Rumor vs Truth: Color Coded: Dyes in Medications

Rumor vs Truth: Color Coded: Dyes in Medications

In this episode, hosts Don Weinberger and Steve Small separate fact from fiction about dyes in medications and food.

Why is the FDA banning certain artificial dyes, and what does it mean for your meds and favorite foods?

Can the color of your pills really affect how you feel about them?

Why do we talk so much about rats and sewers in this episode?

Folks are dye-ing to know the truth…let’s find out!

They’ll share research and insights into some interesting claims including:

  • White tablets or clear solutions don’t have dyes.
  • Certain dyes can cause adverse effects.
  • Recent FDA mandates to remove artificial dyes only affect food products.
  • Pill color can impact patients’ expectations about a medication’s effects.

TRC Healthcare Editor Hosts:

  • Stephen Small, PharmD, BCPS, BCPPS, BCCCP, CNSC
  • Don Weinberger, PharmD, PMSP

Guest:

  • Gina Corely, PharmD (TRC Healthcare Editor)

The clinical resources mentioned during the podcast are part of a subscription to Pharmacist’s Letter, Pharmacy Technician’s Letter, and Prescriber Insights:

Don’t miss out! Subscribe to Pharmacist’s Letter today to stay ahead with trusted insights and tools. If you’re a student, good news—students can access a free version of Pharmacist’s Letter.

Rumor vs Truth is a production of TRC Healthcare.

Send us a text

If you’re not yet a subscriber, find out more about our product offerings at trchealthcare.com.

Follow, rate, and review this show in your favorite podcast app. Find the show on YouTube by searching for ‘TRC Healthcare’ or clicking here.

You can also reach out to provide feedback or make suggestions by emailing us at [email protected].

Click here to listen to all podcast episodes.

 

Listen Now:

Transcript:

Narrator: 

Welcome to Rumor vs. Truth, your trusted source for facts, where we dissect the evidence behind risky rumors and reveal clinical truths. Today, we’re looking at claims about dyes and meds to find out their true colors.

Narrator: 

THIS TRANSCRIPT IS AUTOMATICALLY GENERATED.

Don Weinberger: 

Hey, Steve, how you doing? Are you feeling blue?

Stephen Small: 

I am, if you can see my tongue. Yeah, definitely can. I’ve been having some hard candies. Yeah, exactly. I’ve had some Blue Lake No. 1 candies here. They’re delicious. And I’m honestly tickled pink by this topic. I’m Steve the pharmacist.

Don Weinberger: 

And I’m Don the pharmacist. And you’ll hear buzz about adverse reactions to artificial dyes since FDA announced its ban of the red dye No. 3 due to showing cancer in rats. In this episode, we’re giving claims about dyes and meds, the red carpet treatments, and no promises, but we will try to keep the off-color puns to a minimum. Again, no promises.

Stephen Small: 

No promises at all. And, you know, it’s not just red dyes, Don. It’s also affecting other dyes that the FDA is removing, like FD&C red number 40, yellow number 5, yellow number 6, and blue number 1. And actually, I found out those are all in the candies I’m eating right now. So that’s concerning. But these are all going to be removed from the food supply by the end of next year. But it’s important to think that this wasn’t out of the blue, necessarily. Questions have been building about dyes for a long time. And it seems like people are dying to know about the colors in their meds.

Don Weinberger: 

Well, we warned you already about the puns we’re going to be doing. So.

Stephen Small: 

So buckle up. And ironically, though, let’s start with meds that don’t have color. The claim here is that white tablets or clear solutions and suspensions don’t have dyes. But it’s important to think here, just because a medication is white doesn’t mean it doesn’t have dyes, right? In fact, some white tablets I can think of contain yellow dye to sort of brighten them up. Some examples are cetirizine, 10 milligram TADs, or even oxycodone with acetaminophen. So I’m thinking about that.

Don Weinberger: 

Right, so then I’m thinking, Steve, looking at product labels and that kind of thing, what about those dye-free things that are white or clear even?

Stephen Small: 

Yeah, we use those a lot for kids in my practice being in pediatrics. I’m glad you brought that up because dye-free suspensions like ibuprofen, for example, don’t have dyes, but they are indeed white. So sometimes they don’t get to use a dye. Maybe they’re using things like titanium dioxide or zinc oxide pigments to get that white color for a lot of meds. So based on this claim that white tablets or clear solutions don’t have dyes, the verdict is… Rumor. It’s important to not rely on product colors alone, as we saw. And you can look at the inactive ingredients or the package insert, or you can even call the manufacturer to really see what dyes these meds contain. That’s really going to be your best source of truth.

