is once again on the rise, with the U.S. Centers for Disease Control and Prevention issuing a travel alert across 17 Countries.

The federal agency flagged 'Level 1' risk for breakbone fever, calling for practicing usual precautions. It stated a higher-than-expected number of cases and urged people planning to travel to countries with an uptick in cases to be aware of the risk.

The CDC alert issued on March 23 identified 17 countries reporting an increased number of cases of dengue. These include: Afghanistan, Bangladesh, Bolivia, Colombia, Cook Islands, Cuba, Guyana, Maldives, Mali, Mauritania, New Caledonia, Pakistan, Samoa, Sudan, Timor-Leste, Vietnam, and the United States territories of American Samoa, Puerto Rico, and the US Virgin Islands, where local transmission is already common.

In 2026, the US reported a total of 496 dengue cases to date, and the vast majority of these cases were reported among people who contracted the illness while traveling abroad.

The CDC advised travelers to risk areas to prevent mosquito bites by

• using an EPA-registered insect repellent,
• wearing long-sleeved shirts
• long pants when outdoors,
• sleeping in an air-conditioned room or a room with window screens.

What Is Dengue? Why Is It Called Breakbone Fever

Dengue is a disease caused by a virus spread through mosquito bites. It is transmitted through infected mosquitoes, primarily the species Aedes aegypti.

The breakbone fever is caused by an infection with any of four different dengue viruses. These include:

• Dengue virus type 1 (DENV-1 or DEN-1)
• Dengue virus type 2 (DENV-2 or DEN-2)
• Dengue virus type 3 (DENV-3 or DEN-3)
• Dengue virus type 4 (DENV-4 or DEN-4)

Common Symptoms of the dengue are:

• Sudden onset of high-grade fever.
• Intense headache
• Severe muscle, joint, or bone pain.
• Skin Rash that often appears 2–5 days after the fever starts
• Nausea and Vomiting
• Minor bleeding
• Fatigue.

The disease can take up to 2 weeks to develop, with illness generally lasting less than a week.

However, it can quickly become severe within a few hours, usually requiring hospitalization.

In severe cases, health effects can include hemorrhage (uncontrolled bleeding), shock (seriously low blood pressure), organ failure, and death.

Breakbone Fever: Global Burden

According to the World Health Organization (WHO), about half of the world's population is now at risk of dengue.

It estimates that:

• About 390 million dengue infections occur annually worldwide
• Nearly 100 million people develop symptoms each year

The two main authorized vaccines in the world against dengue are Dengvaxia and Qdenga.

These vaccines are designed to protect against all four serotypes of the virus, with a focus on reducing severe disease and hospitalizations.

In addition, the Butantan-DV vaccine developed by the Butantan Institute in São Paulo has shown potential to be over 80 percent effective in preventing the risk of severe disease for up to five years. It also offers broader protection against all four dengue serotypes.