Two Tablets At The Same Time Or One Twice Daily?

In our latest question and answer, the pharmacist discusses what it means if your prescription says to take two tablets by mouth daily.

Question

I take multiple daily medications and was wondering if I was taking them right. I take them as directed on the bottle (it says to take two tablets daily) but my doctor but did not say if I should wait between pills or take them all at once. If I take 2 daily, I do one in the morning and one after supper. Any thoughts?

Asked by Fred45 On Sep 02, 2021

Answered by
Medical Content Reviewed By HelloPharmacist Staff

On Sep 02, 2021

Key points

  • Prescription directions can be confusing and ambiguous. If you are ever unsure of how to take your medicine as prescribed, be sure to talk to your doctor or pharmacist.
  • The directions 'take two tablets by mouth daily' is intended to mean to take two tablets at the same time, once daily. It is more accurately written as 'take two tablets by mouth once daily'.
  • The directions 'take one tablet by mouth twice a day' mean to take one tablet at two different times of the day (usually separated by a time interval of 12 hours).

This is an excellent question! Thanks so much for reaching out.

What Does Take Two Tablets Daily Mean?

There are often times subtle differences in meaning depending upon how a prescription’s directions were written. Consider the following examples:

  • Example One: Take 2 tablets by mouth daily
  • Example Two: Take 1 tablet by mouth twice daily
  • Example Three: Take 2 tablets by mouth daily as directed

Let's look at each and I'll describe what the intention is.

For example 'one' - Take 2 tablets daily:  Usually, this means taking 2 tablets at the same time once a daily.  There are certainly times that the prescriber (doctor) may have verbally told the patient to take one tablet in the morning and one tablet at night, but that is not how the prescription was written to be interpreted.

For example 'two'Take 1 tablet twice daily: The intentions of the prescription are very clear.  The patient should take one tablet twice daily. There is really no room for interpretation here, except for how long to wait between each dose. For most drugs, each dose should be evenly separated, so by 12 hours.

For example 'three'Take 2 tablets daily as directed: it is implied by the as directed that the patient was given additional instructions on how to take the drug. While usually 2 tablets daily would mean taking both tablets at the same time, as directed in the directions can mean the prescriber (doctor) instructed the patient a different way.  

Confused? Check With Your Doctor Or Pharmacist

If after reading this you are confused, I would call your doctor’s office to clarify the directions. If it turns out you have been taking the prescription a different way than the doctor intended, make sure to tell the office this.

You don’t want to suddenly change your medication routine without getting input from your doctor.

In some cases, taking a drug twice a day won’t make a difference if the doctor really wanted once-a-day dosing. In other cases, the interval between dosing can make a big difference in how effective a drug is potential.

For example, if you accidentally take an antibiotic as two tablets one time daily, as opposed to twice daily, there is a good chance it will not work as well as blood levels of the antibiotic may drop too low with such an extended dosing interval.

Always ask your pharmacist, doctor or other health care provider anytime you have questions about how a drug should be taken. 

Additional Information

As a general rule of thumb, when pharmacies (or your doctor) writes out directions for you for a prescription, they use the following format:

  • Directions: [Verb] + [Quantity] + [Dosage Form] + [Route Of Administration] + [Frequency]

In the above example of "Take two tablets by mouth every day", this translates to:

  • Take [Verb]
  • Two [Quantity]
  • Tablets [Dosage Form]
  • By Mouth [Route Of Administration]
  • Every day [Frequency]

The part that often throws individuals off is the quantity and frequency. To prevent medication errors, "take two tablets by mouth daily" is better written as "take two tablets by mouth once daily" as this is what is intended (unless your doctor tells you differently).

References

  • The pattern of abbreviation use in prescriptions: a way forward in eliminating error-prone abbreviations and standardisation of prescriptions, PubMed
  • List of Error-Prone Abbreviations, ISMP

About the Pharmacist

Dr. Brian Staiger, PharmD

Dr. Brian has been practicing pharmacy for over 11 years and has wide-ranging experiences in many different areas of the profession. From retail, clinical and administrative responsibilities, he's your knowledgeable and go-to source for all your pharmacy and medication related questions!

Recent Questions