By Pharm. Ayodeji Oni
The oral form of drug administration is the most common, as it is safe, cheap and easy to administer. Over the counter, pharmacists experience many medicine related issues, among which is patients’ difficultly to swallow pills.
In a recent study in the U.S, out of 1000 people, 50 per cent were said to find it difficult to swallow pills. Different methods have been used by individuals and caregivers to ease these difficulties. These include: breaking tablets into smaller pieces, grinding tablets into powder form and dissolving into water, or even opening the contents of capsules and dissolving into water to avoid going through the torture of pill swallowing. These methods are known to reduce the bioavailability and effectiveness of the medicines when used in ways not intended by the manufacturer.
Difficulty in swallowing arises from fear of the bitter taste of drug, fear of size or texture of the drug which could cause a fear of choking on it. Most patients who experience this have had life-long battles with swallowing tablets. Some give harrowing experiences of how they would ignore symptoms of pain and discomfort just to avoid taking medicines. This is dangerous and life-threatening. Some have also claimed to prefer their medications given by injections alone, to avoid swallowing, thereby exposing themselves to the risk of nerve damage and over-treatment, especially in cases of mild conditions such headaches.
Injections are excellent alternatives in: (a) patients who have weak swallowing reflex as a result of illness; (b) patients who cannot swallow, due to illness or excessive vomiting, to achieve rapid onset of action.
In children, drug formulations are always made in easy-to-use, sweet tasting, colourful packages and contents to encourage easy swallowing.
There are two methods that can help make swallowing pills easier.
The pop bottle method: In this method, a tablet is placed on the tongue and a bottle of water is tightly locked between the lips. With sucking motion, swallow the pill and water together. Don’t let air into the bottle.
The lean forward method: Place the drug on your tongue, take a sip of water but don’t swallow, then tilt your chin towards your chest and swallow pill. This technique is an improvement on the first one.
Other simple measures that help improve swallowing of pills include:
Putting the pill in pap or cereal. This although is not applicable with medicines without food as it could distort its bioavailability.
Swallow few amounts of pills at a time.
In cases where swallowing is affecting compliance, there are many other pharmaceutical formulation types designed to cater for those situations. They include:
Caplets
Easy-to-swallow soft gels
Patches
Subcutaneous implants
Effervescent tablets
One daily dose tablets (in the case of antibiotics)
Co-formulations: Help overcome pill burden by combining two -three ingredients into one tablet, common in blood pressure and antiretroviral medications.
Depot preparations
Chewable tablets
Lozenges
etc
The pharmacist must make referrals to specialists to offer behavioural therapy or dispense flavoured throat spray to ease patient’s difficulty.
Article written by Ayodeji Oni of Advantage Health Africa
