The People's Perspective on Medicine

Horse Pills Make Her Gag: How to Swallow Big Pills

How do you swallow big pills? Do you ever find they make you gag? We have some tricks to swallow big pills, but some medications require special cautions.
Close-up of many pink 500 milligrams pills.

Have you ever tried to swallow a large capsule, and have it trigger a gag reflex? Even worse, have you ever had a pill get stuck in your throat? Some medications are very irritating. If they get caught, they can cause severe irritation to the delicate tissues of the esophagus. This reader has come up with some solutions to swallow big pills. Not all of them are safe.

Strategies to Swallow Big Pills:

Q. As I have aged, I have increasing difficulty swallowing pills. I have switched to chewables whenever I can, such as chewable ibuprofen, aspirin or Tylenol.

If I have to take a pill such as an antibiotic, I crush it and mix it with yogurt or applesauce. Do I need to drink water if I chew my pills?

A. Please discuss your difficulty with your physician and your pharmacist. The doctor may be able to prescribe some of your medications in liquid formulations to make them easier to swallow.

The pharmacist is a valuable source of information on which pills can be crushed safely. Some cannot, and others should never be taken with yogurt, milk or cheese. This could inactivate antibiotics such as tetracycline, doxycycline or ciprofloxacin, for example.

Milk and Tetracycline-Type Antibiotics:

Someone diagnosed with a potentially life-threatening, tick-borne illness such as Rocky Mountain spotted fever needs doxycycline to be maximally effective.

An article in Drug Topics (Oct. 20, 2003) offered this perspective about a similar situation: 

“A 42-year-old woman had been prescribed doxycycline for the treatment of Lyme disease. The pharmacy provided the patient with an information pamphlet instructing her to take the medication with milk. As a result, the patient alleged, the efficacy of doxycycline was diminished due to decreased absorption of the medication. The patient’s condition improved only after the concomitant administration of milk was stopped. The Baltimore County Circuit Court ordered Rite Aid to pay the plaintiff $250,000.”

To be fair, there is contradictory research regarding the interaction between doxycycline and milk. Some studies suggest there is no problem. Others say there is. But why not err on the side of caution and take tetracycline-type antibiotics with a full glass of water?

Throat Irritation (Esophagitis) from Pills:

There are a surprising number of medications that can cause esophagitis. They include:

Alendronic acid (Fosamax)
Cyclosporine (Gengraf, Sandimmune)
Etidronic acid (Didronel)
Ibandronic acid (Boniva)
Isotretinoin (Accutane)
Lamotrigine (Lamictal)
Paroxetine ER (Paxil CR)
Risedronic acid (Actonel)

Several of these drugs are prescribed for the treatment of osteoporosis. They can be quite irritating to the throat if they get stuck.

Jane shared this experience with Fosamax:

“I took Fosamax for about four months before discontinuing it. I was a pretty active 69-year-old but almost overnight was moving as if I were in my 80s. It worsened my GERD so severely that a few episodes left me crying in pain. Two years later I still feel pain in my esophagus. This drug damaged me, maybe permanently, and I am angry.”

J. B. had an even more devastating experience:

“I took Fosamax for ten years and had heartburn and bad chest pains while on it. No one knew what my problem was until I went to the hospital for tests. They found out that I had serious scar tissue in my throat from the heartburn. The chest pain was caused by irritation to the esophagus. Once I stopped taking Fosamax, the heartburn and chest pain stopped. I still have very bad scarring in my throat.”

How to Swallow Big Pills:

Will suggests kefir to swallow big pills:

“Lowering my chin has helped me both with swallowing pills and having difficulty swallowing food. For years I had my esophagus dilated with little if any benefit. I still have difficulty swallowing large pills and recently tried taking them with kefir. It worked very well. The kefir is thick like yogurt and applesauce, but you can drink it and it lubricates the throat. The thickness keeps my throat from sensing the pill, so I don’t gag. It took me 71 years to figure this out. Hope it helps some of you.”

Kefir contains calcium, so it should not be used with medications that should not be consumed with dairy products.

The Pop-Bottle Trick:

Years ago we received this question from a reader of our syndicated newspaper column:

“I have bought various “pill cutters” at prices from one buck to five dollars. They shatter pills, not cut them.

“Why can’t the pill makers reduce the size of their pills? I’d willingly swallow three or four instead of strangling on one. Besides, I think some of these drugs are too strong, and if I could take half as much it would be a lot better.”

We answered this way:

It is a shame that the pharmaceutical industry does not provide more choices for dosing. Some people really need half as much medicine because they are slow metabolizers.

It may be impossible to create small pills because there is too much medicine to fit in a tiny tablet. Many pills can’t be cut in half, even with one of your devices. But we can offer you a trick on getting those big pills down the hatch.

Find a narrow-necked glass bottle of fizzy water, fruit juice or soft drink. Old-time Coca-Cola bottles are perfect. Put the pill in your mouth, purse your lips on the bottle and take a swig. The sucking action triggers a swallowing reflex and the pill should slip down with a minimum of effort. Check with your doctor or pharmacist, though, before you pick fruit juice or soft drinks. Some medicines don’t mix with acidic beverages.

