Medical Matters: Research helps bitter pills go down in the most delightful way

“A miracle drug is any medicine you can get the children to take without screaming” – Anon

How are you at taking tablets and capsules? Do they glide down effortlessly with hardly a thought? Or do you have a ritual without which the drugs inevitably catch in your throat and make you gag?

I have come across a significant number of adult patients who have difficulty swallowing pills of a certain shape or size. Some simply cannot swallow solid medication, and must have a liquid equivalent.

Taste is another potential barrier: many parents will want to know what flavour a liquid antibiotic is, as they know from bitter experience the offending banana or strawberry taste will result in the dose being spat out by a young child. Older kids become adept at hiding tablets under sofas or carpets.

Apparently about a third of us have difficulty swallowing medication. In response, researchers at the University of Heidelberg decided to look at ways to help.

Promising techniques

Dr Walter Haefeli and his colleagues identified two promising techniques to help with pill swallowing and set about testing them on 150 volunteers who had experienced difficulty swallowing large capsules.

According to the results, published in the Annals of Family Medicine, 60 per cent of those tested found the following helpful:

Called the pop-bottle method, the tablet is placed on the tongue, the lips are tightly closed around the opening of a flexible plastic bottle, and the tablet is swallowed in a swift suction movement, with the head tilted back, so as to overcome the voluntary phase of swallowing. It seems to work particularly well with large, dense tablets.

The second method fared even better, with 90 per cent of volunteers giving it a vote of approval. Designed to help people swallow capsules, the lean-forward technique works like this: place the capsule on your tongue, take a sip of about 20ml of water and lean your head forward as you swallow.

The idea behind the technique is that capsules are lighter than water and so float on the water in your mouth. By tilting your head forward the capsule moves towards your throat. However, if you tilt your head backwards the capsule will float in the opposite direction, towards your teeth.

Although the German researchers were unable to say exactly why some people have difficulty swallowing medication, it does appear that smaller throats in women and children may be a factor. Tablet size and design is clearly an issue: an oval is easier to swallow than a round tablet; and, with some pills more than 2cm long, surely tablets can be made smaller.

Canadian researchers have produced an educational video, aimed primarily at children with cancer and other diseases that affect their swallow, illustrating a slightly different method of swallowing pills. It can be found at iti.ms/11qBJru

Dosing mistakes

On a related topic, research suggests using a spoon to measure out the dose of liquid medicines can lead to potentially serious dosing mistakes.

The study, published in the journal Paediatrics, found that parents who used spoons were 50 per cent more likely to give an incorrect dose to a child than those who used droppers and syringes to measure the dose in millilitres.

Nonadherence to medication is a big issue in medical treatment. Some studies suggest that difficulty swallowing tablets may be the reason for almost 10 per cent of patient noncompliance. However, cutting up tablets is not a good idea.

Some types of medicine are designed to dissolve slowly after you swallow, so that you get the correct dose over a prolonged period of time. Other medicines are coated so as to bypass the stomach and become active in the intestine, and cutting up the tablet interferes with these processes.

Have you any tricks or tips that make it easier to swallow medication? I’d love to hear readers’ suggestions at the email address below.

mhouston@irishtimes.com muirishouston.com