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Some narcotic pills are made the way they are to deter abuse. For instance, some opioid painkillers have a coating around them that makes it painful to crush and snort.

From what I remember, it is a way for telling them apart since there's so many different types of pills, different manufacturers, off-brand vs on brand medications, etc. If you look at a pill bottle (at least my pill bottles have them) there's a descriptor box that describes the size, shape, and color of the meds inside so it's harder to mix them up with other things. Not to mention the amount of dosage for each medication differs, the engineered coatings for different types of meds change things too, the surface area required for the most effective release rate; each type of pill is as unique as possible for their own reasons

It’s a bit of both and other things.

You’re supposed to be able to identify a pill from its appearance. This can be done by a combination of colour, shape, size and symbols imprinted on it or something printed on the side of a capsule. At an individual person level it means that if you’re taking more than one type of pill at a time and pop them into your hand, you can see that you have the number and type you expect. At a bigger level, random pills could potentially be identified from a database

You’ve then got other things like the active drug. 1g of paracetamol is a standard dose for an adult, so you can’t go smaller than the volume of that amount. But you then have to add in any preservatives, binders etc needed

Generally you want tasteless, but it’s not always possible, even with pills. There might be a constituent of that has a horrible flavour so a nicer flavour is put in to mask it (eg in liquid drugs for kids). Other times there will be something that tastes horrendous and there’s no chance of covering it (eg 5mg soluble prednisolone tablets taste horrendous even if swallowed whole and seems it can’t be covered). Then you have a coating that might be needed. Some pills will need to release their contents after they’ve left the stomach and are in the intestines, so need a different coating than a simple water soluble one, and it might have a butter or sweet taste.

Colour is another thing. There’s a fair amount of research about the placebo effect of the colour of the pill. Such as yellow or red pills seeming to have a stimulant effect and blue pills are sedatives. This is with placebos. So if you are making a pill, it makes a bit of sense to match its colour to this research. But many manufacturers don’t do this, so it’s not taken into consideration often

Hi, this is area-adjacent to my doctorate, and will try to simplify as best I can

The actual imprint, shape, and color are specifically used to distinguish manufactured products, and have no bearing on how the drug works.

Now, as to size and coatings, thats a little more complex.

Multiple drug delivery schema exist, such as long acting / intermediate acting / short acting, delayed release, sustained release, abuse-deterrent, and so on. This is in addition to films or coatings designed either to protect you or protect the drug as it travels from your mouth to the stomach to the rest of the digestive tract.

Some drugs will become inactivated due to strong stomach acids, and thus are either coated or buffered to survive past that step.

Some drugs are specifically formulated to become active either in the acidic stomach or relatively basic small intestine, so the reverse to the above situation is also possible.

Other drugs do not become active until they are absorbed by the body and chemically acted upon by the liver.

Some drugs are so poorly absorbed from the digestive tract that they require such large doses just to achieve their desired effect, and you can recover upwards of the majority 70-80% in your poop, nevermind the specific anti abuse or long acting delivery vehicle showing up just like kernels of corn in the toilet bowl.

Size is a mixed bag, as the actual manufacturing process takes these drugs, often in powder form, extremely precisely and with likewise extreme accuracy adds it to fillers, anti caking agents, dry lubricants, and so on in order to create said tablet via industrial machinery. This applies to the vast majority of tablets and capsules.

Some of the long acting or sustained release formulations specifically dissolve slowly (or not at all!) and there is very complex math involved to make sure those forms release the drug in the right amount over the right amount of time

Mostly it's to make pills easier to identify. You don't want to mix up your anti-allergy medicine with your antibiotics after all. There's actually entire dictionaries of pill designs so that doctors and pharmacists can identify pills at a glance.

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