Is It the Drug or the Dye?

Take a look in your medicine cabinet and you’ll see artificial coloring everywhere: orange ibuprofen, red cough drops, purple syrups.

Medicine comes in different colors for different reasons: Some capsule shades help you distinguish one dosage amount from another; differing colors separate a statin from an anti-nausea drug; and very often colors are selected by the manufacturer because they are more attractive to the consumer. After all, blue is a more marketable color for Viagra than pink, for example, so it’s made with FD&C Blue #2 aluminum lake, one of around 80 different color additives the FDA has approved for your meds.

“Aluminum lake” means aluminum salt has been added to the original dye. You can find Blue #2 aluminum lake in Viagra, but Uristat, a urinary tract infection pill, contains the original Blue #2 with no aluminum salt. Many approved dyes have two versions. In part, that’s also why there are so many colors on the FDA list.

To further complicate matters, a blue drug isn’t always made with blue dye. American Pharmacists Association media liaison Norman Tomaka (BS, MS in Pharmacy) says, “Just because a tablet’s purple, or just because a tablet’s green, doesn’t mean that’s the dye that’s used in it.” For example, Dulcolax, a red laxative, contains FD&C Yellow #10 aluminum lake.

Coloring That Does Double-Duty as a Binding Agent

Then there are coloring agents like cobalt that also double as binding agents, a type of inactive ingredient that manufacturers use to physically “bind,” or hold, a medicine together. Cobalt allergies, according to Dr. Purvi Parikh, an immunologist with Allergy and Asthma Associates of Murray Hill in New York, are common. Cobalt is frequently found in vitamin B12.

While all this is interesting, here’s why it matters: You may be allergic to a color additive, and that allergy could be keeping you from taking medicine you truly need.

Tomaka says approximately 40% of the population thinks they’re allergic to penicillin class drugs, but less than 10% actually are.

Take penicillin, for example. When you first swallowed that red and white pill or drank that pretty pink liquid, did you have a reaction? Tomaka says approximately 40% of the population thinks they’re allergic to penicillin class drugs, but less than 10% actually are. That’s because patients exclude themselves from taking something after they mistake a known side effect for an allergic reaction. Then those who really do have a reaction assume their allergy is to the drug when it could be to an inactive ingredient — like a coloring agent — instead.

How Can You Tell If You Are Allergic to the Dye?

So how do you know if you’re allergic to the dye or to the drug? Parikh uses prick tests to identify if cobalt or carmine red is the culprit, while Tomaka “interrogates the allergy”: Do you do better with uncoated tablets in general? Do any other drugs cause the same reaction? If so, do they contain the same dye(s) as this one?

The process of elimination continues from there: “When a patient says to me, ‘I’m allergic,’” Tomaka says, “I ask them what happened. If they say, ‘Within minutes of taking [the drug], my mouth swelled up,’ that sounds to me more like a contact allergy… It might be the capsule or tablet [as opposed to the medicine itself].”

Once your allergy is pinpointed, Parikh says avoiding that color can be challenging. The FDA lists approved additives on its site, but there’s no single list of which dyes are in which drugs. For individual medications — including over-the-counter meds — look for a list of “inactive ingredients” or “other ingredients” on the label. Tomaka also recommends finding the full ingredient list on Google Scholar, and reminds patients that their doctor and pharmacist should also help research this for them.

Ask Your Pharmacist About Dye

But your pharmacist can’t help if he doesn’t know. “Speak up,” Tomaka says. “Tell every medical professional you come in contact with, whether they’re dispensing a drug or prescribing a drug or administering a drug.” And if your pharmacist doesn’t know what’s in the prescription that he’s filling, ask him to call the manufacturer on your behalf.

As our culture trends more toward greater patient awareness of self-health, drug manufacturers are progressively adapting formulas to meet consumer demand: People are looking out for additives in a way we didn’t before, and the trend is that if something doesn’t need to be in our medicine or food, as consumers, we ask why it’s there. That’s why you see white ibuprofen alongside the traditional orange, why certain children’s cough syrups are now dye-free.

Regardless of an increase in alternatives, Tomaka says there’s no replacing conversation. He says, “It’s very important for the patient to tell the pharmacist or physician — any medical professional — what reaction they had to the drug… At least try to find out what happened.”

With the right information, he continues, health professionals can uncover your true allergy and find ways for you to get medication without it. But, he cautions, “not everybody is going to be as sensitive to this issue.” While stressing that American Pharmacists Association members should be trusted to make the time, Tomaka readily admits less professional providers might not want to. That’s when you need to take charge of your own health and make a different sort of change: “If you don’t have somebody who listens,” Tomaka says, “then think about where you’re going.”

In other words — even though other avenues are available — ending color confusion starts with you.

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