By Janie Rosman
Swallowing pills — medicine, vitamins or supplements—is the most commonly-reported problem for people living with dysphagia, according to Jan C. Pryor, MA CCC-SLP, BRS-S, Speech-Language Pathologist at University of Washington Medical Center.
Water is a usual companion with pills, yet there are alternative options besides the clear liquid. “It is very important to take a full glass of water with pills,” says Pryor, who is also a dysphagia consultant with the National Foundation of Swallowing Disorders.“Without sufficient water, it (pill) can get stuck in the esophagus and dissolve, causing erosion in the mucosa and pain, and more trouble swallowing.”
Maggie Kuhn, MD, Fellow, Laryngology and Bronchoesophagology, Department of Otolaryngology-Head and Neck Surgery, UC Davis School of Medicine, says “If able, we’re more confident about the complete dosage being ingested when taken with water; however, for many patients with dysphagia, this is simply not an option.”
Their different consistencies make water and pills difficult to manage together.
“One is held on the tongue, and the water needs to take with pill with it,” Pryor says. Sometimes, though, the water is swallowed while the pill can stick to the tongue.
People with established dysphagia may need to be assessed by Speech and Language Therapy (SALT) to determine the extent of their difficulty and the most appropriate formulations.
Check with the pharmacy or doctor to see if the pills can be crushed. While many tablets can be crushed or opened to release their granules, “some medications should not be crushed—anything that is time released—and you might not know this,” Pryor says.
If the pill can be crushed, then either consult a compounding pharmacy — which changes the formulation (solid to liquid) and delivery, not the key contents — or crush it yourself and mix it with liquid or a soft solid, like pudding or applesauce; helpful for those with difficulty juggling a pill and a glass of water. The soft substance also helps mask the taste of a bitter medication. “When the two (pill and soft substance) stay together and move through the throat at the same velocity — the pill in the substance like a little raft — people can have an easier time,” Pryor says. “(The) caveat here is, some medications are not to be taken with milk products, so (caregivers) need to be aware of this before putting them into ice cream, for example.”
Consider the importance of the pill that is causing difficulty. “Often, when I talk to patients, the problem is large vitamins, and so we have a discussion about the benefit of the vitamin versus the risk of choking on it,” Pryor says. “One can sometimes take two smaller mg pills of the same dosage instead of one large pill — for example, 500 mg of calcium (a large pill).” Many vitamins come in liquid and chewable forms. Alternatively, some pills with indentations can be halved half using a pill-cutter.
Pay attention to the underlying reason for difficulty in swallowing pills, dense solids, bread or other foods, or liquids — coughing, choking or sticking in the throat or chest area, “Let your physician know, and pursue a medical work up for the problem,” Pryor says. “Some of these problems can signal a condition that needs to be treated, such as strictures and webs or diverticulae (pouches) that can develop in the throat or pharynx.”
Use a non-prescription, flavored spray, available over-the-counter, to ease discomfort. Sprayed on a pill, it creates a water-based barrier between it and the tongue/throat, preventing friction and the “stuck in the throat” sensation. It also prevents taste buds from coming into contact with bad-tasting pills.
PillSwallowing.com is an educational Web site developed by North Shore-Long Island Jewish Health System — the nation’s third-largest, non-profit, secular healthcare system, and its 16th largest integrated healthcare network — that offers material for health professionals, health practitioners and consumers, including adults and parents those who have difficulty swallowing pills.
While chewable pills, liquid formulations or beaded capsules (“sprinkled” on soft-consistency foods like applesauce) minimize the need for pill-form medication, some conditions require swallowing pills.
Each person can check to make sure his or her swallowing reflex is automatic and comfortable by swallowing an average-sized mouthful of water. If none spills, and there is no coughing, gagging, or vomiting, then try the following methods.
Practice taking pills by starting with small “faux” pills like cake decorations — round candy balls in white so they look like medicine — and move to larger-sized decorations.
The caregiver can first demonstrate the technique:
- Initially, take and swallow a comfortable mouthful of only water.
- Take the smallest cake decoration and place it in the middle of the tongue. Where it is placed may need to be modified by its size, form and the degree of the person’s gag reflex.
- For those with a sensitive gag reflex, keep the chin to the chest and relax, then breathe before tipping head back when ready to swallow.
- Take a sip of water, and either keeping the head level or tipping it back, swallow the water and the “pill” together.
- Take another sip of water to keep the “pill” moving down the throat.
- Continue until anxiety/frustration at taking the small “pill” is diminished and continue to the next larger-sized “pill,” gradually increasing the “pill” size.
PillSwalling.com cautions against calling fake pills “candy” since the latter is usually chewed; not so with medicine. In addition to Pryor’s suggestions, the following may be helpful:
- Use cool, never hot, liquids since drinking the latter may dissolve the medication before it reaches the stomach.
- Take the pill with a carbonated beverage, which can help transport it quickly and help with swallowing.
- Try a two-gulp method by placing the pill on the tongue, taking a sip of liquid and swallowing it, not the pill. Take a second sip immediately and swallow the pill together with it.
- Put the pill or capsule far back on the tongue and use a straw to quickly drink the liquid.
- Chew a cookie, cracker or small piece of bread after moistening your mouth. Just before you swallow, put the pill in your mouth, and swallow both together, taking care not to tilt the head back to avoid choking.
- Take pills while standing or sitting up to help them pass quickly down the throat and into the stomach and avoid lying down for half an hour after taking pills.
- Don’t rush, eliminate distractions, and take a deep breath before taking the pill.
Caregivers will want to use trial and error with various methods and techniques to see what works best and is most comfortable for the person with difficulties.