Keep taking the tablets

Every day I take levodopa, rasagiline, entacapone, carbidopa, propranolol, metformin, simvastatin, benserazide, clonazepam, rotigotine and a modest number of vitamin supplements. These amount to 19 tablets/capsules/patches usually at six timed intervals. That’s 133 a week, 6935 a year. Yes, count them.

Some are delivered to me in bottles, others in those infernal blister packs which seem to serve little purpose other than to destroy one’s nails. They certainly don’t make it easy.

And they come in pretty much every colour of the rainbow, albeit with a preponderance of white. My propranolol tablets are a rather fetching pink (usually – occasionally they are white thus making them indistinguishable from the amitriptyline tablets of the same dose and in identical packaging) and have the letters embossed on them although you would need the magnification of the Hubble space telescope to read them, so minuscule are they.

Two tablets, on the face of it identical, are apparently distinguishable as well. Clonazepam (pale whitish peach) and simvastatin (pale peachy white) I understand can be distinguished from each other by their embossed lettering. Clonazepam also has a kind of score mark down the middle. No chance of a drug error there then.

I’m told that you can have your daily tablets lovingly sealed into your own personal blister packs by your pharmacist should you so wish. Also, bearing in mind just had diabolically difficult blister packs can be, deliberately sequestering one’s medication into such an inaccessible format seems perverse.

Moreover the resulting blister packs (certainly those that I’ve seen) are virtually the size of an A4 document wallet. And secondly, as was the case this month, pharmacists make mistakes. In this case they managed to double the dose of one of my drugs. Oh well, that’s life (or death).

There are some medications where this makes little difference but in the case of others can have serious consequences. At the end of the day it is quite important to be able to distinguish your different drugs especially when, as in my case, there are so many.

There is also the psychology of colour to factor in. For example, drugs affecting the heart and circulation tend to be red, orange or yellow – bright colours for brighter days. Conversely drugs affecting the mind and brain tend to be more muted – muted purples and blues, perhaps hinting at the dark arts of psychopharmacology and neuropharmacology.

These are not just mere flights of fancy. The colours and shapes of tablets to reflect marketing considerations and integral part of the overall promotion [1]. A recent paper found that different shapes of tablet also has an effect on patient responses [2].

Of course little of this applies to generic drugs. Once a drug’s patent expires it is a free for all. Every Tom, Dick or Harry can make and market their own version of Sinemet. And they don’t have to make it even look like the original’s comforting pastel pink and baby blue capsules.

Generic drugs are a minefield in terms of regulation. But that’s for another day.

[1] Drug Tablet Design: Why Pills Come in So Many Shapes and Sizes.

[2] Olesya Blazhenkova, Kivilcim Dogerlioglu-Demi. The shape of the pill: Perceived effects, evoked bodily sensations and emotions. PLoS One. 2020; 15(9): e0238378. published online 2020 Sep 8. doi: 10.1371