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Problems swallowing pills? - Practical tricks make it easier to take

Almost all of us need to take medication at some point or even on a regular basis. But every third person has problems swallowing tablets and capsules. The tablet sticks to the roof of the mouth. The capsule doesn't even want to disappear into the throat. Or it literally gets stuck in your throat. "Many medical professionals underestimate how many people have problems taking medication," says Professor Dr. Walter Haefeli.

However, a study with over 1,000 patients in general medical practices in Baden-Württemberg at the end of 2012 showed that more than half of the people who have problems swallowing tablets therefore take less than the number prescribed for them. And even one in ten does not even take their medication because of this. This can cause complications and worsen your health. "So it is important to find ways to help those affected," says Haefeli. The medical director of the Department of Clinical Pharmacology and Pharmacoepidemiology at the Heidelberg University Hospital and his team went in search of techniques that could be useful as swallowing aids.

It seemed to them to make sense to try out two different techniques. One technique to make tablets easier to swallow and a second technique for capsules. “Why is this difference necessary? Capsules - unlike tablets - are usually half filled with air. They are therefore lighter than water and float on the liquid. While tablets are denser and tend to sink. You therefore need different swallowing techniques, ”explains Haefeli. With 151 volunteers - around half of them with difficulty swallowing medication - the researchers recently tested whether the two techniques actually make it easier to take.

The “bottle trick” for tablets

The “bottle trick” helps when taking large tablets. It is important to use a flexible plastic bottle with an opening that is not too narrow, from which the water can be sucked in easily. The tablet is placed on the tongue, the lips closed tightly around the bottle opening. Now a strong sip of still water is sucked in and swallowed together with the tablet in one go. The head can be tilted slightly backwards. The plastic bottle must contract when you drink. The tablet follows the force of gravity to the base of the tongue and is flushed when swallowed.

The "nod trick" for capsules

The second technique is the "nod trick". It is suitable for capsules. Here, too, the capsule is placed on the tongue and a sip of water is taken, but without swallowing it immediately. Now tilt your head forward, chin towards your chest. In this position you swallow. “This technique is only suitable for air-filled capsules. When the head is tilted, these rise in the direction of the throat that is now higher and can thus be swallowed more easily, ”explains Haefeli.

Techniques make swallowing easier

The result of the study: With the “bottle trick”, two-thirds of those taking part in the study found it much easier to swallow large tablets than before. Thanks to the “nod trick”, none of the test subjects had any more problems swallowing large capsules. With slightly smaller capsules, almost 90 percent reported relief when swallowing.

None of the techniques had previously been tested for effectiveness in a controlled study. In the study funded by the Federal Ministry of Research (BMBF), the test subjects swallowed tablets and capsules of various sizes that were free of active ingredients - initially as they were used to, then strictly following the instructions of the scientists with the respective technology. On a scale from one to eight, they then rated how easy it was for them to swallow. The techniques worked well for test subjects who previously had no difficulty swallowing tablets, as well as for those who had previously had difficulty swallowing. “Overall, the tricks are trivial and easy to implement. The main problem is that they are not known and have not yet been scientifically evaluated, ”says Haefeli. Problems with taking tablets are also not addressed enough in medical practices. “As a doctor, it is worth asking. If patients have problems, there is often the option of switching to another brand of medication with smaller or differently shaped pills. That, too, can help the patients. ”The two swallowing techniques described and many other tricks for the correct intake of drugs were put together in the BMBF-funded project“ ESTHER ”. They were then published in book form under the title “Using Medicines Correctly” by Thieme Verlag.

Haefeli's team is currently evaluating a swallowing study in people who have had a stroke. "Because we cannot automatically assume that these techniques are practicable and safe even with paralyzed patients."

Contact Person:
Prof. Dr. Walter E. Haefeli
Clinical Pharmacology and Pharmacoepidemiology Department
Medical University Clinic Heidelberg
In Neuenheimer Feld 410
69120 Heidelberg
06221 56-8722
06221 56-4642
[email protected]