Lack of medication adherence (that is, taking your medication as you should) is called “the other drug problem.” It’s thought that one in four people fail to take their prescribed medication, with half doing so because they struggle with compliance to their medication regime.
Some don’t take their prescriptions because of drug side-effects. Others may not understand how or whether they should be taking the drug, and still others may simply forget.
Difficulty swallowing tablets and capsules is another of the reasons. But this is one that can be solved.
Making swallowing easier is one approach. Moisten your mouth with saliva or a couple of sips of water before swallowing because a dry mouth makes swallowing very difficult. Take a sip of water, swallow the tablet, then drink some more water. The quantity of water is also important. At least four ounces or about half a cup is needed to efficiently move a tablet or capsule down the esophagus and into the stomach. How much water do you take with your medicine?
Sometimes a thicker liquid such as juice works better, and if children like a specific type of liquid, for example an orange liquid, try that. Using a straw to drink the liquid means that there is some suction, which may also help. (If you sometimes “gag” after you swallow a tablet, take a deep breath after swallowing. This may help suppress this reflex.)
Throwing back your head after swallowing is another approach, but putting your chin down to your chest may work better.
Food may also help. Chew a little bit of a soft food like bread, but before you swallow it, take the tablet or capsule. You’ll be swallowing both the food and the medication. After swallowing, following up with some more food will help move the tablet down into the stomach. You can also use foods like applesauce, peanut butter, cottage cheese, yogurt, or pudding to help take your medication. Fill a larger spoon with the food and tablet or capsule and swallow the whole spoonful.
Before you add any medication to any food, you need to check with your pharmacist if the combination is suitable. Some combinations, for example tetracycline and milk-containing foods, counteract drug effectiveness. Crushing tablets or opening capsules and mixing the drug with a food is another option, but you also want to check with your pharmacist to ensure that the crushing or opening doesn’t interfere with the drug therapy.
With children you want to be aware of flavour because adding a poor-tasting medication to their favourite juice may mean they won’t like the juice in the future. A better approach may be to use the juice as a “chaser.”
Remain upright after you take any medication, either standing or sitting straight. This posture lets gravity help move the tablet down the esophagus and also helps prevent tablets or capsules from getting stuck in your throat. And, for some medications like alendronate, remaining upright is essential in preventing esophageal ulcers.
You do want to get the most from your medication, but if you just can’t swallow it, look for alternatives. There may be a liquid, patch, or even suppository option that you can use. Another formulation may be available, meaning you need to swallow it fewer times daily. Or there may even be an alternate drug that has a smaller tablet size but is equal in therapeutic effect. Just don’t give up!
Marie Berry is a lawyer/pharmacist interested in health and education.