Why is that tablet blue?

The art and science of selecting medication colors


“Look at a shelf of pain relievers. So many are designed to entice a consumer with their color,” observed Leslie Harrington, PhD, Executive Director of the Color Association of the United States (CAUS).

That’s because intense competition and the growth of generics make it increasingly challenging for a pharmaceutical company to differentiate a product. “Sophisticated brand-builders attempt to engage a consumer’s senses for the strongest impact and impression about a drug’s qualities,” explained Harrington, coauthor of “Color–emotion associations in the pharmaceutical industry,” the most comprehensive study ever done on medication colors, published in Color Research & Application in February. “Sight is often the first sense engaged in responding to something, making color a natural target to best communicate the maximum sensual effect of a drug’s ‘personality profile’ by how it looks.” Sight is one of the strongest sensory stimulants, because we often see the color of something before we smell, taste, or touch it.

The majority of tablet medications are white and uncoated, but about 20% of tablets worldwide are coated with colors meant to support their particular attributes; for example, drugs claiming to be innovative are often produced in different colors than those positioned as reliable.

A color strategy can target either the company’s overall brand or one particular product, such as Pfizer’s blue Viagra (sildenafil). Because it’s more expensive to make and coat a colored tablet, marketing managers have to justify a color choice. Many drugs have a global identity and require brand consistency, but a color’s meaning and associations may vary among countries. Harrington’s international study, coauthored with Anat Lechner, PhD, CAUS Director of Education & Data, and Jeffrey Simonoff, PhD, of the New York University Leonard N. Stern School of Business, was designed to explore the link between colors and what they mean to consumers when used in medication tablets.

Study design

Color decisions are guided by intuition and experience as much as science, Harrington and colleagues found. Previous research has shown that color can be a design lever, able to promote object memorization. In 2003, David Vernon and Toby Lloyd-Jones published research in the Quarterly Journal of Experimental Psychology: Human Experimental Psychology assessing the effects of objects in which color is a cue to identification. They argued that during an initial encounter with an object, color information is encoded, which activates stored color representation. “If tablets can be colored to trigger specific, desired responses, then color can aid in drug differentiation,” hypothesized Harrington and colleagues.

Color, as an “agent of meaning,” is used to “create user experiences that augment and reinforce the brand attributes of a drug,” Harrington and colleagues wrote. For example, a cardiovascular drug tablet should not only be efficacious, it should also look efficacious. Color signals the drug’s potency and generates a desired patient experience: the drug is perceived as powerful because it has been proven safe and efficacious, and because it looks that way. “The visual experience of the tablet effectively competes for the attention and memory space of end-users,” said Harrington. For OTC products, more attention is usually paid to the packaging design, she added.

Harrington and colleagues designed their research to explore “color language, universally consistent associations, and local contextual patterns critical to global brand decision making.” Using a Web-based survey, they asked 2,021 participants in the United States and 11 other countries in Europe, Asia, and North and South America to report their responses to 27 different colors. Through literature review and an expert panel, the researchers selected 27 attributes and emotions matching the factors that marketers most frequently try to gauge. These attributes encompassed the following three categories:

  • Effectiveness, such as fast-acting, safe, calming, or powerful
  • Emotional response, such as exciting, discomfort, confidence, or happy
  • Product preference, such as first in class, expensive, new, unhealthy, or quality


“We already knew that color is contextual,” Lechner observed. “Many factors help determine what something means. We can’t generalize that a color means ‘exciting’ for both a car and a capsule. The fact that you put one in your mouth versus sit in it evokes a different response.”

With culture as important as context, color choices have to match where the tablet is sold. For instance, responses to black are nearly universally negative, with people citing attributes of unhealthy, disgust, or failure. However, in Japan, it’s regarded as calming.