Don Weinberger: 

I love that last point, Steve. Now that colorless meds are out of the way, let’s get into dyes and let’s go and start with some of the news, you know, our next claim. So the claim is actually recent FDA mandates to remove artificial dyes only affects food products. Interesting. So, you know, thinking about the recent FDA announcement in April of 2025, it’s managed to remove the six petrochemical based dyes that you mentioned earlier from food and replacing those with natural dye alternatives.

Unknown: 

Interesting.

Don Weinberger: 

But that announcement actually didn’t say anything about medications. So did some digging. The announcement actually back in January of 2025 had some different mentions in it. So they’re removing the red dye number three from foods and medications.

Stephen Small: 

Okay, so it’s both for that one. But when I hear that, now I’m worried. So does that mean they need to submit a lengthy new drug approval from scratch to do this for each med just to change one dye?

Don Weinberger: 

Well, Steve, were we not? Changing or removing dyes in a med generally only requires submission to FDA in the annual report. It does not require a formal drug application beforehand.

Stephen Small: 

Okay, so it’s kind of like an FYI. That’s good to know. So I’m guessing then they may substitute those dyes with natural coloring, but are there risks with those natural dyes?

Don Weinberger: 

See, that’s the thing. Natural, as we all know, does not necessarily mean harmless, right? So to stress that. Also need to consider things like contaminants and unintended consequences of that as well.

Stephen Small: 

Yeah, good point.

Don Weinberger: 

All right, let’s dive back into that claim, which is recent FDA mandates to remove artificial dyes only affect food products. And the verdict is… True with conditions. You know, there’s not as much red tape as I thought for removing dyes.

Stephen Small: 

Right. And it’s also important here to think about flavorings and dyes in those. As a pharmacist, we get asked to add flavorings to medications all the time for pediatrics, and there are dyes in those too. So check that labeling closely.

Don Weinberger: 

Right, right. Very good point, Steve. Okay. You know, honestly, so what’s all the fuss? What are the problem with dyes? Really, to answer that, I recently spoke to our dye expert, Gina, who’s a pharmacist and editor at Pharmacist Letter with TRC Healthcare, to provide some of that color commentary on one of those claims. Let’s go and take a look. Well, hey, Gina. How are you? I

Gina Corley: 

am good. What about you?

Don Weinberger: 

I am good. And I’m much better now that you dress the parts. So you have nice colors going on.

Gina Corley: 

Thank you. Thank you. Hopefully they will be less controversial than some of the red dyes that we talk about in this

Don Weinberger: 

show. We’ll see, right? You never know. Okay. So I thought you are the perfect person to strike the right tone with some of these claims. So let’s get to it. You

Gina Corley: 

ready? Thank you. Yes.

Don Weinberger: 

All right, so I have one for you and it is some dyes have adverse effects.

Gina Corley: 

What do

Don Weinberger: 

you think?

Gina Corley: 

Yes. So red dye number three has actually been banned by the FDA because it is shown to cause cancer in rats. And right now, companies currently have until 2027 to remove red dye number three in foods and until 2028 for meds. So don’t be shocked if you still find this dye listed in some ingredient labels for foods and meds in the next couple of years.

Don Weinberger: 

And

Gina Corley: 

then another red dye, which is red dye 40 may contain benzidine, which is a known cancer causing substance. And you may have heard about red dye 40 because it is the one that people often talk about that can cause increased hyperactivity in kids.

Don Weinberger: 

Yeah. Okay. So it seems like you love to pick on red dye. So I’m going to go ahead and ask you, uh, Have you kind of seen any other colors that may have adverse effects?

Gina Corley: 

Yeah. So technically, it’s possible for patients to have adverse rate reactions to any type of dye, whether it’s more of an allergic reaction or more of a severe reaction, such as trouble breathing. I have read reports of yellow dyes causing hives. But Really, if patients ask, why are dyes even in my food and in my meds? What we can tell them is they’re in there solely to make things pretty. They’re in there to brighten up our food, brighten up our meds. They have no nutritional or therapeutic value at all. So really, taking them out is not a bad thing. It just is going to make your food less visually appealing. Food and meds. Correct. Correct. Yes.

