Medical technology and drug development have been in a rapid, constant evolution over the years and new drug molecules and innovative biologic treatments are discovered and developed all the time by pharmaceutical scientists. Listed among other types of pharmaceutical forms such as oral liquid formulations, injectables, or inhalers, pills remain the most common and easy-to-administer formulation, with an accurate dosage used by both patients at home or within medical centers.

A pill is a solid pharmaceutical formulation designed to be taken orally by mouth, usually swallowed whole. Once administrated, it is absorbed systemically, usually through the stomach, and it has effects around the body, depending on the location of the target receptors. Pills have a wide variety of applications, as they are used in order to both treat and prevent diseases, improve medical conditions or simply promote a state of well-being. As any medicine has side effects, and if taken when not needed or in large amounts can lead to toxicity, administrating the wrong type of pill voluntarily or by mistake may have serious health consequences.

There can be various moments in one’s lifestyle when knowing how to identify a pill may be very important. Whether the label got misplaced or they simply forgot what type of pills they put in a specific pill jar, consuming unknown pills might be very dangerous, which is why identifying a pill’s type must be the very first step.  This can also be vital in cases of medical emergencies such as medication overdose by accident or drug poisoning. 

How to avoid owning unidentified pills?

As taking an unidentified pill may be harmful and have serious side effects, it is recommended to try to avoid any confusion regarding the types of medication. A first step can be keeping all the pills in their original packaging, including the patient information leaflet. In case they are ever transferred to other pill jars or pillboxes, it is important that they are labeled accordingly right away. Another recommendation is to periodically check the expiry date of the medicines you or other family members keep in the medications cabinet.

How to identify a pill?

In the case of unidentified drugs, it is important to observe some of the main features, which are:

• A pill’s physical properties such as its color, shape and size can be a great start in the process of identifying its type. Professionals might check for texture and coating as well, looking for a line-shaped mark called a score mark. A pill can have one or more score marks, playing a role in showing where to cut or split a pill, usually in order to consume a smaller dosage. For example, young teenagers may be allowed to administrate some pills that are designed for adults, but their dosage should be smaller. Splitting a medication should only take place after consulting a professional regarding this. If a healthcare professional recommended splitting the medications for various particular reasons, this can be done with a tool known as a “tablet-splitter” or a “pill-cutter”, unless the pill has a very specific size or shape. Specialists recommend only splitting pills that are soon going to be administrated because different environmental factors such as humidity or heat may affect the state of the pre-cut stored pills. Of course, not all pills have these marks, which may imply that they are unsafe to cut.

• The imprint code of a pill is the most important detail, being a unique text imprinted on the pill in order to easily identify it. The Food and Drug Administration (FDA) now requires imprint codes to be carved into or imprinted on most types of pills. The imprint code is composed mostly of letters and numbers that may go along with other symbols or marks, as well as names (for example the drug maker name), or any combination of these. The FDA also recommends that drug manufacturers only use simple letters and numbers, as they are easier to look up. Once a pill is developed and ready for authorization and launch on the market, its imprint code is submitted to the FDA that keeps it in a database that health care professionals are free to access at any time. Finding the imprint code should not be difficult, as some pills have it imprinted on both sides. It is such an important detail that sometimes this is the only way to narrow the options down to a unique result.

In some situations, pills of the same type that contain the same drug may have different imprint codes. This is usually caused by multiple existing versions of the same pill, meaning the companies producing them are different, even though the medicine is the same. However, if they are all produced by the same company, different imprints typically mean different doses.  

In addition to that, there is a chance of different pills having the same imprint codes. For example, multiple pills may have the same letter imprinted on them, which is when other physical properties mentioned above play an important role. The distinction regarding color and size helps tell one pill apart from another.

In case a pill has no imprint code, difficulties in identifying it may appear. There could be a few possible reasons why a pill’s imprint code is not visible. The first option is that the imprint code simply faded away over time, especially if the unidentified pill is very old. It can also happen due to unsuitable heat or humidity. This may mean that the drug is already past its expiration date, but that is not a certain rule. Another possibility is that the unidentified pill is actually a vitamin/ a dietary supplement, medication from a foreign country or a type of non-FDA approved pill, such as illegal drugs.  However, some drugs that are FDA-approved are exempted from the general imprint code rule.

Some illegal drugs and other drugs of abuse also include imprinted symbols. For example, Ecstasy usually contains a carved design looking like a flower, a smiley face, or other symbols that seem appealing to teenagers and younger age groups. The imprints are not manufactured in legal circumstances, which is why they are not considered imprint codes and are not available for pill identifier websites or apps. 

