Capsule or Tablet?

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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One of the most glaring examples of random pricing of medications is the varying price of capsules vs tablets. Most physicians and pharmacists know that the same medication will work just as well in a capsule or tablet form, but many don’t know there is such a huge price difference. Listen up.

Aside from some obvious differences (capsules can’t be crushed or split while tablets often can) here are some surprises in the capsule vs tablet discussion. Know this, and know you can check on the price of your medication to see if it varies based on what form it comes in: capsule vs tablet. Price differences between $10 and $100 a month are common, so let me give you some examples.

Doxycycline is commonly used for acne, rosacea and infections. Doxycycline monohydrate and doxycycline hyclate both come in capsule and tablet form. Guess what, it doesn’t matter which one you take, so pick the cheaper one. In some doses the tablet is cheaper while in others the capsule is cheaper. The way the drug works and its absorption are exactly the same, so track this on Goodrx to see if you can save some money.

Minocycline is also used for acne, and has the reverse problem of doxycycline. See how random this is? The 50 mg and 100 mg tablets of minocycline are way more expensive than the capsules.

• Now, to antidepressants. There is a 70-dollar difference here: venlafaxine ER (the generic Effexor XR) is more expensive in tablet form than capsule form at all doses. There is no reason not to take the capsule other than that the tablet will allow you to split your pill (which is not always recommended for extended release formulations anyway).

• The blood pressure medication diltiazem ER (Cardizem CD and Cardizem LA generic) comes in a capsule and tablet at all doses, and the capsule is much cheaper than the tablet. Again, there is no benefit of one over the other.

• There are rare examples where the tablet and capsule are slightly different. Tizanidine (Zanaflex) is a muscle relaxant, and the tablet form is much more expensive than capsules. The two forms of this medication ARE bioequivalent under fasting conditions (when taken on an empty stomach) but not under non-fasting conditions (when taken with food).

If you are taking a medication that is cheaper in a tablet or capsule form, ask your doctor about switching. My bet is your doctor won’t care which form of the medication you are on and would like you to save some money. Lesson learned.

Dr O.

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