Don Weinberger: 

Yeah. So I’m glad you brought that last point up because, you know, as of now I’m hearing patients in the pharmacy asking, okay, why, you know, dyes are the conversation of the day. Right. And asking, okay, why are these dyes in there? They provide no value. So I’m glad we, you got to that point. So thank you.

Gina Corley: 

Of

Don Weinberger: 

course. Thank you very much for joining us and solving that claim for us. And let’s go and kick it back to Steve for his thoughts.

Gina Corley: 

All right.

Stephen Small: 

You know, she had a lot of really good points there. Something I really liked that she mentioned, it really comes down to benefits versus risks, right? We know that it causes cancer in rats, maybe not confirmed in humans, but if they’re just in there to make drugs and meds and food pretty, what’s the point there? Those risks probably outweigh those benefits. So really good points there.

Don Weinberger: 

Yeah, the benefits really seem almost nil, right? When you can kind of put it into perspective. Correct. So, all right. So let’s go ahead and get back to the claim. So it is, Certain dyes can cause adverse effects. The verdict is… It is true. So some dyes have been shown to cause cancer in rats, and those have been potentially linked to other symptoms such as low reactions and hyperactivity.

Stephen Small: 

And you know, Don, I’m trying to think of what meds have that red dye number three in them. And ones that can kind of come to mind are like certain doxycycline capsules, omeprazole capsules, and even some amoxicillin suspensions for kids that I’ve dispensed has that in there probably. Since we know a lot of the sort of fruity flavored ones have red dye in there to help with the look, so to speak. Even though it comes as a white powder. Definitely turns pink once you mix it. So now that Gina mentioned that dyes are only there to make things pretty and that’s true and there’s no nutritional or therapeutic value, right? Is there more to that? And this leads us to our next claim that pill color or med color can impact patients’ expectations about a medication’s effects. And this is pretty interesting because now it kind of gets into the psychology behind all this. We’ve actually looked at medication colors in studies since the 1950s. And what’s relatively consistent across multiple studies is that blue and white colored meds rank the highest for people thinking that they have a sedative or anti- I can tell you the blue hard candies I’m eating don’t have that effect, but some people it has that sort of placebo effect. Also, white colored pills are most associated with pain relief for some folks. Whereas, and this is interesting, yellow and red colored pills usually rank highest for things like hallucinatory effects. So people tripping out on red colored pills. Although we know, for example, certain ibuprofen comes as red colored pills and people are definitely not hallucinating on that. And what’s interesting here is there can be a lot of cultural factors at play. For example, I found one study that compared responses to these medication colors in the United States versus Kosovo. And there were different responses, right? However, USA respondents had similar answers to what the United Arab Emirates subjects had. So it kind of depends across international boundaries for some. And studies have shown that participants usually report these associations are based on sort of an emotional response or a symbol, or maybe they’re thinking about past medications that had this effect and their brain kind of makes those connections psychologically. Yeah. And being a pediatric pharmacist, we also have to think about the differences in age. They found that children actually prefer red-colored meds, and they actually rate white-colored meds lower in terms of favorability. So who knows? I wonder what that kind of tells. I’m sure that plays into marketing for some meds, right? So with that, with this claim that pill color can impact patients’ expectations about a medication’s effects, the verdict is… True. Right? We’ve seen just now that visual appearance of meds is important, how we perceive them. And I think our psychology plays a pretty big role. And I have to ask you, Don, this is kind of a gross question, but what if I dispensed you a brown suspension to drink? What would you think if you had a med that that was that color?

Don Weinberger: 

Honestly, what comes to my head first is you pulled it out of a sewer. Yeah. When I think appetizing liquids, brown does not come to mind.

Stephen Small: 

And you know what? I bet drug manufacturers definitely take that into account. Yeah. And you know, it kind of makes you think too of like the methylene blue challenge. You’ve heard of this, right? It’s kind of going around.

Don Weinberger: 

Yeah. Go ahead and kind of explain that one.

Stephen Small: 

Yeah. I’ll fill you in. So my understanding is that people are buying methylene blue on the internet. It’s a really brilliant blue dye. It, does have some pharmacologic properties, but people are taking it for things like anti-aging and cell oxidation reversers and things like that that don’t really have a whole lot of evidence. But like we were saying before, blue is known to kind of be associated with stimulatory effects or relaxation. Maybe people do feel that way, even though that Chemical isn’t really doing anything in the body. It could all be psychological. So they’re just drinking this, the methylene blue? That’s what they’re doing? I suppose so, yeah. Whereas I’m just eating blue. That’s crazy. Number one. Yeah. That’s crazy. Says the guy drinking

Don Weinberger: 

blue. That’s so crazy. Yeah.

