Sunday, November 22, 2009

Swallowing Forum

We had to prepare (what felt like) a half-gallon of amoxicillin suspension the other day. It was a prescription for a teenager. Yes, Mom said, she "can't swallow pills."

Come on now. Sometimes I have a hard time --er--- swallowing that story. I am just somewhat disbelieving of these teens and adults who claim the total inability to swallow a tablet or capsule. I'm not talking about people who are handicapped or developmentally disabled or have some anatomical defect or injury. I'm talking about the normal folks who, somewhere in their past, gagged on a dry tablet or had something go down the wrong way and are now totally convinced it's beyond their capability. Sometimes they don't tell you until the prescription is all ready -- they look at you wide-eyed and say, "oh, I can't swallow THOSE !!" Well, what the heck did you think you were going to get after coming in for a doctor's appointment, receiving a prescription and waiting for it at the pharmacy --- a smoothie, a Big Gulp, what? They act kind of outraged that you would even present them with this daunting task.

The suggestions I give for this problem --- wetting the tablet or capsule and using a straw to drink the liquid needed to swallow it --- are sometimes accepted and sometimes not. Sometimes you can crush the tablet or open the capsule, but not always. But if a person has convinced themselves they can't swallow a tablet or capsule at the age of 15 it will be a difficult pharmaceutical road ahead, for sure.

Anyone have any favorite tips for our non-swallowers? I need some.


oddharmonic said...

At 15, I was convinced I couldn't swallow pills either. I'd also developed a highly sensitive gag reflex so that made pill-taking even more difficult in my mind.

When I got to college, a few of my friends took it upon themselves to cure me of my pill-swallowing aversion. Their plan:
- learn to swallow a spoonful of applesauce without gagging
- adjust to swallowing the same amount of applesauce with a Tic-Tac mint in it
- place the Tic-Tac in the mouth first and swallow it, chased with applesauce as needed
- swallow the Tic-Tac with a drink of water

It took 2-3 weeks, but I haven't had a problem with swallowing pills since then. The "tip your head down with a mouthful of water" trick to help swallow capsules has been useful to remember too.

was1 said...

I've had people tell me they can't swallow anything bigger than a sudafed, or anything bigger than an otc ibuprofen. If they're getting a capsule or caplet (when did caplets come into existence?) I show them the pill so they can just see it from one end and they can see that its really quite small that way. Then I tell them to be sure to swallow it longways and not sideways. You'd be surprised at the amount of BS people can swallow. Mind over matter, baby.

Pharmer Jones said...

I pulled the whole I-can't-swallow-this-stuff crap back in the day too, until I got a prescription that didn't come in a liquid formulation. Surprise, I learned real fast how to take it. Amazing what necessity will teach you.

She won't learn until she has to. (Or until her friends bust out the Tic-Tacs.)

Liz RPh said...

I learned how to swallow pills by practicing with M&M's or Skittles. Pill-shaped candies (if not a bit bigger than candies) were good practice for me - and if I couldn't swallow them, I just ended up with candy in my mouth! Of course, I "couldn't swallow" a few on purpose as I was practicing, but now I can swallow pills ... Although I admit to not being terribly graceful/suave about it ...

Anonymous said...

Good suggestions. I 'taught' my kid to swallow pills ahead of time by casually introducing licorice All-Sorts, the kind that look like 'caplets'.

One time when I was working in a mental hospital we had a patient that stated to the nurse that she couldn't swallow tablets which was going to be inconvenient especially since we didn't even start IVs there, so I gave her some lessons using the 'tip your head down with a mouthful of water' trick. It worked like 'mind over matter'.

ThePharmacyIdealist said...

Yeah, I agree I think you need to figure out what the reason is. If it isn't something anatomical and the tablets arent huge like KCl or Metformin or something, then you need to convince the patient of the necessity.

At some point they need to get beyond the mental block because as we age we just take more medications. And if you can swallow a bit bite of steak, a potato chip, or a piece of candy, you can probably swallow a small tablet.

Good topic though, certainly does come up seemingly more often!


Grumpy, M.D. said...

Take the pill or fucking DIE you bozo. I think that's a good approach. Your manager may disagree.

pharmacy chick said...

well, yes. Dr Grumpy has a very good approach. LOL. I personally choose the M&M's approach for years. I royally pissed of one mother one time when she whined that her (huge) son couldn't swallow pills. I said. "well, he seems to be able to swallow food".

Anonymous said...

I've gone from not being able to easilyt swallow pills (as a child) to dry-swallowing them if I must. I have RA and now am compelled to take a literal handful of pills each day -- after getting tired of swallowing them one by one, I finally learned to pop the whole shebang into my mouth and wash them down with just a few swallows of water. We really can un-learn these silly problems if we try.

Stacey said...

I know this is really really late but thought I would mention the trick I used. I could never swallow pills, my parents laughed at me as I even 'chewed' puddings or jello. I used to chew every pill (gravol is the worst!) until I as anemic and had to take iron pills. Horrible!!

What I did was start to eat something and when I had it chewed up enough that I could swallow it, I would put the pill in, move the 'lump' of food and pill around in my mouth with my tongue then swallow all of it down just like food. Worked real well.

Like Wren said, I also now have a rare disorder that means lots of pills and I can swallow a handfull at a time now with no problems.

Anonymous said...

WOW, I am not exactly sure I agree with this article. I had suicide attempt in the past taking over 200 pills and now I am having a major problem taking pills, everytime I take them I gag. Its really difficult