I find it hard to swallow tablets: what can I ask my pharmacist?

What alternatives you can ask for at the pharmacy, which tablets must not be split or crushed and which simple techniques make swallowing easier.

If you find tablets hard to swallow, the first step is to talk to your pharmacist: they can check whether your medicines come in an easier form, whether any can be split and what you must never alter. With that review and a couple of simple techniques, most people find a solution.

It is not a minor problem or anything to be embarrassed about: if every dose is unpleasant, it is easier to skip it. Looking for an alternative is part of looking after your treatment.

Is it normal to find tablets hard to swallow?

It is quite common, including in young and healthy people. In a University of Heidelberg study of 151 adults from the general population, more than half said they had difficulty swallowing tablets or capsules.

It is worth telling two situations apart:

• Only tablets are a problem, especially large ones, or swallowing them makes you anxious: the alternatives and techniques in this article may help.
• You also find food or drink hard to swallow, you choke or cough when eating: this may be dysphagia, a problem your doctor should assess. In that case, do not try swallowing tricks, because you could choke.

What can you ask your pharmacist for?

Ask for a review of all your medication with one specific question: "which of these tablets have an easier form and which can be split?". Your pharmacist knows the available presentations and can tell you what to raise with your doctor.

1. Forms that do not require swallowing a whole tablet: according to the Spanish Society of Hospital Pharmacy guide, the most suitable are orodispersible, sublingual and freeze-dried tablets, dispersible capsules, and chewable or effervescent tablets. Oral solutions or sachets may be other options.
2. Whether it can be split: tablets with a score line can usually be divided, but not all. We explain this in how to cut tablets.
3. Change of medicine or route: if there is no other form, your doctor may consider an equivalent medicine with a better presentation.
4. Check whether you still need them all: NHS pharmacy services recommend first checking whether each medicine is still needed.
5. Swallowing aids: there are small cups and devices designed to make taking tablets easier; ask whether they suit you.

If you also find packs hard to open, read solutions for opening blister packs.

Which tablets must not be split or crushed?

You cannot tell just by looking, which is why you should not alter any tablet without asking. Splitting or crushing a tablet that does not allow it can stop it working or release the whole dose at once.

Do not mix your medication with food or thickeners without asking either, because it can change how it is absorbed.

Which techniques can help you swallow more easily?

Small changes in posture and in how you drink can make a difference. These recommendations come from the Spanish Society of Hospital Pharmacy guide, the Welsh NHS 111 Wales service and a study published in Annals of Family Medicine:

• Take a sip of water before the tablet and a glass of water afterwards.
• Take your medication sitting or standing, and stay upright for 5 to 10 minutes afterwards (30 minutes with bisphosphonates for osteoporosis).
• Tilt your head slightly forward when you swallow and avoid tipping it back or throwing the tablet to the back of your throat.
• For capsules, the "lean forward" technique (swallowing with your head bent slightly forward) improved swallowing in most cases in the study.
• For tablets, the same study found the bottle technique helped: tablet on the tongue, lips sealed tightly around a flexible plastic bottle and swallow with a quick sucking movement. The authors warn that, if you have dysphagia, you should only try such techniques after talking to a doctor or speech therapist.

A practical example: Carlos and his large tablets

Let us take the case of Carlos, 48, an IT worker who has just started treatment for blood pressure and cholesterol. One of his tablets is large and makes him gag, so he has started splitting it with a knife and on some days he skips it.

1. He takes his boxes to the pharmacy and asks which ones can be split.
2. The pharmacist explains that one is prolonged-release and must not be split, and suggests asking his doctor whether another presentation exists.
3. Meanwhile, he tries drinking water first, tilting his head forward and using the bottle technique with the tablets that are ordinary ones.
4. His doctor switches him to a smaller presentation and Carlos stops skipping doses.

If you would like to share this information with an older relative, there is a specific guide on older people with swallowing difficulties.

How can IMA Health help you?

With IMA Health, a specialised pharmacy prepares your medication by the day and time of each dose and can advise you on which presentations are easier to take or what to raise with your doctor. IMA also coordinates with the pharmacy, delivers your medication to your home and provides personalised follow-up of your treatment.

Sources

• Spanish Society of Hospital Pharmacy and La Paz University Hospital: Guide to giving medicines to people with swallowing problems (2021, in Spanish)
• NHS 111 Wales: Problems swallowing pills
• Specialist Pharmacy Service (NHS): Swallowing difficulties
• Schiele J. T. et al. Two techniques to make swallowing pills easier (Annals of Family Medicine, 2014)

This article is for information only and does not replace advice from your doctor or pharmacist.