Can’t swallow pills? Here’s how to do it right

By “pills,” I mean medications that come as tablets or capsules. There aren’t any actual pills on the US market today but people still use that term so I will too.

Some children and adults have difficulty swallowing pills. People may feel too sick or be unable to swallow them or have an unpleasant association between pills and illness. But medicines are very important, so one can either learn (or teach children) how to swallow pills, or use creative ways to make it easier to take the medicine by cutting it, crushing it, chewing it, opening a capsule, or mixing it or dissolving it in a pleasant-tasting liquid or soft food. 

It may be easier than you think to learn how to take pills or to teach children how to take pills. If an adult or child can swallow chunky textured food like oatmeal or chunky applesauce without gagging or choking, and can swallow mouthfuls of water, he or she can usually learn to swallow pills. While a toddler is too young to learn to swallow pills, a 6- or 7-year-old child should be ready to learn—some even sooner. 

There are several methods with proven track records in teaching children and adults this skill. One method involves a simple behavioral program developed by the New York University Child Study Center that uses tiny candy jimmies to start the process and works up to swallowing Tic Tacs. Another method was developed at the University of Calgary. This method provides videos to support training sessions that focus on head positions when swallowing a pill. Both training resources have been highly successful and are available free on the Internet.  

Some over-the-counter (OTC) and prescription medicines can be cut, crushed, chewed, opened, mixed with jelly, or dissolved prior to taking them. But other specific forms of medicines must be swallowed whole and are not safe to cut, crush, chew, open, or dissolve. These medicines are designed to release an even amount of medicine over a specific period of time. Or, they may have a specially designed coating to prevent stomach irritation. Some lozenges or effervescent tablets are intended to be dissolved slowly in the mouth or in a specific amount of liquid.

Medicine that is not meant to be broken down may cause harm if it is not taken exactly as instructed on the label. Altering the medicine this way may affect how it works and how quickly it is released and absorbed. Crushing, chewing, opening, or dissolving these tablets or capsules also increases the risk of adverse reactions. Injury can range from minor to severe, depending on the type of medicine taken. Severe injuries are often related to rapid release and absorption of the medicine.

Here’s what you can do. For OTC medicines, always read the Drug Facts label to determine how the medicine should be taken. If a specific medicine should not be cut, crushed, chewed, opened, or dissolved, a special warning will be provided in the Directions section of the product’s Drug Facts label.

 

Figure 1. The directions on the Drug Facts label for this medicine specify to swallow the tablets whole—do not chew or crush the tablets.

For prescription medicines, always ask your pharmacist whether the medicine can be cut, crushed, chewed, opened, or dissolved. Also, look for these descriptions of tablets or pills on the label that may suggest the medicine cannot be cut, crushed, chewed, opened, or dissolved.

  • Extended Release
  • Time Release
  • Time Delayed
  • Slow Release
  • Sustained Release
  • Controlled Dose
  • Long Acting
  • Sustained Action
  • Safety Coated
  • Enteric Coated
  • Comfort Coated
  • 8, 12, or 24 hours of relief
  • Lozenges (dissolve slowly in the mouth)
  • Effervescent tablets (dissolve in a specific amount of fluid before ingestion)

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