same amount of medication, different size

January 19, 2018 5:58 PM

Is there a chemical reason for why a larger pill, the same amount of medicine as two smaller ones, works faster?

I take generic Ativan as needed for panic attacks. (Please do not use this post to tell me not to do that, I know how MeFi is about benzos sometimes.) Normally, if I wanted to take 1mg, I'd take two .5 pills. Today I got a different pill size from the pharmacy, so I wouldn't have to take as many pills at once if that happens, and I felt as if the 1mg single pill worked much stronger/faster.

If it's the same amount of medication and I'm swallowing both of the smaller pills at the same time, what's the difference? I've noticed it with other medications in a similar situation, as well.

I remember reading an explanation of it somewhere, probably here, but I don't know what keywords to look for. Thanks for explaining in advance!

posted by colorblock sock to Health & Fitness (6 answers total)

Well, the coating on the pill is (often) what controls it's time-release abilties...maybe they use a different formulation on the larger pills to make them work faster? (if everything was identical, then the multiple, smaller pills should work faster because they have more surface area.) However, you're also working from an experimental sample size of 1 dose, so your experience could just be subjective...did you eat anything? That can make pills absorb/work faster as they get taken into the system along with the food. If it keeps happening then it's probably either the coating or the binder that dissolves easier.
posted by sexyrobot at 6:14 PM on January 19, 2018 [4 favorites]

Are the pills from the same lab? I've had generics made in different places affect me differently.
posted by unknowncommand at 6:30 PM on January 19, 2018 [1 favorite]

Response by poster: Not to threadsit but yes, the pills are from the same lab, the same brand of generics I've taken before.
posted by colorblock sock at 7:30 PM on January 19, 2018

Yes. The reason often has to do with manufacturing. The engineering science behind powder compaction is actually super complicated and oftentimes the shape and size of the pill is guided by the properties of the raw granulated material that is pressed into the pill shape. Different manufacturers might be using different constitutive materials which are more conducive to being formed into larger or smaller shapes. Especially if the pill is scored, (meaning it can be broken in half and still taken effectively) which means that the manufacturer must produce it to a much higher level of uniformity of active agent, they may have to affect a very particular mold geometry to ensure consistency and uniform compaction.
posted by incolorinred at 8:56 PM on January 19, 2018 [6 favorites]

Everything regarding medical treatment, including evidence-based medicine, is susceptible to the placebo effect.
posted by kandinski at 3:08 AM on January 20, 2018 [5 favorites]

So if we look at Ativan's prescribing info (https://www.pfizer.ca/sites/g/files/g10017036/f/201505/PM_Ativan_Clean_E_Level_3_10-Oct-2014.pdf) we see that the composition of the 0.5 mg and 1 mg tablets is identical:

Non-Medicinal Ingredients:
Each 0.5 mg, 1 mg, 2 mg Ativan tablet contains:
Lactose, Magnesium Stearate, Microcrystalline Cellulose, Polacrilin Potassium

None of these ingredients seem to be a time release coating. So this is strange because Noyes Whitney predicts that if anything, two 0.5 mg tablets would release more quickly than a single 1 mg tablet because the two smaller tablets should have more surface area.

So I dunno.
posted by Comrade_robot at 7:00 AM on January 20, 2018 [1 favorite]