Donna was diagnosed with clots in her lungs 15 years ago and took the same dose of blood thinner for over 10 years with no problems, after which she and her doctor decided to stop it. Three years later, after developing shortness of breath she was given an antibiotic, which didn’t help; it turned out to be blood clots in both lungs.
When the doctors restarted her previous blood thinner and discharged her home, she starting itching all over her body and felt “wiped out”. In and out of the doctor’s office for the next 3 weeks, Donna tried one allergy medicine after another with no improvement in her itching and fatigue.
The only thing left to try was her old blood thinner medicine. Surprisingly, when they changed her blood thinner, within days, Donna’s itching and fatigue went completely away. Could she have developed an allergy to her old blood thinner medicine? That’s possible, but there is another explanation. She could be allergic to one of the several other ingredients also found in that medicine.
These “inactive” ingredients are called excipients, and lurk in our tablets, capsules and liquid medicines. There are dozens of compounds that can be used and many generic medicines use different excipients than the original brand’s formulation. Generic medicines only have to include the same active ingredient; they can have different colors, coatings, sizes and shapes as well as different “inactive” ingredients, leading to differences in how an original medicine acts in your body compared to any of its generic counterparts.
Tablets and capsules start out with a specific amount of the drug’s active ingredient, usually as tiny crystals of powder. Other compounds, called excipients, are added to it to help preserve it, color it, sweeten it, make it easier to manufacture and to help it dissolve more easily, whether under your tongue or inside your stomach.
One type of excipient is a stabilizer or preservative. They work to either protect the final product from contamination from microbes or slow down the degradation of the active ingredient when it’s exposed to oxygen and moisture. Sodium bisulfite is a common stabilizer that helps an active ingredient stay potent longer. Some commonly used preservatives include sodium benzoate, sorbic acid, and parabens like methylparaben, ethylparaben, propylparaben and butylparaben.
A diluent is often added to the active ingredients and coloring agents to help blend them more evenly into the mixture that will become tablets or capsules. This gives the tablets a more consistent color and provides a consistent dose in each piece when tablets are cut or broken in half.
With most medicines, combining the active ingredient, diluent and dye or coloring agent won’t provide enough powder to fill out each dose and create tablets big enough to pick up easily and swallow. A filler agent like cornstarch, lactose, sucrose, dextrose, or talc is then added to the mixture, adding bulk in order to create a tablet or capsule of a certain size.
Although you may now have the active ingredient, diluent, food coloring and filler added together, to make the pill easier to manufacture when using automated pill presses you usually will need to add a couple more compounds: a binder and a lubricant.
A good snowball fight needs snow with just a bit of moisture to help the snow “stick together” when forming snowballs. Dry, powdery snow is fun to ski in but hopeless when trying to make good snowballs because it doesn’t stick together when you compress it. A binder gives your powdered medicine the “stickiness” it needs to form a tablet when pressed into a particular shape by the pill press during its manufacture.
When making waffles, you pour batter onto a hot waffle iron, and then close it while it cooks. When it’s done and you open up the waffle iron to retrieve your treat, it’s wonderful to lift the waffle out easily onto your waiting plate, but aggravating when it refuses to come loose and you end up peeling each half off the sides of the waffle iron. After pressing a tablet of medicine into its final shape it also must LET GO and drop away to allow more tablets to be formed, so a lubricant is often added.
Other inactive ingredients include wetting agents, also called disintegrants, which help to pull water into a tablet more quickly and speed up the process of dissolving the tablet to release the active ingredient more quickly and completely. Sometimes there is flavoring added to chewable tablets to make them taste better, and preservatives are often added to liquid medicines like ear drops, eye drops and nose sprays to discourage the growth of microbes.
The only thing a generic medicine is required to have to be considered an equivalent for the original medicine is the same amount of active ingredient. Otherwise it can and often does have a different size, shape, and color, plus many other compounds that may be different from the original and could affect how your body reacts to it. You may not absorb the generic medicine as well, or develop a sensitivity to one of the inactive ingredients.
Here Are The 7 Most Common Compounds Found in Your Medicines:
- Active Ingredient.
All generic medications are required to prove that they have the same amount of active ingredient as the parent or original brand-name medicine.
- Diluent.
This helps the active ingredient get mixed in evenly with the other ingredients, like fillers, dyes and flavoring, so the pill has the same amount of medicine throughout the tablet.
- Filler.
Most active ingredients don’t have enough bulk to make up an entire pill all by themselves, so some extra powdered ingredient is added to the active ingredient to create enough for the size of tablet the manufacturer is making.
- Dye.
Many pills are white but others are distinctive colors, with food grade coloring added to create the shade. Similar to colors of yarns, it’s not unusual to see a slight difference in color when changing to a different lot, even with the same generic manufacturer.
- Binder.
To help the powdered medicine form itself into a solid tablet, a slightly sticky compound is added so as the powder is compressed it forms a nice tablet shape instead of crumbling.
- Lubricant.
Pills are made by forming them with a pill press. Sometimes a lubricant is added to help the pill release from the pill press machine quickly and completely, especially important if there are indentations like a scoring mark or identifying letters or numbers pressed into the tablet.
- Disintegrant.
Pills need to be somewhat resistant to moisture, which can interfere with dissolving in your stomach. A disintegrant is sometimes added to encourage water to spread through the tablet, helping the pill to dissolve more quickly.
