How to Overcome Swallowing Difficulties to Keep Taking Medicine

If you or someone you care for has trouble swallowing pills, you’re not alone. About 1 in 7 older adults living at home struggle with this, and in nursing homes, it’s nearly 7 out of 10. Yet, skipping or crushing pills because they’re hard to swallow can be dangerous - and it’s happening far too often. A 2023 study found that nearly half of all medication changes made to help people swallow - like crushing tablets or opening capsules - were unsafe. Some led to overdose risks. Others made the medicine less effective. The good news? There are real, safe ways to keep taking your meds without risking your health.

Don’t Crush or Open Pills Without Checking First

Crushing a pill or opening a capsule might seem like the easiest fix, but it’s often the riskiest. Many medications are designed to release slowly over time. Crush them, and you get a full dose all at once - which can cause dizziness, low blood pressure, or even overdose. Extended-release opioids, blood thinners, and some antidepressants are especially dangerous when altered. Coated pills, like enteric-coated aspirin, are made to bypass the stomach. Crush them, and they can irritate your stomach lining or break down too early.

Even if a pill looks easy to crush, don’t assume it’s safe. A 2020 UK study found that doctors and nurses often didn’t check whether a medication could be altered before modifying it. Pharmacists are the best people to ask. Bring your list of meds to your pharmacist and ask: "Can this be crushed, opened, or mixed with food?" If they say no, ask for an alternative.

Ask for Easier-to-Swallow Forms

Not all pills are created equal. Some are smaller, smoother, or shaped to glide down more easily. Torpedo-shaped capsules and coated tablets are often easier than large, round tablets. Ask your doctor or pharmacist if your medicine comes in a different form:

• Liquids - Often the safest option. No swallowing required.
• Orodispersible tablets - These dissolve on your tongue in seconds. No water needed.
• Effervescent tablets - Dissolve in water to make a drinkable solution.
• Topical patches or gels - For pain, hormones, or nicotine, these bypass the mouth entirely.
• Rectal suppositories - Used for nausea, fever, or certain heart meds when oral intake isn’t possible.

But here’s the catch: only 37% of essential medications have these alternatives available. That’s why you need to ask early. If your current medicine doesn’t have a safe alternative, your doctor may be able to switch you to a similar drug that does. For example, instead of a large extended-release tablet, you might switch to a liquid version of the same active ingredient.

Use the Lean Forward Method for Capsules

If you’re stuck with a capsule you can’t swallow, try the lean forward method. It’s simple, proven, and works for most people. Here’s how:

1. Place the capsule on your tongue.
2. Take a medium sip of water - not too little, not too much.
3. Before swallowing, bend your head forward slightly, like you’re looking at your toes.
4. Swallow while keeping your head tilted forward.

This trick works because tilting your head forward opens up the throat passage and helps the capsule float down naturally. A clinical study from the University of Michigan found that people who used this method saw up to a 75% improvement in their ability to swallow capsules - even those who had struggled for years.

Try it with water first. Once you get the hang of it, you can use it with thicker liquids like applesauce or pudding if your doctor approves.

Use Thickened Liquids - But Only If You’re at Risk of Aspiration

If you cough, choke, or feel like food or liquid goes down the wrong way, you might be at risk for aspiration - when stuff enters your lungs. That’s serious. For these cases, speech therapists recommend thickened liquids. They don’t spill as easily and give your throat more time to react.

But here’s the twist: if you’re at risk of choking - not aspiration - thinner liquids are actually better. Thick liquids can stick in your mouth and make swallowing harder. So don’t guess. Ask a speech-language pathologist to assess your swallowing. They’ll tell you whether you need thin, nectar-thick, or honey-thick liquids.

Many pharmacies sell thickening powders that you can add to water, juice, or even medicine mixtures. Always follow the label instructions. Too thick, and you’ll gag. Too thin, and you risk aspiration.

Work With Your Care Team - It Takes a Village

Managing swallowing problems isn’t just about you. It needs a team: your doctor, pharmacist, nurse, and a speech therapist. Yet, too often, no one talks to each other. Your doctor prescribes a pill. Your nurse gives it to you crushed. Your pharmacist never gets asked. That’s how errors happen.

Here’s what you can do:

• Ask your doctor: "Do I really need every pill?" Some meds can be stopped safely.
• Request a speech therapy evaluation. They’re trained to test swallowing and recommend safe techniques.
• Keep a list of all your meds - including doses and times - and bring it to every appointment.
• Ask your pharmacist: "Is there a better form of this medicine?" They know what’s available.

Pharmacists are now being trained to flag patients with dysphagia in electronic health records. If your doctor knows you have trouble swallowing, they should be alerted before prescribing a hard-to-swallow pill. But until that system is universal, you have to be your own advocate.

Try New Technologies - Like Dissolvable Films

There’s exciting progress in medicine design. Companies are now making thin, dissolvable films that stick to your cheek or under your tongue. They don’t need water. You don’t swallow them. They just dissolve in seconds. One brand, called VersaFilm, has shown 85% adherence rates in patients with moderate swallowing problems.

These aren’t available for every drug yet - but they’re growing fast. Ask your pharmacist if any of your medicines are available as a dissolvable film. If not, ask if they’re working on it. Patient demand is driving change. The global market for dysphagia-friendly meds is expected to hit $2.9 billion by 2029, and that’s because people are speaking up.

What to Do If You’re Giving Medicine to a Child

Parents often struggle with kids who refuse pills. Here’s what works:

• Have your child take a few sips of milk before the medicine - it makes the mouth slippery.
• Place the pill on the tongue, then have them fill their mouth with water, puff out their cheeks, and swallow.
• Use a syringe to give liquid meds slowly, aiming toward the inside of the cheek, not the back of the throat.
• Never mix medicine into a full bottle of milk or juice. If they don’t drink it all, they won’t get the full dose.

For toddlers, some pediatricians recommend using a pacifier dipped in medicine - it tricks the mouth into accepting it without gagging.

When You Must Use Food - Do It Right

If your pharmacist says it’s safe to mix medicine with food, use applesauce, yogurt, or pudding. Avoid grapefruit juice - it can interfere with dozens of medications. Don’t use hot foods - heat can break down some drugs.

Always give the full dose in one bite. Don’t save half for later. And always follow it with a sip of water to make sure everything goes down.

And never use a feeding tube without guidance. If you’re using one, flush with at least 10ml of water between each medication. Some drugs stick to the tube or react with each other. Always give them one at a time.

Keep Track and Speak Up

Swallowing problems don’t always show up on tests. Sometimes, people just stop taking their meds because they’re embarrassed or frustrated. That’s the biggest danger.

Write down:

• When you have trouble swallowing
• Which pills are hardest
• What methods helped (or didn’t)

Bring this to your next appointment. Your doctor can’t fix what they don’t know. And remember - you’re not being difficult. You’re being smart. Asking for help with swallowing isn’t weakness. It’s how you stay healthy.