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
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
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
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
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
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
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.
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
- 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
- Put the pill or capsule far back on the
tongue and use a straw to quickly drink the
- 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
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