Difficulty swallowing medicines

Yes, 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

You can minimise, or even avoid, this discomfort 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.  

• 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.

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.

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.

Leaning forward

Some people find it helpful to lean forward slightly when they swallow their tablet or capsule.

• Put the tablet or capsule on your tongue.
• Take a medium sip of water, but do not swallow yet.
• Bend your head forward by tilting your chin slightly toward your chest.
• Swallow the tablet or capsule and the water with your head bent forward.

Other 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)