Swallowing difficulties and Medicines: Does it matter?

Most medicines are taken by mouth in the form of tablets or capsules, but for many people, even those with a healthy swallowing function, it can be a challenge to swallow solid oral medications. There are many reasons why people struggle, it may be due to illness, ageing or just a general aversion to swallowing solid medicines. Whatever the reason, research shows that medicines are missed, tablets are crushed and capsules are opened by patients and carers trying to find a solution to the problem.

This is why I set up swallowingdifficulties.com. The platform aims to help patients, their families, health professionals and carers to access independent, research-based advice on swallowing difficulties and medicines, including alternatives which are available.

As a pharmacist with a keen interest in the science of medicine formulations, combined with extensive clinical experience, I felt I could offer something unique which would truly benefit patients. My research has helped me to understand why patients and carers often resort to crushing tablets. If a tablet is not designed to be crushed, it can be dangerous to do this and given the alternatives available, it is usually unnecessary. Swallowingdifficulties.com brings together the latest research and information to help patients and health professionals make informed choices based on evidence.

Patients who have clinical dysphagia often view medicines as a low priority. Some have described their administration as a daily ‘chore’. This is because their prescribed medicines don’t usually improve their dysphagia and have been prescribed to manage other conditions.

Given that our social lives are often centred around eating and drinking, I recognise that for someone with dysphagia this is their greatest concern, rather than taking their medication.  From a healthcare professional’s perspective, ensuring that a patient has appropriate nutrition and hydration, combined with a safe swallow are key priorities.  Medicines are understandably not at the top of the priority list when managing swallowing problems. Unsurprisingly their safe administration is not always adequately considered.

What really opened my eyes however, was finding that pneumonia is either the first or second most common cause of mortality in many conditions strongly associated with swallowing problems e.g. dementia, stroke and Parkinson’s, and the need for a safe swallow is to prevent things accidentally going into the lungs. Most foods, liquid and medicines won’t be sterile and if they travel into the lungs, they will increase the chances of pneumonia.  Whilst a lot of effort goes into worrying about the right consistency for foods and liquids, failure to properly consider the medicines may be leaving the patient at unnecessary high risk of infection and early mortality.

The first question should always be what is more important to the patient and therefore are all medicines still necessary or effective?  If they are, we need to consider the best route for administration and if we still want to administer orally what is the safest formulation? Should we be using liquids, granules, melts or dispersible tablets?

Seeking advice from a pharmacist at this point is what would be expected of any competent practitioner. Using this website to inform the decision-making process could also be seen as good practice. Therefore, whilst I understand how we find ourselves where we are, I would really like the process of medicines administration to be routinely considered alongside nutrition, hydration and as part of the safe swallow.