Help! I can't swallow pills!

Dear Can't Swallow,

Sometimes, it takes more than just a spoonful of sugar to help the medicine go down. You can rest assured you're not alone in this predicament. Many young adults and some not-so-young adults share your problem. It's understandably a strange sensation to swallow a solid substance without chewing; it can seem against natural reflexes (not to mention, against table manners). Nonetheless, when it comes to medication, pills are regarded as convenient and a standard form of many types of medicine. There are different approaches to address the difficulty you’re experiencing, ranging from choosing a non-pill form of medication (when possible) to trying different techniques to make swallowing easier. While it's possible there is a physical reason for your difficulty swallowing, the challenge of mentally relaxing enough to allow the throat to swallow without chewing may also be the culprit.

Depending on the drug, your health care provider may be able to prescribe a form other than a capsule or tablet. Alternatives to pills can include creams, inhalants, injections, patches, chewable pellets, liquid drops or sprays, tablets that dissolve in water, suppositories (inserted in the anus or vagina), and buccal tablets (which dissolve in the mouth). Among pills made for swallowing, there are different sizes, shapes, and coatings that may make some easier to send down the hatch than others. Some, but not all, pills can be crushed (then mixed into food or liquid) to make swallowing the meds easier. However, there are many pills that aren't effective or safe when altered in that manner. Be sure to check with a health care provider first to see if that strategy is appropriate for the specific medication in question.

If there isn’t a suitable alternative to a pill form available, there are two techniques research has found to be helpful when swallowing pills. The first is the pop-bottle method, which is helpful for larger pills. Place the tablet on your tongue, and then using a flexible plastic water bottle, close your mouth around the bottle opening. Start drinking from the bottle, tilting your head back and keeping contact between your lips and the bottle, ensuring no air gets into the bottle. The pill should then glide down your throat with the water. The other method is the lean-forward technique, which is useful for smaller pills. Placing the pill on your tongue, take a medium sip of water, but don’t swallow. Begin to tilt your head forward by bringing your head down towards your chest (not bringing your entire chest forward) and swallowing simultaneously. This motion will help the pill move down your throat more easily.  

If these techniques don’t work for you, incorporating some of these other strategies may be helpful:

• As you mentioned, you could practice swallowing small foods like candies as this can help some people get used to the feeling of swallowing a pill.
• You also mentioned embedding a tablet in food and consume both together. A variation on this strategy is to chew some food, then pop the pill in your mouth before swallowing. However, some medications are affected by certain foods, so seek medical advice before trying this one.
• Try putting the tablet in your mouth and then either drink any beverage straight from the bottle or through a straw, letting the suction help the swallowing process. Sometimes taking a sip before putting the capsule in your mouth can help lubricate the process.

While it may seem as if you have a strong gag reflex or odd throat mannerisms, consider that it may actually be the power of your mind, not the mechanics of your throat that prevents you getting the medicine down. Fear of choking, fear of medicine, a negative past experience, or general anxiety may be preventing you from swallowing pills. While it’s a bit more unlikely, the possibility of a greater medical issue does exist. The medical term for experiencing difficulty with swallowing is dysphagia, and the term is often used with regard to a disorder of the esophagus. Regardless, it’s worth talking with your health care provider about your difficulty swallowing pills and the reasons why this might be happening. The saying that something is “a hard pill to swallow” is used for a reason, but hopefully one of the techniques above will help make it a little less difficult!