Difficulties in identifying tablets have emerged as a major issue in a recent US survey of 150 pharmacists who are warning drugmakers that the lack of distinct appearance in pills leads in dispensing errors that cost more than 7,000 lives each year just in US hospitals.
Almost 80 per cent of pharmacists believe that multiple look-alike medications are responsible for preventable medical mistakes that the US Institute of Medicine estimates cause tens of thousands of deaths in outpatient facilities.
An aging population and a growing number of new treatments exacerbate the problem, and so does the practice of some patients who transfer their medications to unlabelled containers.
Look-alike medications were blamed by 79 per cent of respondents in the survey for preventing identification while 74 per cent also pointed the finger to an unreadable code on the medication.
The lack of a company logo or product name was an issue for 67 per cent of those questioned and the absence of a printed code on the tablet was faulted by 65 per cent.
Out of twelve tablet characteristics listed in the survey, on a scale of 1-12, with 1 being "most commonly used," pharmacists rated colour (3.0) and shape (3.4) as the most common attributes patients and caregivers use to identify medications outside the original packaging.
The next most common attribute was the numerical code (5.0) or drug name or logo printed on the tablet (5.7).
Although most in the survey conceded that non-tabletting issues, such as physician handwriting, similar product names and package labelling, are first and foremost to blame for dispensing errors, tablet similarity is cited by 56 per cent of pharmacists as a contributing factor.
On a scale of 0-10, with 10 being "extremely helpful," colour is clearly preferred to standard white tablets, which averaged only a 1.4 rating.
In addition, brightly coloured tablets, rated 6.9, are seen as a significant improvement over pastel tablets, rated 3.0, in helping reduce medication error. Unique shapes (7.6) would also substantially differentiate tablets according to the survey.
Other factors that reduce errors are a high-resolution imprint, rated 7.6, drug name and dose etched into the tablet (7.3) and contrasting colour imprint (6.9).
While not as strong an impact as colour and shape, finish, such as pearlescence or gloss, are marginally helpful in identifying tablets. Flavour and aroma were believed to be slightly helpful (2.2 and 3.6 respectively).
"As the number of discrete solid dose tablet offerings continues to grow, differentiation is becoming more difficult for pharmacists, nurses, physicians, patients and caregivers," said Rick Kettinger, managing director of Colorcon, a supplier of film-coatings systems and excipients to the pharmaceutical industry and a sponsor of the survey.
"Clearly identifiable medicines can help reduce dispensing error, and help ensure patient safety and compliance."
A coloured tablet with a unique shape, pearlescent finish, drug name and dose imprint, aroma and flavour is the best combination of characteristics according to the survey, resulting in an eight-fold improvement in helping identify medications and reducing errors.
Pharmacists are not disputing that they are the best qualified to help patients and caregivers identify their medicines, indeed 70 per cent say that patients ask them to assist in identifying tablets or capsules outside the original packaging at least once a week, however they want drug manufacturers to make their work easier by making pills more distinctive.