Swallowing Difficulties

If you find that you can’t swallow tablets or capsules, discuss this with your doctor or pharmacist.
^[1] Alternative formats are increasingly available, which may be appropriate and more acceptable to those who struggle to take their medication.^[2] Most commonly prescribed medicines are available in a liquid format, which can make swallowing easier.^[2]

Why can’t I swallow tablets?

There can be many reasons to why some people have difficulty swallowing tablets or capsules (solid medication). As we naturally chew food before swallowing, tablets and capsules require a conscious over-ride to the normal chew & swallow reflex.^[3] Some of us have a phobia of swallowing medication, others have a dry mouth and some people have illnesses or are taking medications which can affect swallowing.^[4] In the case of children, some are not able to or can be resistant to swallowing tablets or capsules. Having difficulties swallowing solid medication is common for many people.^[2]

What is dysphagia?

Dysphagia is the medical term for ‘difficulty swallowing’ or swallowing problems.^[5] Dysphagia is not a disease, but a symptom caused by structural or neurological dysfunction.^[6] The main function of swallowing is to prevent food, drink or medicines from entering the airway, instead ensuring that it reaches the stomach as intended.^[6] Difficulties swallowing can happen at any stage, from the time a food, drink or medicine enters the mouth until it reaches the stomach.^[6]

What are the symptoms of dysphagia?

One of the main symptoms of dysphagia is choking and/or coughing when trying to swallow.^[5] Other symptoms include shortness of breath or a change in breathing pattern and regurgitation.^[5],^[6]

If any of the following apply to you or someone you are caring for, let your doctor, nurse or pharmacist know, so that an alternative formulation can be prescribed:

• Finding it hard to swallow tablets or capsules
• Not taking medicine because of fear of swallowing it
• Crushing tablets or opening capsules to make them easier to swallow
• Breaking tablets into smaller pieces to enable swallowing
• Mixing medicine with food or drink to make it easier to take
• Sucking or chewing medicine before swallowing

Early signs of a swallowing difficulty include:^[2]

• Problems chewing
• Difficulty moving food through the mouth
• Food sticking in the throat or slow movement downwards
• Food or drink coming back up
• Coughing or spluttering during or after eating
• Excessive salvia

One of the main concerns of dysphagia is aspiration, which can occur if something goes down the ‘wrong way’ and enters the lungs. It often also causes choking and coughing. Longer term dysphagia may lead to dehydration and malnutrition.^[2]

What causes dysphagia?

Dysphagia has many possible causes and happens most frequently in older adults.^[7],^[8] Causes range from having a dry mouth (where there isn’t enough saliva to help with swallowing) to several neurological conditions like Parkinson’s disease, Multiple Sclerosis and Motor Neurone disease. Sometimes, a stroke may cause people to have difficulty swallowing. Certain medications can contribute to swallowing difficulties as a side effect of the treatment.^[7],^[8],^[9] Because there are many reasons to why dysphagia can occur, treatment depends on the underlying cause.^[5],^[9]

Conditions that cause dysphagia

Many people find tablets or capsules hard to swallow, but some are more likely to find it difficult. The swallowing of tablets or capsules is a challenge to a person with dysphagia and affects the safe administration of medication.^[6]

Risk factors for dysphagia include:^[8],^[2]

• Ageing - Older adults are more at risk. This can be due to a reduction in the production of saliva and weakening of the muscles involved in swallowing. Also, certain diseases associated with old age can cause dysphagia, such as Parkinson’s disease. ^[8]
• Neurological conditions - Central nervous system disorders make dysphagia more likely. ^[8] Damage to the nervous system can interfere with the nerves responsible for the process of swallowing.^[9]
• Older people – a study showed around 60% of people over 60 have struggled to take solid medicines like tablets or capsules at some time.^[10]
• Dry mouth – getting older can mean less saliva in the mouth which makes swallowing tablets more difficult. Some medicines can also cause mouth dryness.^[6]
• Stroke – after having a stroke, many people have swallowing difficulties for at least the first few weeks. In the early stages of stroke, 50% of patients will have some sort of swallowing problem, the majority of these will recover in the first 7 days.^[11]
• Other diseases – such as Parkinson’s, Alzheimer’s and Motor Neurone disease can all affect a person’s ability to swallow solid medicines^[9].
• Throat or oesophagus problems - Conditions that cause an obstruction in the throat or a narrowing of the oesophagus (the tube that carries food from your mouth to the stomach) can make swallowing difficult.^[9]

As dysphagia often happens at the same time as other health conditions, it is difficult to be certain of the prevalence rate.^[12]

How to make children’s medicines easier to swallow

Children may not like taking medicine and there are concerns about the age young children can safely swallow tablets and capsules. A child’s ability to swallow solid medication is highly dependent on the individual and the training and support that they receive from healthcare professionals and caregivers. Liquid formulations are the most appropriate format for younger children who are unable to swallow tablets and capsules.^[13] An oral syringe is recommended for accurate measurement and safe administration of a liquid medicines.^[14]

If your child is prescribed a tablet or capsule which they are having problems swallowing, crushing is not recommended in order to make it easier for them to take. Ask your pharmacist, doctor or nurse for a suitable alternative such as a liquid medicine instead.^[15]

ROS000051-006 DOP October 2023