Size Matters!

If your mind went to “that” place after reading the title, that’s on you. I mean, there isn’t even a blue pill in the picture above! And now that I have your attention, let’s move on. I have reached the age where medications/vitamins are a part of my daily routine, as I am sure they are for many people out there. I took this photo the other day of two of the pills I take every morning. The pill on the left is a prescription, and the size of the pill is actually quite a bit smaller than the picture illustrates. The two pills on the right are the same – 600 mg of calcium with D₃ (a dietary supplement), and they are both made by the same company. So, why is the one on the far right so much bigger, causing a near-gag reflex when swallowing? That is exactly the question I was asking myself when I opened the new bottle to find these ridiculously large capsules, the size of small torpedoes. I don’t even own a submarine.

Armed with this burning question in my head, I let my “fingers do the typing” and found several possible answers to my question, many of them leaving me scratching my head and with more questions. The “answer” was provided by Mr. Lim, a pharmaceutical industry consultant and university lecturer in chemistry and pharmacology, on the website “For The Love of Science.” Interestingly enough, the article starts of with the following: “Have you ever wondered why drug tablets come in so many shapes, sizes, and even colors?” Get out of my head Mr. Lim. But, since you asked, yes I have wondered exactly that. And now the fun begins. Shortly after that question, in bold no less, the following appears: “As part of the drug development process, pills are made to have different shapes, colors and sizes. Among other factors, having a unique design helps with patient safety (preventing them from taking the wrong pill), prevents counterfeits, and enhances the drug’s brand image.”

My cynical side, which has been well developed over the last seven decades, reads this and thinks: “Among other things” … Yeah, right. While I understand “patient safety” to some degree, if you are taking multiple pills at multiple times of the day, I’m not quite sure how the pill size, or color for that matter, is going to do you any good. But “preventing counterfeits!” How does that work? Do you meet a guy in a dark alley who goes by the code name “drug man” and ask him how much he’s asking for his blood pressure medication? And lastly, I don’t know about you, but I always have a long conversation with my doctor whenever she/he prescribes a new medication because I want to make sure that I’m not making a “brand” faux pas. After all, my image is far more important than my health.

What I did learn that I did not know beforehand is that all drugs have two components: 1) Active Pharmaceutical Ingredient (API), or as Lim calls it, “the good stuff;” and 2) Excipients, which are an inactive ingredient or inert compounds that serve as drug delivery systems that can control the rate at which the API is released into the bloodstream. Given this, it makes sense that the composition of tablets “is a critical part of research to ensure that the drug product remains stable and have a shelf life of at least one year. Choosing the right packaging (shape and size) for the tablet is also important for its stability.” While I can kind of get my head around the science of this, how does the color of a pill make any difference? The answer to that comes under the subheading: “Why Not Just Use a Plain White Tablet?” It’s starting to worry me that this guy is still in my head. The answer: “Pharmaceutical companies can choose to be boring (emphasis added!) and produce standard round white tablets without any special shape and color.” Indeed. Lim also adds that because of the high costs of drug development, at times for products that never make it to the market, it doesn’t make much sense to spend time and effort, not to mention money, on tablet design, which is the main reason drugs used in clinical trials are always round, white, and boring.

I can assure you that when I take this one pill that is bright orange in color, the last thing on my mind is that I am so happy to not be boring! So why is color important? According to Lim, there are psychological effects associated to the color of pills. Take, for example, the light blue color of Viagra (Sildenafil). Come on, you knew I was going to bring Viagra up (pun intended). According to Lim, the “light blue color of Viagra is associated with the color of the sky, giving individuals feelings of happiness and relaxation.” Unless, of course, after taking one your erection lasts more than four hours and you find yourself in the emergency room because your face has turned blue. Or perhaps the “blue sky” analogy refers to what must be the common practice, after taking one, where you look up to the blue sky and say: “Thank you, God!” But I digress. It would also appear that many heart medications are “colored red or pink, signifying both power and danger.” I’m just going to leave that one alone.

Lim does eventually get to the size of pills under the heading. . .wait for it. . . “Size Matters” (no, my name is not Lim), and while the explanations for this are similar to the ones above, it still does not explain why one drug company would make the same pill with the same API and excipient structure in two different shapes and sizes. Especially given that one (pictured above in the center), is relatively easy to swallow, and the other (pictured above on the right), if swallowed the wrong way, might make you look like you consumed a boomerang. I will leave you with a photo of some of the different drug shapes and sizes. How many of these are in your daily routine?

Los Angeles 2023