The ministry said a batch of the syrup contained ethylene glycol, which health officials say is a toxic substance.

Consuming ethylene glycol can cause vomiting, fainting, convulsions, cardiovascular problems and acute kidney failure, the statement said.

Uzbekistan’s health ministry claims 18 out of the 21 children who consumed the cough syrup, while suffering from an acute respiratory disease, died after taking it.

The syrup is marketed on Marion Biotech’s website as a treatment for cold and flu symptoms. The ministry said the over-the-counter medicine was given to children at home without a doctor’s prescription and at a higher dose.

Since the deaths, Uzbekistan has ordered all Doc-1 Max tablets and syrups to be pulled from pharmacies.

India, which is often called the “world’s pharmacy,” produces about a third of the world’s medicines and mostly generic drugs.

The deaths in Uzbekistan come after at least 70 children died in The Gambia after consuming a different brand of India-manufactured cough syrup.

Last week, a parliamentary committee in The Gambia recommended New Delhi-based cough syrup manufacturer Maiden Pharmaceuticals be held accountable for exporting what it called “contaminated medicine.”

In its report, The Gambia’s parliamentary committee said the syrups contained diethylene glycol and ethylene glycol, which are toxic to humans. The children, all under the age of five, died from acute kidney injury between June and November, after taking the cough syrup.

The World Health Organization issued an alert in October advising regulators to stop selling four Maiden Pharmaceuticals cough syrups.

Both India’s government and Maiden Pharmaceuticals have denied the medicines were to blame for the children’s deaths.

Marion Biotech has not issued a statement regarding the deaths in Uzbekistan. India’s government is investigating.