Intended for healthcare professionals

Practice Sustainable Practice

Why learning how to swallow pills is good for patients, parents, and the planet

BMJ 2024; 384 doi: (Published 09 January 2024) Cite this as: BMJ 2024;384:e076257

Linked Editorial

Sustainable practice: what can I do?

  1. Emma Lim, consultant paediatrician1 2,
  2. Emily Parker, sustainability fellow, junior doctor1 4,
  3. Nicola Vasey, lead paediatric pharmacist3
  1. 1General Paediatrics, Great North Children’s Hospital, Newcastle upon Tyne
  2. 2Population Health Science Institute, Newcastle University, Newcastle upon Tyne
  3. 3Pharmacy, Great North Children’s Hospital, Newcastle upon Tyne
  4. 4Centre for Sustainable Healthcare, Oxford
  1. Correspondence to E Lim emma.lim2{at}

What you need to know

  • Pills are likely to have a reduced environmental impact compared with an equivalent dose of liquid medication, with less packaging and less wasted medicine

  • Pill swallowing is an important life skill that can improve dosing accuracy and adherence

  • Young patients often prefer pills to liquids. Pills contain fewer additives, need fewer doses, and have a longer shelf life

  • Children can successfully learn to swallow pills from the age of 4

Healthcare professionals and patients often assume that liquids are the most suitable oral medicinal formulation for children and young people. However, swapping liquids to pills can be safer, more cost effective, more acceptable to patients and carers, and is likely to reduce the carbon footprint of prescribing.

Why change is needed

Medicines and chemicals account for 25% of the NHS England carbon footprint.1 Few environmental impact studies compare liquid and tablet medicines, although available evidence suggests that pills have a lesser carbon footprint than equivalent liquid medications. A life cycle assessment based in India found that the carbon footprint of paracetamol pill production is 15 times less than an equivalent dose of liquid.2 Pills typically come in smaller, lighter packets than liquids, take up less space in distribution lorries, and create less packaging waste. Liquids also require dosing syringes or spoons, contributing to increased plastic waste.

Importantly, pills have a longer shelf life and can be stored out of the fridge so have lower energy requirements during their use, and are less likely to be discarded as a result of inadequate storage conditions. Pill packets can be divided up to dispense a specific number of doses, whereas liquid formulations must be dispensed in whole bottles, meaning excess doses from short term prescriptions (such as antibiotics) …

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