Common barriers that prevent patients from adhering to their medication regimen include cost, difficulty keeping up with dosage, confusion how and when to take it, and not feeling the medication is necessary. A recent study conducted at the Brigham and Women's Hospital (BWH) suggests that patients who have suffered a heart attack will choose to continue or discontinue their necessary post-heart attack drug regimen based on the shape and color of generic pills.

"After patients have a first heart attack, guidelines mandate treatment with an array of long-term medications and stopping these medications may ultimately increase morbidity and mortality," Dr. Aaron S. Kesselheim, assistant professor of medicine in the Division of Pharmacoepidemiology and Pharmacoeconomics at BWH, said in a statement. "Medications are essential to the treatment of cardiovascular disease and our study found that pill appearance plays an important role in ensuring patients are taking the generic medications that they need."

Kesselheim and his colleagues analyzed the medical insurance records of over 10,000 patients discharged between 2006 and 2011 who received treatment after being hospitalized due to a heart attack. Medication options included generic beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin-II-receptor blockers, or cholesterol-lowering statins. The research team checked medical records for non-adherence to medication regimen by way of breaks in refills and determined if a change had occurred in the pill’s appearance.

The likelihood of a patient discontinuing use or failing to refill their medication increased by 34 percent when the pill changed in color and 66 percent when it changed in shape. According to the research team, generic versions of the same prescription drug more often than not carry the same degree of effectiveness, but can vary in appearance depending on the manufacturer. Since the Food and Drug Administration does not require that the look of a pill remain the same, patients will often receive medications that are different shapes and sizes reliant on their pharmacy’s supply.

"The association between changes in pill appearance and non-adherence to essential cardiovascular medications has important implications for public health," Kesselheim added. "This study suggests the need for physicians and pharmacists to proactively warn patients about the potential for these changes, and reassure them that generic drugs are clinically interchangeable no matter how they look, especially in light of the prevalent use of generic drugs and public health importance of promoting patient adherence to essential medications."

Source: Avorn J, Tong A, Kesselheim A, et al. Burden of Changes in Pill Appearance for Patients Receiving Generic Cardiovascular Medications After Myocardial Infarction: Cohort and Nested Case–Control Studies. Annals of Internal Medicine. 2014.