Their tablets keep changing colour or brand: what can I do?

A tablet that looks different does not mean the treatment has changed, but it can lead to missed or double doses: here is why it happens and how to avoid mistakes.

If your mother gets confused because her tablets change colour or brand, the first thing is to reassure her: in most cases it is the same medicine with a different look. The second is to change the system, so that she stops relying on the colour of the tablet or the box and goes by a list with the active substance or, better still, by medication already prepared by dose.

This is a very common problem for older people who take several medicines, and it can be solved. We explain why it happens, what the risks are and what you can do.

Why do tablets change colour or brand?

Because the same active substance is made by several manufacturers, in different presentations. In Spain, when the doctor prescribes by active substance, the law states that the pharmacist will dispense the lowest priced medicine, and that medicine may come from a different manufacturer from last time.

That is why a blood pressure or cholesterol tablet may come one month in a blue box with white tablets and the next in a green box with yellow tablets. The active substance and the dose are the same; what changes is the brand, the packaging or how the tablet looks.

Is it the same medicine even if it looks different?

Yes, as far as the active substance goes. According to the European Medicines Agency, a generic contains the same amount of active substance as the reference medicine and is used at the same doses for the same diseases, although its name, appearance (for example, colour or shape) and presentation may vary.

• To be authorised, in most cases the manufacturer must show that it produces the same levels of active substance in the body (bioequivalence).
• It may contain different excipients, that is, ingredients with no therapeutic effect.
• If an excipient requires precautions, this is stated on the box and in the leaflet, which matters if the person has an allergy or intolerance.

If you notice any different effect after a change of brand, mention it to the doctor or pharmacist rather than stopping the treatment.

What are the risks if she mixes up her tablets?

The main risk is not the medicine itself but a mistake in taking it. The CAMBIMED study, carried out in Spanish health centres with people over 65 taking blood pressure and cholesterol treatments, concluded that switching between bioequivalent medicines with different appearance might increase medication errors and reduce adherence; the most common error was missed doses.

• Missed doses: she does not recognise the new box and stops taking that medicine.
• Double doses: she thinks the new box is a different medicine and takes both, the old one and the new one, with the same active substance.
• Mistrust: she thinks her treatment has been changed and decides not to take it.

If she has already taken one tablet too many, see our article on what to do if a tablet has been taken twice.

What can you do to avoid confusion?

Change the point of reference: the person and the family should identify each medicine by its active substance and its dose time, not by its colour. These steps help:

This last point is key: the good practice guide from the Spanish General Council of Pharmacists says that the dosage system label must describe the pharmaceutical form, colour and features of each medicine included, so the person does not have to recognise boxes. If she also has poor sight, read how to organise medication for someone with poor sight.

A practical example: Pilar and the new box

Let us take the case of Pilar, 86, who takes six medicines and has always recognised her blood pressure tablet by its blue box. This month the pharmacy gave her another brand in a white box, and her son discovers she has been taking both.

1. Her son calls the health centre or the pharmacy to explain what has happened and follows their advice.
2. He removes the old box and leaves only one of each active substance.
3. He makes a large print list with the active substance, dose and time of each medicine.
4. At the pharmacy, he asks about having the medication prepared in a dosage system, so that Pilar only opens the pocket for each dose.

From then on, a box changing colour no longer matters, because Pilar no longer chooses between boxes.

How can IMA Health help?

At IMA Health we coordinate with a specialised pharmacy so that medication is prepared by day and time, delivered to the home and followed up personally. That way, even if the brand of a medicine changes, the person still finds each dose in its place. Find out about our home medication service.

Sources

• European Medicines Agency: questions and answers on generic medicines (Spanish version)
• BOE: Royal Legislative Decree 1/2015, consolidated Law on guarantees and rational use of medicines (in Spanish)
• Atención Primaria (2020): effects of changes in medicine appearance on safety and adherence in people over 65 with chronic conditions (CAMBIMED study, in Spanish)
• Spanish General Council of Pharmacists: good practice in community pharmacy, preparation and provision of personalised dosage systems (2018, in Spanish)
• AEMPS: CIMA, online medicines information centre (in Spanish)

This article is for information only and does not replace advice from your doctor or pharmacist.