A different situation occurs when one keeps at least most of the medicine's original packaging, even though the pills are being misplaced. Another pill identification code is usually imprinted on the outer packaging or label of human medications: the National Drug Code (NDC).  This is a unique medication identifier composed of not more than eleven digits representing the labeler, the product itself, and the general packaging size. Typically, there are four or five digits identifying the labeler (the company that manufactures, distribute or simply repackage the medicine) and three or four digits for the code of the product (this helps identify general characteristics of the drug such as its strength or dosage form), while the remaining one or two digits indicate information regarding the actual package. The labeler code is generally allocated by the Food and Drug Administration (FDA) to the producing or distributing company, while the other two codes contained by the NDC code are assigned by the labeler. Most NDC numbers are composed of ten digits, yet some of them include eleven due to billing regulations. Mainly, the ten-digit code includes an additional zero (it used to include an asterisk as a replacer) in order to achieve the 5-4-2 configuration.

For instance, a pill bottle containing a hundred pills of Prozac 20mg has the following National Drug Code imprinted on its packaging label: 0777-3105-02. As described above, the first four digits (0777) stand for the company labeling the product, in this case, Dista Products Co., the next four (3105) are used to describe the specific form of the drug, the capsule form, while the third part containing the last two digits (02) refers to its packaging, identifying its size: a hundred capsules per bottle.

The FDA keeps information regarding the National Drug Codes stored in a searchable database on their website, making it accessible for anyone to easily look up medicine they need. This database is, of course, constantly updated as new medications are authorized, or there simply is a modification in labeling regulations.  However, there are a few reasons why a drug product may not be listed among the others in the NDC Directory. This generally happens when a medication is no longer available on the market due to various reasons, the company providing the specific product did not offer a complete description to the FDA, or the drug product is simply not listed among usual prescription drugs, over-the-counter (OTC) medicine or insulin products, as it is not FDA-approved.

However, a ten or eleven-digit configuration only provides a limited number of combinations, which is why the FDA foresees the NDC numbers running out of possible combinations even sooner than the year 2033. As the number of companies providing drug products constantly increases, FDA will most probably start allocating six-digit labeler codes due to the lack of possible five-digit combinations that remained unassigned. The maximum of characters in a NDC number will not increase as well, which leads to new various configuration types in the near future.

Considering this, a pill can also be recognized by using this identifying method designed by the Food and Drug Administration, as the NDC code is unique for each individual drug product.

Observing a pill’s properties is very helpful in the process of identifying its type, as they make it easier to tell it apart from other pill form medications. This information is required while consulting a pharmacist or a health care professional, any specialist that is well trained to identify different types of medications. However, if one does not want to consult a specialist regarding this situation, the advanced technology nowadays brings an innovative solution: an online pill identifier (also known as Pill Identifier Wizard).

Online Pill identifier

Even though the most accurate and recommended way of identifying a pill remains asking for a professional’s help, using the faster version of looking it up online may be a great option in cases of emergency.

To use the Pill Identifier Wizard, one has to input the characteristics of the pill: its imprint code, color and shape. It is recommended to input the imprint code at first, since it is the most important detail, and then other features as a follow up in case there are multiple results for the first search. Another reason why color shouldn’t be the first search option is that it can easily be misinterpreted by humans due to light and errors may appear due to simple confusion. Another uncertainty that leads to incorrect results or none at all is making a common mistake while reading the imprint code: seeing letters, numbers, or symbols from an inaccurate angle. For example, a nine may look like a six due to their similar shape, the letter ‘I’ might be confused with the number ‘1’, as well as the letters ‘Z’ and ‘N’. In case of a clearly wrong result after the search, it is recommended to try different combinations of similar characters.

When one doesn’t typically throw medication packages away, another option for using the pill identifier is searching for several different medicine types by their name or NDC code (as mentioned before, this is usually found on the product packaging, but it is also imprinted on its package insert). This step must be followed by comparing the unidentified pill with the results of the search, trying to identify a match by other characteristics. Generally, the result comes with additional information such as color and shape, strength, availability, main drug class, supplier (previously mentioned as labeler), imprint code and NDC number.

Similar to a simple Internet search, the pill identifier works by comparing the input information with the one stored in its database. In case there are multiple matches for the search, the identifier usually indicates all of them, as well as the additional information required.  If there are no other features to be input into the pill identifier and there is still more than a unique result, it is better to consult a specialist, as it is strongly suggested not to ever administrate an unidentified form of medicine.

In addition to the web version described above, pill identifier apps have also been developed for both Android and iOS operating systems, making everything incredibly easy for their thousands of users.

