Taking tablets

“Healthy living” – good diet, regular exercise, enough sleep, stress reduction, positive outlook – and natural therapies can achieve a lot, but in many cases of medical illness they are not enough on their own. I am thankful to have found effective drugs to control my own episodes of high blood pressure and cardiac arrhythmia. At the same time I can well understand why around 50% of people with chronic disease fail to take some or all of the medication prescribed for them.

There are many reasons for non-compliance (or non-adherence). Side-effects: the experience of unpleasant symptoms in the present, or concern about possible permanent damage in the future. Reluctance to accept a need for ongoing treatment: especially if the benefits cannot be felt immediately, if healthcare professionals have not explained them clearly, or if there is genuine uncertainty about the pros and cons of longterm medication. A desire to avoid artificial chemicals. The financial cost of the drugs.

All these are valid points and there is no doubt that some prescriptions are unnecessary or harmful. But assuming that taking the drugs is indeed the right thing to do, here are some personal observations about how the physical form of the tablets (or pills or capsules) might affect compliance. These aspects may not be considered by the prescribing doctors, though I expect nurses and pharmacists appreciate them more.

Size: while this is partly determined by the chemical makeup of the drug, big tablets are hard to swallow, and small ones can get lost.

Colour and shape: many generic drugs are presented as small round white pills which are hard to tell apart, and this can lead to mistakes in dosage. Coloured tablets of different shapes are much easier to identify. Incidentally, there are some interesting studies showing that the colour of a tablet affects patients’ reports of its effects.

Strength: having to break tablets into halves or quarters is tedious and often inaccurate. Tablet-cutters can help, but it is better if low-dose versions are available.

Frequency of dosage: again this is partly dependent on the properties of the drug, but if it is possible to get a controlled-release preparation to be taken once daily this is preferable to divided dosing.

Such practicalities were not mentioned in my pharmacology course at medical school, as far as I recall. Perhaps they seemed too simple and obvious to be considered in an academic context. I certainly paid them little attention when I practiced as a doctor, not always being aware what the tablets I was prescribing would look like when dispensed. I now realise that size, colour, strength and frequency of dosage can be quite important to patients, especially those who have problems with eyesight or memory. Here in New Zealand it is impossible to get some of the low-strength and controlled release preparations that are available in the UK and elsewhere, and make patients’ lives easier.

 

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