Trouble swallowing pills: two techniques that help, liquid and chewable vitamins for adults, and whether you can crush tablets

Pill trouble or dysphagia: which is it?

Most people who struggle with pills swallow food and drink without a problem. The trouble is the tablet itself: large, rough, oval, or a capsule that floats. Worry about choking can make it harder still. This is common and usually fixable with technique or a different form.

Dysphagia is different. It’s a swallowing problem that affects food and drink as well, and it usually has a cause: a stroke, dementia or another neurological condition, acid reflux, or some medicines.

The NHS advises an urgent GP appointment, or NHS 111, if you or someone you care for has:

• swallowing difficulties with food or drink;
• frequent chest infections;
• shortness of breath after eating or drinking.

Your GP may refer you to a speech and language therapist, who tests the swallow and suggests safe food textures and drinks.

Two techniques that make swallowing pills easier

In 2014, German researchers tested two simple methods on 151 adults, with and without swallowing difficulties. Each technique matched one type of pill.

The pop-bottle method, for tablets. It made swallowing easier in 59.7% of attempts with large tablets.

1. Fill a soft plastic water bottle.
2. Put the tablet on your tongue.
3. Close your lips tightly around the bottle’s opening.
4. Drink with a quick sucking motion, keeping your lips sealed, and swallow straight away.

The lean-forward method, for capsules. It helped in 88.6% of attempts. Capsules are light and float, so tipping your head back pushes them away from your throat.

1. Put the capsule on your tongue.
2. Take a medium sip of water, without swallowing yet.
3. Tilt your head forward, chin towards your chest.
4. Swallow with your head bent forward.

The authors note that tilting the head back while swallowing may raise the risk of liquid or food going down the wrong way. If you have dysphagia, check with your GP or speech and language therapist before trying either method.

Liquid, chewable and other easier forms

When technique isn’t enough, change the form. The Specialist Pharmacy Service (SPS) lists the same options for medicines: smaller tablets, dispersible or effervescent tablets, chewables, orodispersible tablets that melt in the mouth, and liquids. Each has a catch.

Sodium in fizzy tablets. Many effervescent tablets get their fizz from sodium salts. A 2013 BMJ study of 1.29 million UK patients found that sodium-containing effervescent, dispersible and soluble medicines went with 16% higher odds of heart attack, stroke or vascular death. The odds of high blood pressure were about 7 times higher. If you have high blood pressure, heart failure or kidney disease, check the Sodium line on the label first.

Pick your situation:

Most adult chewables are multivitamins. Read the label for sugar and for the mineral amounts, then compare with your usual tablet. Our guide to multivitamins explains what to look for, and our page on vitamin D3 covers drops.

Can you crush tablets or open capsules?

Sometimes, but never by default. SPS, which advises NHS pharmacists, lists the types that are usually unsuitable:

• modified-release tablets and capsules, marked MR, SR, XL or LA: crushing can release the whole dose at once;
• enteric-coated (EC) or gastro-resistant (GR) tablets: the coating protects the contents from stomach acid, and once broken the product may not work;
• soft capsules with liquid or paste inside;
• some medicines that are hazardous to whoever crushes them.

On supplement labels, look for the same idea in other words: “time release”, “sustained release”, “delayed release” or “enteric coated”, common on vitamin C, B complexes and fish oil.

Crushing a medicine outside its licence is “off-label”, so the pharmacist checks the product information first. Splitting is safer with tablets designed for it, such as those with a score line, but still ask. Before you crush, split or open anything, run through this list:

SPS also suggests a step people often skip: review whether every medicine is still needed and whether doses can be fewer. Fewer tablets is the easiest fix of all. Take a full list to your GP or pharmacist; our medicines list for your GP helps.

Who should be careful

• People with dysphagia after a stroke or with dementia or another neurological condition: forms and drink thickness are set by the speech and language therapist.
• People on a salt-restricted diet: avoid effervescent tablets.
• People with diabetes: count the sugar in gummies, chewables and syrups.
• Kidney disease: liquids and powders still contain magnesium, potassium and vitamins; see our page on supplements with kidney disease.
• Children in the house: gummies look like sweets; store them out of reach.

How to choose easy-to-swallow vitamins on iHerb

1. Try a technique first; you may not need a new product.
2. Choose the form by dose: drops for small doses, powders for large ones.
3. Check sugar per serving for gummies and chewables.
4. Check sodium for effervescent tablets.
5. Avoid “time release” products if you need to split or crush.
6. Compare the dose per serving with what you took before.

More pages for this age group are in our 50+ section, and an unsure parent can start with our vitamin check.