Examples of common pill identifier searches

• Searching for the letter ‘L’ as an imprint code provides Aspirin (a salicylate) as the most common result. For example, one of the results matched the letter L with a round-shaped, yellow pill supplied by multiple companies , Aspirin 81 mg, having the NDC numbers 57896-0981 for Geri-Care Pharmaceuticals, 00904-7704- Major Pharmaceuticals, and 00363-0255- Walgreens Company. Its role is to reduce pain, fever and inflammation, often used in treatments of heart attacks, strokes and chest pain, medically known as angina.
• The letter ‘V’ searched as an imprint code is associated with multiple results, the first four being Zelapar, Spritam, Edluar and Vitafol Strips. By clicking them, essential information for all of the results is provided. This can be compared to the unidentified pill in question and narrow the possible options down.
• The imprint code ‘L484’ leads to the drug product called Acetaminophen, described by the pill identifier as being a white capsule-shaped pill with a strength of 500mg, size of 16.00 mm and NDC number 30142-0484. Its drug class is Miscellaneous analgesics.  It is used for treatment of sciatica, helping improve symptoms such as muscle pain or fever.
• ‘M365’ is the imprint code of Acetaminophen and Hydrocodone Bitartrate, being detailed as a 15.00 mm white capsule only available with a medical prescription, its strength being 325 mg/ 5 mg. The drug class is Narcotic Analgesic Combinations. Its NDC number depends on its labeler as follows: 00406-0365 or 00406-0123 - Mallinckrodt Inc.; 52959-0737- H.J. Harkins Company, Inc.; 68071-0296- Nucare Pharmaceuticals Inc.
• Regardless if we search it by the name ‘Tramadol’ or its imprint code ‘AN627’, the results describe a white pill with a strength of 50 mg, measuring  9.00 mm, provided by Amneal Pharmaceuticals LLC with the NDC 65162-0627 and Amerisource Health Services with the number 68084-0808. It can also be identified using other NDC numbers, due to various companies that repackage the product. It is not available without a prescription, being described as a treatment for moderate to severe pain in adults, classified as a synthetic opioid.
• While searching for the drug product named Xanax, there are multiple results differing in strength level, color, and also shape. The term refers to a group of highly addictive medications only available by prescription, known as benzodiazepines. This type of medicine can be extremely dangerous, especially when combined with certain substances such as pain killers or alcohol.

For instance, the first result shows a white rectangular pill imprinted X ANA X 2, with a strength of 2 mg and a size of 15.00 mm. Its NDC number is 00009-0094. A different result is imprinted XANAX 1.0,  being a blue oval (elliptical) pill measuring 9.00 mm with a strength of 1 mg and the NDC numbers depending on the providing or repackaging labeler 00009-0090- Phizer Inc.; 55289-0345- PDRX Pharmaceuticals Inc. and 54868-1251-Physicians Total Care Inc.

Other results include various concentrations of 3 mg, 0.5 mg, and 0.25 mg, different shapes such as five-sided (similar to a star shape) , four-sided or three-sided, and multiple colors-for example green, orange and yellow.

For each search, further information is also provided, such as the pill’s role in treating medical conditions, risks of administrating during pregnancy, and other details that may be useful for the consumer, including recommended dosages, interactions with other types of drug products, or usage of different substances, as well as the health side effects that may be extremely severe if the instructions are not followed strictly. This being said, all the information regarding the safety of administrating a specific type of medicine is provided and only one click away for the consumer to acknowledge.

Considering the constantly-evolving medical technology and the very numerous types of drug products currently existing that are not always safe while being mixed up, it is very important to be extremely careful regarding administrating medications. Misplacing different types of pills and forgetting exactly what some of them are tend to be common human mistakes that we often make without completely realizing the large variety of consequences. Once again, organizing the medication cabinets in our homes with regularity, checking for expiration dates of the drug products, keeping all original recipients, packaging or package inserts and making sure to identify unknown found pills are all essential for our general safety. Neglecting these aspects may lead to severe temporary or permanent health issues, which is why we need to be very cautious in order to protect ourselves and other people around us.

Conclusion

General aspects important to remember:

• Just like any other type of medication, pills may cause serious health side-effects if not administrated following a healthcare professional’s recommendations regarding dosage or interactions with other medicines
• It is recommended for consumers to keep the original packages and package inserts at all times, as this may help identify unknown drug products.
• In case pills are misplaced and need to be identified, consulting a pharmacist or any other specialist is the best option for guaranteed certainty.
• The pill identifier (the web version or the app) helps recognize a pill by inputting its general characteristics such as imprint code, color and shape. It can also be used by searching the specific names of drug products or their NDC (National Drug Code) numbers, if this is a valid option for the user.
• Safety regarding usage of medication should be a priority for every individual and maintaining an organized cabinet for storing medications may be vital.