The same medicine can come in different shapes and sizes


A patient taking a prescription for potassium recognized her pills by their distinctive appearance: flat, circular, neon orange-colored tablets. But some months later, the potassium pills from the pharmacy had suddenly transformed into white, capsule-shaped ones. Another patient reported his medication changed appearance nine times over a 15-year period. Variations in a medicine’s color, shape or size are common. Unfortunately, this can lead to patients mixing up their medications and potentially cause serious health consequences. Equally troubling, a study published several years ago in the medical journal Annals of Internal Medicine found a 34% likelihood of patients discontinuing their medication after the pill changed color. A change in the pill’s shape increased that likelihood to 66%. Darrick Lee, DO, a UCLA family-medicine physician in downtown Los Angeles, and Erin M. Noren, MD, a UCLA internalmedicine physician in Beverly Hills, discuss why medications can vary in appearance and suggest ways to take them safely.

Why do the shape and color of prescription medications change? Once a branded medication becomes generic, different companies will make their own versions. Each manufacturer will choose its own size, shape and color for the pill. “One company’s pills will look different from another’s, even though they’re basically the same medication,” Dr. Lee says. Pharmacies look for the most economical option, which can vary from month to month, so a pill’s appearance may change accordingly.

What strategies can help patients avoid confusing their medications? “I absolutely recommend a pill organizer,” Dr. Noren says. Some pill organizers allow users to sort by day, while others will break daily times down by AM and PM or Breakfast, Lunch, Dinner and Bedtime. There are electronic pill organizers with built - inalarms . Patients can also set medication reminders on their phones. Some pharmacies will create a blister package, a card or sheet with doses of medication within small plastic bubbles, or blisters, she says. Others may use different colors on prescription bottles or lids to help patients differentiate their medications.

Many online resources provide medication lists, including one entitled “ Tracking Your Medications,” at talking-with-doctors-worksheets. An online pill identifier, such as, provides a way to verify a medication by its appearance.

Are there specific issues for seniors? “I always tell my patients to keep a list of all their medications and bring it with them for us to review each visit. I may ask them to bring in all the actual bottles,” Dr. Lee says.

Dr. Noren also suggests having a family member or caretaker help organize medications and medication reminders. Physicians may refer patients for medication-therapy management, where they meet with a pharmacist to review and organize their medications.

What safeguards does UCLA Health have in place regarding medications? “When we order medications, alerts pop up if the system recognizes anything as a possible adverse drug interaction or drug allergy,” Dr. Lee says. He notes that a pharmacist also reviews each prescription to ensure safety.

What other advice do you have for safely taking medications? “Save your medication bottles with their labels for reference, but once you’ve used up the pills, throw the bottle away to avoid confusion,” Dr. Noren says. “Also, ask your doctor’s advice before starting vitamins or supplements. They may change how your body metabolizes other medications. In regard to medication interactions, Dr. Noren cautions patients to be aware that Paxlovid, the antiviral COVID-19 medication, interacts with a number of prescription drugs, including statins.