Medicines – swallowing difficulty

Difficulty in swallowing can affect how you take your medicines and may even cause you not to take your medicines, which can be harmful. If you or the person you are taking care of has problems swallowing medicines, talk to your doctor or pharmacist – there are ways they can help you.

On this page you will find information on:

• What makes medicines difficult to swallow?
• Medicines can cause swallowing difficulties
• Tips for swallowing tablets and capsules
• Finding an alternative form
• Crushing tablets or opening capsules
• Trying different head positions

What makes medicines difficult to swallow?

Medicines may be difficult to swallow for many reasons, including the following:

• Tablets and capsules may be large.
• Having a dry mouth.
• Having a developmental or learning disability.
• Some liquid medicines have an unpleasant taste and children may not like taking them. Read more about tips on how to give medicines to babies and children.   
• A child may not be able to swallow tablets or capsules. There is no set age at which children are able to swallow solid medicines; some can find it difficult until they reach their early teens. 
• Older adults who have weakened muscles around their food pipe (oesophagus) because of ageing may find it difficult.
• Conditions that may affect your throat and throat muscles, such as stroke, dementia, multiple sclerosis, muscular dystrophy, Parkinson's disease or cancer.  

Medicines can cause swallowing difficulties

Some medicines can cause severe discomfort and inflammation of your food pipe (oesophagus). This usually happens if you take tablets or capsules without drinking enough water to help the medicine pass from your mouth into your stomach or lying down while taking your medicine (not sitting upright). 

This can cause pain and discomfort and make swallowing difficult. Medicines that are commonly known to have this effect include doxycycline, clindamycin, alendronate, aspirin and other NSAIDs (ibuprofen, naproxen, diclofenac), potassium chloride, and ferrous sulfate.

Prevention 

Discomfort can be minimised, or even avoided, by taking every dose with a large glass of water, and remaining sitting upright or standing for at least 30 minutes (and up to 2 hours) afterwards. For medicines that can be taken with or after food, take your dose with meals or a snack.  

Tips for swallowing tablets and capsules

• Moisten your mouth with saliva or water beforehand (a dry mouth makes swallowing harder).
• Place the tablet or capsule in the centre of your tongue, and lengthways along your tongue if the tablet is oval-shaped.
• Immediately take a sip of water and wash the tablet directly into your throat.
• Try using a straw to drink the water (the suction may help).
• Taking a deep breath may help suppress your gag reflex.
• Try chewing some food before placing the tablet in your mouth, and swallow the food and tablet together, or you could put the tablet into a small piece of bread or a marshmallow. 
• You may find it helpful to take tablets with foods that are soft and thick, such as a spoon of yoghurt or a smoothie.
• After swallowing the pill, have a drink of water to help it go down.

Finding an alternative form

If you or the person you care for finds it difficult to swallow tablets or capsules, talk to your doctor or pharmacist about alternative forms of the medicine. They may also be available in one of the following forms:

• a liquid 
• a tablet that disintegrates in water
• a tablet that dissolves when held between your cheek and gum
• a patch 
• a suppository – inserted into your bottom 
• an inhaled version.

Crushing tablets or opening capsules

Ask your pharmacist if your tablets can be crushed, or your capsules opened and dispersed in water, before taking them. Only certain tablets or capsules can be given this way. 

Some tablets and capsules must be swallowed whole, as they are designed to be released over a longer period of time such as 12 to 24 hours. Generally, when crushing a tablet or opening a capsule, the dose is released over 5 to 30 minutes, resulting in an initial overdose (and a higher chance of side effects).

Before crushing your tablets or opening your capsules, always check with your pharmacist if this is suitable. As a guide, the following preparations should never be crushed:

• CR or CRT (controlled release, or controlled release tablet) such as Betaloc CR
• CD (controlled delivery) capsules such as Cardizem CD
• ER (extended release) tablets such as Plendil ER
• LA (long-acting) tablets 
• SR (sustained release) tablets such as Apo-Diclo SR
• SA (sustained action) tablets
• XL (extended release) tablets such as Adefin XL.

Trying different head positions

The following video describes how using different head positions can be helpful to swallow pills. These techniques will require some practice. When practising with lollies, you can start with something small like hundreds and thousands or Tic Tacs and build up to bigger lollies like M&M's.

(Hardy Nutritionals, 2017)

Learn more

Problems swallowing pills NHS, UK
Dysphagia Patient Info, UK

References

1. Oesophagitis with doxycycline and others Medsafe Prescriber Update, 30 October 2003
2. Optimising administration in patients with swallowing difficulties PSA, January 2017, Australia
3. Medication management for patients with trouble swallowing Rosemont, US