Question: I always have difficulty swallowing pills, my body just won’t do it no matter how big or small the pill is. What can I do?
Answer: Trouble swallowing pills is not uncommon. We might think there is something physically wrong, while others do it so easily. Most likely, trouble swallowing pills has a lot to do with your mind, not your body.
The Globus Sensation
Globus sensation is a tightness in your throat not related to an external physical condition but from a feeling of fear or dread. You may experience tightening of the throat when you are in the act or thinking about swallowing a pill. The key to overcoming this sensation is to learn not to focus on the act of swallowing. It is definitely easier said than done, but there are many strategies to take your mind elsewhere other than thinking about how you’re going to have to swallow this pill.
Strategies for Hard to Swallow Pills
- Hide the pill in applesauce
Since difficulty swallowing pills is often mental, tricking yourself into thinking you are only ingesting something else can help. Hiding a pill in applesauce is a common method recommended by a lot of medical practitioners.
- Try the “pop bottle method”
This is a popular method which involves putting the pill in the back of your tongue, closing your lips tightly around the opening of a plastic water bottle, and sucking down the water while tilting your head back and keeping your lips around the bottle. This method works better with tablets than capsules. Tablets tend to be heavier and bigger; the pop bottle method helps them sink toward the back of the throat to make them easier to swallow.
- Putting water in your mouth first.
If your issue is that you do not want to feel the pill on your tongue at all, some people find that filling their mouths with water first then tilt your head up and dropping the pill in their mouth and swallowing is the way to go. This is the method I personally always use, and it works for me!
- Pill lubricant gel
Yes! There are flavored pill lubricant products you can use to help swallow your pills more easily. These lubricants can improve the taste of your medication. They also limit the discomfort some people feel as it slides down the esophagus and into the stomach. Per the package label, it is safe for use for children 2 and older. Recommendations on use is a max of 3 times for children ages 2 to 6, and no limit restrictions for people older than 6.
You can purchase pill lubricant gel here
- Pill swallowing cups
Special pill-swallowing cups are available for purchase as well. These cups have a special top that extends towards the back of your throat. The pill is stored on top inside the mouthpiece, and as you are drinking out of the cup, it should help you with focusing on the drinking action and not on swallowing the pill. This method is not recommended for people with dysphagia, as there are higher risks of choking.
You can purchase a pill swallowing cup here
- Using a straw
This method involves you taking a glass of liquid and then dropping the pill inside the cup. You would then try using a straw to suck up the liquid as well as the pill. This reflex movement of sucking a straw should distract you while you try to drink up the liquid and get the medication down.
Here is a link for a straw specifically for pill swallowing, it has a special opening in the bottom which lets you drop the pill to the bottom of the straw without it falling out, however any straw large enough will do:
Capsules vs Tablets
Capsules tend to be more difficult to swallow than tablets. This is because capsules float on the top of the surface of liquids since capsules are relatively light. Because capsules cannot sink in water, it may be more difficult to swallow. If capsules are more difficult for you to swallow, ask your doctor or pharmacist to see if your medication comes in tablet form. If you prefer neither, you can ask if your medication comes in other forms suitable for you:
- Liquid suspension
- Oral-disintegrating tablet
- Sprinkle capsules
These are just some other formulations available that do not require swallowing. In special scenarios you might be able to have a compounding pharmacy make your medication into any of the other forms.
Implications of drug modifications
Always ask a healthcare provider before you try to take a medication differently, as some medications are made a certain way so that the drug can be delivered and distributed the way it was intended to.
One example would be enteric-coated tablets. Crushing enteric-coated medicines that are acid labile will damage the coating and expose the drug to the acidic stomach environment. This may have a two-fold effect of irritating the stomach lining and causing discomfort, or inactivating the drug if it is extremely susceptible to acid degradation.
Another example is if controlled-release opioids are crushed, there is a risk of dose dumping and overdose. Controlled-release, slow-release and extended-release products are specifically designed to deliver the drug over a prolonged period of time. If a controlled-release formulation is crushed, the duration of drug activity is reduced and the entire quantity of the drug may be immediately released resulting in toxicity.
Not all of these strategies are for everyone. They are just alternative and crafty ways for swallowing pills that some people have said worked for them. If you have tried the strategies mentioned and still have difficulty swallowing your medication, now would be the time to talk to your doctor to see if there are other solutions. At any point you may be assessed by a speech pathologist to see if you may have a health condition related to difficulty swallowing such as dry mouth or dysphagia, which could make swallowing pills difficult for you. Another solution would be to see if your medication comes in another formulation suitable for you. As a general rule, you should not quit taking your medication if you have difficulty swallowing. Make sure you are seeking medical attention by a healthcare provider so that they can find the right solution for you.
Prepared by Tyler Nguyen PharmD Candidate 2021