Dear Alice,

I'm a young adult who can't swallow pills — so far I've always been able to find a chewable form of anything I've had to take, but this is a life skill that I think I should have. I've tried all sorts of methods — putting a pill in Jello/ice cream, filling my mouth with water and then trying to take a pill, even trying to swallow small candies as practice — but I just seem to gag. I think it's because my throat doesn't want to relax enough to let something solid slide down it — do you have any suggestions for how I could improve this situation?


Can't Swallow

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 extremely convenient and very much the norm — about two-thirds of all medicines are in pill form. 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 is possible there’s a physical reason for your difficulty swallowing, the challenge of mentally relaxing enough to allow the throat to swallow without chewing may be a more likely culprit.

Depending on the drug, your health care provider may be able to prescribe a different form other than a capsule or tablet. Alternatives to pills can include creams, inhalants, patches, chewable pellets, 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 are not 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 some tricks you can try that might make swallowing easier:

  • As you mentioned, you could practice swallowing small foods like candies as this can help some individuals 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 check with your health care provider 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.
  • It may help to play around with body positioning before swallowing, whether it’s resting your chin on your chest, tilting your head forward (especially with a lighter capsule) or tilting your head back (with a heavier capsule) after filling your mouth with both the tablet and some water.

While it may seem as if you have an extraordinarily strong gag reflex or odd throat mannerisms, consider that it may actually be the power of your mind, not the power of your throat that is not allowing you to get 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!


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