Pill Bottles and Child-Resistant Caps: How They Work and How to Open Them

A pill bottle, also called a prescription vial or pill vial, is the plastic container a pharmacy fills with your medicine and labels with your name, the drug and the directions. In the US, most prescription pill bottles come with a child-resistant cap because federal law requires child-resistant packaging for most prescription medicines taken by mouth, unless the prescriber or the patient asks for an easy-open cap instead.

This guide covers how pill bottles and child-proof caps work, how to open each type, how to get easy-open caps, how to read the label and what to do with empty bottles, with a cap comparison table and a pharmacy checklist. It is general information, not medical advice: follow your prescription label and ask your pharmacist about anything specific to your medicines.

What a prescription pill bottle is

A prescription pill bottle has three working parts:

• The vial: a round plastic container, often amber or orange, in a size the pharmacy chooses to fit the number of pills dispensed.
• The label: your name, the medicine, the directions and the pharmacy's details, often with colored warning stickers on the side.
• The cap: in most cases a child-resistant cap, which needs two motions at once to open.

Pill bottle sizes and dimensions are often described by volume in drams. The pharmacy picks the size to fit the pills and the quantity. If a bottle is too full to close properly or too small to handle easily, ask the pharmacist for a different size.

Some people swap the pharmacy cap for a pill bottle timer cap, which shows how long it has been since the bottle was last opened. If you use one, check whether it is child-resistant and keep the bottle up and away from children.

Child-resistant packaging: what the law requires

The Poison Prevention Packaging Act (PPPA), enacted in 1970 and enforced by the US Consumer Product Safety Commission (CPSC), requires a number of household substances to be sold in child-resistant packaging. Under the CPSC's rules, that includes prescription drugs taken by mouth, with specific listed exemptions, such as sublingual nitroglycerin. The CPSC says this packaging must be significantly difficult for children under five to open within a reasonable time, and not difficult for normal adults to use properly.

The federal test standard shows what "child-resistant" means in practice:

• Children: panels of children aged 42 to 51 months, tested in pairs, get 5 minutes to try to open the package, see a demonstration, then get 5 more minutes. At least 85% must fail to open it before the demonstration, and at least 80% must still fail by the end of the full 10 minutes.
• Older adults: a panel of adults aged 50 to 70 must be able to open and, if it is reclosable, properly close the package within 5 minutes, then do it again within 1 minute. At least 90% must succeed.

Notice the numbers. A cap can pass while some children in the test still open it. Child-resistant is not childproof, which is why Up and Away, a PROTECT initiative initially created in partnership with the CDC, tells families to keep medicines up high and out of sight even when they're in child-resistant containers.

Types of child-resistant caps, compared

Designs vary by maker, but most pharmacy caps work in one of these ways:

How to open a child-proof cap

These steps are for the most common type, the push-and-turn cap on a prescription bottle:

1. Stand the bottle on a table or counter so you can use your body weight instead of grip strength.
2. Hold the bottle steady with one hand and lay the palm of your other hand flat on top of the cap.
3. Push straight down firmly and keep pushing.
4. While still pushing, turn the cap counterclockwise (to the left) until it comes loose.
5. To close, screw the cap back on clockwise until it stops or you hear it click. Up and Away advises twisting a locking cap until you can't twist it anymore or you hear the "click."

Why a child-proof cap keeps clicking or won't come off

If the cap spins and clicks but doesn't loosen, it usually means you are turning without pushing down hard enough to engage the cap. Push down harder before you start turning, and keep the pressure on. If the cap is stuck, check that the label or a sticker isn't caught under the rim, and try a rubber jar grip for more traction. With one hand, set the bottle on a non-slip mat or wedge it against something steady, press down with your palm and turn. If that's still hard, ask the pharmacist about easy-open or reversible caps instead of forcing a child-resistant one. If a cap is cracked or still won't open, take the bottle back to your pharmacy and ask them to put your medicine in a new container. Don't leave a bottle open or loosely closed as a workaround if children could reach it.

