Opinion: Color Coded Inhalers

Kreckel's Propsed Color Codes; Click to View

On July 15, my daughter Gretchen Garofoli appeared before the Senate Subcommittee to discuss financial barriers to adult immunizations. The night before she headed to Washington DC, I said “nothing to worry about GG, but please while you’re there get me an appointment to the FDA. I’ll have them straightened out in a couple of months before I get fired!” 

Many of us in healthcare feel that the Food and Drug Administration (FDA) are in the back pockets of the drug companies. It seems that the FDA are always catering to the desires of the pharmaceutical manufacturers. In a previous column in September 2018, I implored the FDA to standardize the appearance of all generic drugs. This would show beyond a doubt that the FDA is concerned about patient safety. No one ever contacted me. Hey, I’m just a community pharmacist whose major concern is always the safety of his patients. Heck, old Kreckel doesn’t even have a political action committee!

Back in October 2013, my niece Rachel Fritz was staying at our home when she was doing an optometry rotation in State College. I presented an online lecture on optometry at the college. After I completed my lecture, she asked “Uncle Pete, why didn’t you tell them about the cap colors on ophthalmic products?” Rachel explained that the anticholinergics had red caps, prostanoids had teal caps, anti-inflammatories had grey caps, antibiotics had brown caps, et cetra. In over 30 years of community practice, I never had this explained to me. I’ve yet to meet a pharmacist who ever had this covered in pharmacy school. The American College of Optometry pushed the FDA for this, they even provided the pantone colors to minimize variations on the color green! 

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Last week, at the doctor’s clinic I work at, once again there was great confusion regarding the asthma/COPD inhalers. I’ve complained about this for years that there is no standardization of asthma inhalers with respect to appearance. We’ve heard horror stories of people using steroid inhalers for emergency, and no one steps up to push standardization. 

My niece, now Dr. Fritz, says that optometrists use these color codes to talk with patients. “Use the yellow cap (Timolol) twice daily, and your teal color cap (Xalatan) at bedtime.” She says during post-refractive surgery, it is less complicated when instructing patients when to use the red, gray, and brown cap colors.

I’d like to see the FDA take the initiative to resolve this issue. I’ve heard some of the sales reps say they would have to retool their equipment to change these colors. Fifteen years ago, we were selling generic albuterol inhalers for $8.00 each, and the FDA had the manufacturers change the valves to accommodate CFC-free formulations, to minimize chlorofluorocarbons that were allegedly damaging the ozone layer. Albuterol inhalers all cost over $50 now. Most of the other inhalers for asthma or COPD cost over $300. Certainly, the lives of my asthma and COPD patients deserve as much attention as the ozone layer.