The researchers conducted a case-control study of patients taking antiepileptic drugs and compared the odds that patients who did not refill their medication had been given pills that differed in color or shape from the prior prescriptions. Using a large national database of filled prescriptions, when the researchers identified a break in the patient’s use of the drug, they looked at the previous two prescription fillings to see if they were the same color and shape. They found that interruptions in the prescription filling occurred significantly more frequently when the pills had different color. Interruptions in antiepileptic drug use for even a few days can raise the risk of seizure and have important medical and social consequences for patients.
These findings offer important take-home messages for physicians, pharmacists, and patients. As Kesselheim explained, “Patients should be aware that their pills may change color and shape, but that even differently appearing generic drugs are approved by the FDA as being bioequivalent to their brand-name counterparts and are safe to take. Physicians should be aware that changes in pill appearance might explain their patients’ nonadherence. Finally, pharmacists should make a point to tell patients about the change in color and shape when they change generic suppliers.”
Researchers acknowledge that medication adherence is a multifaceted issue, but suggest that taking steps to permit (or even require) similarity in pill appearance among bioequivalent brand-name and generic drugs may offer a relatively simple way to contribute to better adherence.