One surprise for Harrington and colleagues was the universality of responses to red, across all countries and attributes (Figure 1). For many of the study’s participants, the color was associated with a sense of excitement. Medium and dark red are especially popular, identified in most countries with multiple positive attributes. For Spanish participants, red connoted expensive, first in class, and exciting. In the United States and China, red was perceived as energizing, and evoked a happy response. Only a few nations saw negative attributes. Koreans experienced disgust, Indians caution, and Japanese people felt discomfort or failure. Lighter shades of red evoked only a few mild reactions.

Blue was associated with both positive and negative values. Light blue elicited feelings of disgust in China and France and caution in Spain. Dark blue, however, was very popular in France, signaling relieving and first-in-class attributes. Brazilians thought dark blue products looked safe and responded with emotions of excitement and happiness. In the United States, participants said the color reflected quality and dependability, which inspired confidence.

Green also brought a range of responses. In the United States, only light green got much reaction; respondents thought it suggested innovation. In Japan, participants felt caution or disgust and regarded green products as unhealthy. Medium shades of green were extremely popular in Italy, where participants said the colors expressed trust, confidence, and first in class. Response to green was very positive in China as well, with respondents citing associations with innovation, quality, and trust.

Reactions to light purple were slight, but darker purple brought some strong response, especially in the United States. Americans associated the color with first in class and expensive. Both Brazil and China associated it with “new.”

Neutral shades brought only modest reactions. Gray has no association except in Japan, where it was considered unhealthy. White was widely linked to positive, basic attributes, including common, plain, and safe. In Korea, however, participants felt cautious toward white tablets.

Color and identity

Tablet color can provide important benefits for patients, pharmacists, and manufacturers, reported Jerry Phillips, BSPharm, President and CEO of the Drug Safety Institute in Miami. “For pharmacists, when you’re dispensing 1,000 prescriptions a day, you often do a visual check of tablets. Color can be a quick, obvious indicator that you’ve chosen the right one,” noted Phillips, a former official with the FDA Office of Drug Safety and Division of Medication Errors.

“Especially with different product strengths in the same medication, manufacturers can distinguish them by color, along with shape and imprint coding, to be unique among the 20,000 pills out there” and to meet the FDA tablet identification requirement, said Phillips. “Manufacturers can also match bottle labels to tablet color, indicating the strength of that bottle’s contents.”

Distinctive colors, sizes, and shapes of pills might also help companies protect their product from counterfeiters, Harrington noted. Some marketers are convinced that color helps distinguish their brand, Phillips observed. For AstraZeneca, “Nexium [esomeprazole] has made ‘the purple pill’ synonymous with their medication.”

Color subtly affects adherence as well. “If a pill looks like it will work, the patient is more likely to take it,” Harrington explained. Noticing the color can also help patients remember that they took a particular tablet.

Color and safety

When patients take multiple medications daily, different colors help indicate which is which. “If they’re all white and round, patients can get confused. Color definitely helps differentiate products within an individual drug regimen,” asserted Phillips, citing the manufacturer–patient link. “A narrow therapeutic drug leaves little leeway for a mistake, and color can help the patient avoid taking the wrong pills by making them more recognizable.”

Any feature that familiarizes patients with a specific medication can be valuable. “For instance, Coumadin [warfarin—Bristol-Myers Squibb] color-codes different strengths. Once a patient learns that Coumadin 5 mg is reddish pink, if they don’t see that in their refill, they may ask a question, which is good,” Phillips noted.

Color can occasionally cause problems, however. Generic products are not required to look like the original medication. If a patient accustomed to a certain color of a drug receives a generic version, its different color may be confusing. “It’s important for the pharmacist to let the patient know it’s the same drug, but in a different color, to reassure the patient,” said Phillips.

Color allergies are also possible. FDA requires warnings about certain dyes, so pharmacists should check with patients to avoid adverse reactions. Some countries have banned the use of particular colors for tablets because of the ingredients used in making them, Harrington said.

The message for pharmaceutical companies, Harrington said, is that color is “one piece of the puzzle for how to visually brand a product and communicate its attributes.”