The Pill Burden

Recommendations for Medications with Dysphagia

Swallowing problems are associated with increased age, cancer treatment, and conditions such as Alzheimer’s disease, Parkinson’s disease, or stroke. The law requires that medicines should be given to the right person, at the right time, in the correct form, using the correct dose, via the correct route. The size, shape, and texture of pills can contribute to swallowing difficulties. Hard and soft gelatin capsules, oval pills, and oblong-shaped tablets are more likely than round pills or irregularly shaped tablets to cause swallowing difficulties.  Crushing and mixing pills with juice, applesauce, or thickeners to ease swallowing are common. Understand the differences and the options available.

Pill Gels and Mouth Sprays

Pill swallowing gels are registered medical devices suitable for use in healthcare settings as well as by patients at home. Mouth sprays and pill coatings are best suited for at-home use. As integral members of the patient care team, speech-language pathologists should educate care providers on the implications of pill crushing and mixing and alternative methods of easing swallowing for patients.

  • Phazix® (PSG)—the first purpose-designed medication lubricant—provides a safe, simple, well-accepted alternative. Easy and effective—just add a teaspoon of gel over a pill or tablet to ease swallowing. Pleasant vanilla flavor masks medication taste, smell. ll-natural ingredients with half the sugar of Mott’s applesauce
  • MEDCOAT® covers pills and capsules with a coating camouflaging the bad taste. It's sugar, soy, and gluten free. The special coating applicator is easy to use and can work on any size shaped pill or capsule.
  • Pill Glide is a flavored lubricating spray that makes it easier for everyone in the family to swallow their tablets and capsules. It is sugar free, dye free and safe for everyone to use. Just a few sprays in the mouth before taking a tablet or capsule and the pill goes down without the discomfort.

Crush Meds

Crushing medications can destroys the release characteristics of controlled-release medications.

Avoid pill crushing as a general practice without consulting the prescriber and the pharmacist before altering dose forms. If you can crush a pill, use a recommended method like a pill crusher or a mortar and pestle to grind the pill to a fine powder. Always ask your doctor or pharmacist before you crush or take apart medication. “This method can dump too much of the drug into your system at once, or change the way the drug works.  Ask your healthcare provider or pharmacist how you should take the powdered drug, including which foods or beverages they can be safely mixed with

Embedding Pills

Many people who have trouble swallowing pills like to embed them in applesauce or pudding. While mixing medications with applesauce, juice or thickeners may not pose a direct health risk such substances may well alter the dissolution rate and drug effect (i.e., bioavailability) of medications. 

Water or juice or other

  • Coffee, juice and soda make pills dissolve faster than they are supposed to. Therefore, the body does not have time to absorb as well and therefore will not work as well. 
  • Fruit juice may have a significant effect on drug levels, either by magnifying drug levels (grapefruit juice) or reducing them (apple or orange juice). Never mix pills with grapejuice – prevent enzymes in lever and intestines from breaking down meds
  • Dairy – makes meds less effective
  • Alcohol – makes meds less effective and could cause toxicity

In general, it typically takes approximately 30 minutes for most medications to dissolve.

Pills should be swallowed with 4–8 ounces of water, and you should remain upright for at least 10 minutes after taking medications. People with underlying esophageal disease, such as diverticulosis or dysmotility disorders, should consider the use of liquid medication formulations or crushed pills instead of standard tablets and capsules., Taking pills with warmer water is more effective with helping them dissolve, than ice cold water.

Do not thicken your liquid medications with cornstarch-based or xanthan gum-based thickeners. Although thickened liquids provide an adequate profile for safe swallowing, administration with drugs may impact bioavailability.

1 pill at a time

It is safer to swallow 1 pill at a time than multiple at a time, to slow clearing through the throat or the esophagus

The more meds you take at one time, increase the risk of harmful interaction

Pill esophagitis 

Pill esophagitis occurs when capsules or tablets get stuck in the esophagus (food pipe) and cause ulcers, inflammation, and other damage to the esophageal tissue. Common symptoms include pain or difficulty swallowing. People can also experience chest pain, back pain, and discomfort or difficulty swallowing solids or liquids. Gastrointestinal bleeding, manifested as bloody stools or vomit, can indicate a more serious condition, such as a pill penetrating through a blood vessel. Older people and people who use antihistamine medications (including Benadryl®) can have decreased saliva production or a dry mouth which can slow the passage of pills through the esophagus and increase the risk of pill esophagitis. 

Globus sensation – “It feels stuck” 

Possible Causes:

  • Osteophytes – boney outgrowth in cervical spine
  • Vallecular retention
  • Pyriform retention
  • Zenker’s Diverticulum
  • Reflux
  • Esophagitis

How can I assess my ability to take pills or see if it is traveling down my esophagus ok?

 Request a Modified Barium Swallow Study.