Easy-open pill bottle caps for seniors, arthritis and weak hands

If child-resistant caps are hard for you, you can ask for something different. Under federal law, a prescription medicine may be dispensed in packaging that isn't child-resistant when the prescriber directs it or when the purchaser requests it, and the CPSC confirms that the patient can make that request. The National Institute on Aging also advises checking that you can open the container and, if you can't, asking the pharmacist to put your medicines in bottles that are easier to open.

How to ask:

• Tell the pharmacist you'd like easy-open (non-child-resistant) caps on your prescriptions. Some pharmacies call this a child-resistant cap waiver and ask you to sign one.
• Ask whether the pharmacy can keep that preference on file for future refills.
• Ask about other options too, such as a reversible cap or larger bottles that are easier to grip.

If grandchildren or other young children live with you or visit, think this through first. Easy-open bottles need to be stored up, away and out of sight, including medicines in a purse or bag. Over-the-counter medicines work a little differently: a maker may sell one size in non-child-resistant packaging if it also sells child-resistant sizes, and that package must carry a statement such as "This Package for Households Without Young Children."

How to read a prescription bottle label

Label layouts vary by pharmacy, but most show the same information. The National Institute on Aging suggests checking:

• Your name: check it before you leave the pharmacy. If the name or directions aren't right, tell the pharmacist before you leave the counter.
• The medicine's name and the directions: make sure you can read and understand both.
• The colored warning stickers on the side of the bottle.
• The prescription number, usually printed in the upper left corner. You'll need it for refills.

Labels often use short abbreviations. NIA explains a few common ones: Rx means prescription, prn means "as needed," qd means every day, bid means twice a day, tid means three times a day and qid means four times a day. Ask your pharmacist about any abbreviation that isn't clear. If the label is hard to read, ask the pharmacist to print it in larger type. For the habits that go with reading the label, see our guide to how to take medicine correctly.

Keep pills in the original pill bottle

The original bottle keeps the label, the directions and the child-resistant cap together. Up and Away advises keeping medicines in their original child-resistant containers at home and away, and notes that many pill organizers are not child-resistant and can be easily opened by young children. If you use a weekly pill box, store it up and away too. When you fill it, work from the original bottles so you can check each label.

When you fly, NIA advises carrying your medicines with you, not in checked luggage, along with a list of everything you take.

What to do with empty pill bottles

Before you throw away an empty prescription bottle, the FDA advises scratching out all your personal information on the label to protect your identity and privacy. Recycling rules for pill bottles vary by town, so check with your local recycling program before putting them in the bin. If there are leftover pills, don't put them in the trash in the bottle. The FDA says a drug take-back location or a prepaid mail-back envelope is the best way to get rid of most unused medicines. If none is available, check the FDA flush list: if the medicine is on it, flush it; if it isn't, take it out of the bottle, mix it with something unappealing such as used coffee grounds, dirt or cat litter, seal it in a bag or container and put it in the household trash.

Pill bottle checklist for the pharmacy counter

Caregivers can fold these checks into a weekly routine; our caregiver's guide to medication management covers the full system, from the medication list to refills.

How Dose+ approaches the pill bottle

Dose Storage, part of the Dose+ system we're building, is a pill bottle with 30 cells, one capsule in each, that gives out one pill at a time instead of letting pills pour out, with a child-resistant design. It's about the size of a phone and needs no batteries: you slide the top across and a single pill drops out.

The second part, the Dose Home Station, holds up to ten Dose Storages and dispenses the right one on schedule. A camera in the lid reads every Storage, the screen logs each dose, and its one warning is a duplicate-dose alert if someone tries to take the same medicine again soon after taking it. Dose+ is in development and not for sale, so there is no price or pre-order. Everything above applies to standard pharmacy bottles. You can read what Dose+ is and where it stands, learn more about Dose Technologies, or compare automatic pill dispensers in our guide to how automatic pill dispensers work and how to choose one.

Safety tips for pill bottles at home

• Close the cap fully after every use, until it clicks or won't turn further.
• Keep every bottle up, away and out of sight of young children, including bottles in bags, coats and pill organizers.
• Read the label every time and follow its directions, as NIA advises.
• If you think a child got into a medicine, call Poison Help right away at 1-800-222-1222, even if you're not sure.