Editor—The pharmaceutical industry seems to be dominated by packaging initiatives that unnecessarily compromise patient compliance and thus safety. A middle aged male patient in Ireland reports the challenge he faces daily as a result of inventiveness in product presentation. Currently he is prescribed six not unusual medications for a hypertensive condition and related effects, one replacing a previous drug. The packaging of each is in blister packs, one tablet to be taken per day, but the total non-standardisation of presentation is shown in the table.
The utter confusion is clear: no two packages are the same. Whether a blister pack covers one week or two, presentation may be in parallel rows or round the pack. Each pack has to be considered separately, the end of the run of removed tablets identified, and the next to be used identified.
The only commonality is that the labelling of days of the week takes the form of three letters (with “THURS” for Thursday in six cases). The print is always in fine lettering and never larger than 12 point. It is in capitals in six cases, and seldom in a dark colour. The typeface of one pack is such that if “MON” is viewed upside down, it reads as an imperative “NOW.”
Three products originate or are packed in Ireland, three in England, and one is labelled as “UK-Ireland” packaging of a French licensed product. The only correlation is that it is the English products that give Sunday and Monday equal position as the start of the week.
This patient is fit, mentally competent, and has good vision, yet this variety faced at breakfast time and bedtime needs alertness—at a time of day when this may be compromised. As pattern of removal is more prominent than indistinct printing, but leads to false decisions given the different patterns of presentation, wrong dosage is very possible and does occur. These drugs are more likely to be prescribed in the later part of life—for elderly or confused patients the risks are obvious, yet unnecessary.
There seems no need for this variety. Pharmaceutical manufacturers are not competing for patients on the basis of consumer choice of packaging, and patients have this non-conformity forced on them. Patients are unnecessarily put at risk by design inventiveness.
Producers of other products based on days of the week, such as diaries, calendars, and television listings, have moved towards a high degree of concordance even though consumers have personal choice. But in pharmaceuticals, where health and life are involved, this is not the case.
In the interests of consumer safety and optimised compliance this is an issue that would benefit from standardisation, including also a specification of bold or heavy type. Given the international nature of pharmaceutical supply, it seems a legitimate subject for a European approach.
Table.
Packaging of seven commonly prescribed drugs for one patient
| Product No | No of weeks per pack | Format of week | Day starting week | Location of print | Colour of print |
|---|---|---|---|---|---|
| 1 | 2 | Up one side, down the other, clockwise | Sun/Mon | Foil side | Turquoise |
| 2 | 1 | Parallel rows of 4 and 3 days | Mon | Foil side | Maroon |
| 3 | 2 | Heart shaped circle per week, clockwise | Sun/Mon | Foil side | White on red (red on white for 2 days a week) |
| 4 | 4 | Parallel rows | Mon | Both sides† | Blue, striated silver background |
| 5 | 2 | Parallel rows | Mon | Blister side | Red |
| 6* | 1 | Up one side, down the other, clockwise | Sun/Mon | Foil side | Black |
| 7 | 2 | Parallel rows | Mon | Foil side | Reversed grey on foil |
Replaced 7.
But one line is in fine print between middle two, manufacturer's name being more prominent.