Stephen Small: 

I’m sorry. Well, with that, I think we can say that dyes may not be completely harmless after all, but it is important to keep things in perspective since our patients will probably ask for dye-free items with undue alarm, right?

Don Weinberger: 

Yep, I agree. And it looks like our claim today, truth mostly wins with flying colors. But it’s not 100% black and white when it comes to dyes.

Stephen Small: 

I like that, Don. And it’s a good practice to really view these extra ingredients as excipients. I really don’t like the term inactive ingredients because as we saw, they can have pharmacologic effects. And after all, the modern pharmaceutical industry, as a historical tidbit, was born from dye companies when you think about it.

Don Weinberger: 

Oh, yeah. Like Bayer and Sandoz. Exactly. Very true. So when it comes to dyes, each product for the same med can be different, and it may not be obvious. So know where to spot dye content on labeling and look for dye-free alternatives if needed. Make note of the patient’s allergy or intolerance in their profile. But keep in mind that some allergy warning software may not know an exact product dye’s content to fire off that alert.

Stephen Small: 

Yeah, technology, you got to be careful with. And another kind of last resort option I can think of is be ready to compound a medication if needed to avoid dyes completely. But you have to balance your risks, right? Because then that’s making an unapproved med. So weigh those options there carefully.

Don Weinberger: 

Right. That’s a good point, Steve. So Steve, you know what? We actually got a message from our podcast that send us a text link from audience member. You know, we get excited about those when they come. Yes. And they kind of, and they had this question and it was kind of a big question because you have expired meds. They just throw them away. Can they be of use to anybody, right? If they’re slightly expired or whatever it may be. Good point. The answer actually, unfortunately is no, officially. Although as of 2024, 45, U.S. states have laws allowing drug donation for depository programs and 20 and a half the active programs. But, you know, there’s that rigid requirements, including expiration dates, you know, being in dates or slightly expired. So it’s important. People do want to help. They want to donate their medications. You know, there’s like expired kind of get the knowledge of the state programs and run with that.

Stephen Small: 

Yeah, that’s a great point. And in Iowa, where I’m currently broadcasting from, we have one of the largest donation programs in the US. And for us, I believe the drugs need to typically be donated at least six months or more before their expiration date, because we don’t want to have to deal with those expiration dates happening. So that’s a great point. And if you’d like to have your question about this episode answered next month, send us a message, please. We’d love to answer your questions about dyes. Uh, it’s a very hot topic.

Don Weinberger: 

Yes. Uh, second that. And also a couple more things here. If you liked what you heard on this episode, be sure to follow rate and review rumor versus truth. wherever you get your podcasts. And of course, check us out on trcealthcare.com. You can also help grow our show by telling a friend about the awesome things you learned about and where you found us. And

Stephen Small: 

definitely take a look at the show notes or description for this episode. We’ve linked directly to some of the great resources you mentioned today, like the article in our May 2025 issue, a pharmacist’s letter, pharmacy technician’s letter, prescriber insights, and our hospital issues too. And we also have a link to our handy algorithm for investigating drug allergies and sensitivities, which you can use for dyes.

Don Weinberger: 

And if you aren’t already a subscriber, don’t miss out on these resources. Sign up today to stay ahead of With trusted insights and tools, we are an industry-leading, non-biased source of information and continuing education.

Stephen Small: 

And also, we need your help compiling more rumors and truths to analyze, so please send us your ideas at trchealthcare.com forward slash contact dash us, or use the contact us link at the bottom of your TRC Healthcare homepage, or send us a text, that button, right from the podcast show notes.

Don Weinberger: 

And we know you’ve got great ideas for us to demystify. Do not miss our next episode. We will celebrate our 40th anniversary of Pharmacist’s Letter with a throwback to claims we investigated decades ago and see if they still hold up in the 2020s. Yeah,

Stephen Small: 

I’m looking forward to looking at that ancient history. So thanks for joining us on Rumor vs. Truth, your trusted source for facts, where we dissect the evidence behind risky rumors and reveal clinical truths. See you next time.

Narrator: 

Want to put faces to these voices? Catch the video version on YouTube – just search ‘TRC Healthcare’ or click the link in our show notes. While you’re there, check out our other TRC podcasts like Medication Talk and Clinical Capsules.

Rumor vs Truth

Rumor vs Truth Podcast: Full Episode History

Rumor vs Truth: Full Episode History