Another reader offered his margarine and tea trick:

“I really sympathize with people who gag when they try to swallow big pills. Maybe this will help. I use tea and a roll with margarine. I soak the roll with tea and stick the pill into the middle of it. Then I put it in my mouth and swallow. Down it goes. This works for me and leaves no bitter aftertaste.”

Thanks for the tip, but it may not work for every medicine. Some drugs must be swallowed on an empty stomach and others may interact with tea. Iron supplements or vitamins with iron will be less effective if taken with tea.

This reader wants to know the size of the pills in advance:

“I have a hard time swallowing pills. I nearly choke on big ones and sometimes feel like they get stuck in my throat.

“I have asked my doctor not to prescribe big pills, but he doesn’t seem to take my problem seriously. I often get to the pharmacy, pick up my prescription and then discover the pills are too large. Isn’t there a way to find out in advance what size the pill will be?”

Ask your doctor to show you the size of the pills he is prescribing before you leave the office. He can look them up on his computer and show you the actual size. This should give you a good idea if you can swallow a pill.

To make it easier to swallow pills, drink out of a narrow-necked bottle of carbonated water. The sucking motion required carries the pill down more readily.

Always Check for Food and Drug Interactions!

Your pharmacist should look up potential food interactions and tell you how to take your pills for greatest effectiveness. As for the very first question, it is a good idea to swallow even chewed or crushed pills with six to eight ounces of water. That is especially true for drugs like aspirin or ibuprofen that may be irritating to the esophagus.

To learn more about food and drug interactions here is a link to our free Drug & Food Interaction Guide

Share your own trick about how to swallow big pills in the comment section below.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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Place the pill in a small amount of olive oil, just for a second to coat the pill. Then take it out of the olive oil with a spoon, and swallow with liquid as usual. The olive oil is almost tasteless, and the pill goes down easily.

I have found that any hot liquid, including hot water, helps me to swallow larger pills, especially if I have to take multiple pills at the same time. The heat seems to relax the throat.

Capsules have always been more challenging to me so I am glad to learn the trick of putting my head back to swallow a capsule!

Recently I had surgery on my neck due to 3 missing discs. After surgery it was difficult to swallow, and even the normal size pills looked huge! The huge Calcium and Vitamin D combo pill looked like it could kill me. However, some nurses showed me if you take the pill with applesauce, it would go right down.

I didn’t believe them – however was delighted when it worked! It really works. I always keep applesauce on hand, just in case I start to gag on a pill. One swallow or two of applesauce, and down it goes. Hope this helps some of you.

Jes, I have used the pop bottle trick. Works great!

I crush my horse pills in a mortar & pestle; then mix with a little peanut butter & jam

I think the problem is primarily psychological, then mechanical. People who claim difficulty swallowing even moderate size pills seem to be able to swallow much larger food items with no issue but say they need to take the pill with a spoonful of yogurt or some such.

Perhaps it’s just me, but I can swallow a small handful of pills all in one shot, with water. Pills in mouth, mouthful of water, tilt the head back, swallow, and down they go. Follow that with another couple of big swallows of water and nothing gets stuck. Can’t imagine people actually have throat linings so dry that pills are trapped unless lubricated.

John, who said he had good results drinking from a water bottle vs a glass of water is a good example of the mechanical issue. Drinking from a bottle, one is more likely to have the head and neck tilted back, opening the throat, as in CPR, and allowing for easier passage of whatever is in the mouth.

I agree that tilting the head back is the trick. I put the water in my mouth first, tilt my head back, and throw in the entire handful of pills — some pretty big ones — and usually have no problem.

However, once I started having acid reflux, I started making sure to eat right afterwards. It may be mental, but if I try to take a single pill in between meals, I feel it is sitting in my throat.

There have been several times when I believe the pill was truly stuck in my throat. In each case I began eating before I started choking on the pill, but I don’t think it was the food that was stuck. It definitely felt like one of the bigger pills was sideways in my throat. Eventually the feeling subsided after I tried eating. I have a hiatal hernia, a possible cause.

I use Pill-Glide. Also have a mini bowl of olive oil. Spray throat with P-G, dip pill in oil and voila!

Thanks for all the suggestions. I take a number of pills per day both morning and evening. I throw the pills in my mouth and take a (bottle of water) and take a swig and shake my head to mix the pills with water and quickly drink again from the bottle. All go down smooth and no problems. Remember quickly. Some pills dissolve quickly and that is not always pleasant.

People have often asked me how I am able to take a handful of pills, including horse pills, at one time. I answer rather simply: Toss them into your mouth, take a good mouthful of your chosen liquid, allow them to float and then swallow them down. It’s most important that they float off of your tongue. The gag reflex is caused by solid contact with the back of the tongue/throat. It has never failed me and I seldom need another chasing gulp of liquid.

The Best liquid I’ve found to help wash them down is Orange Juice with it’s lubricating effect.

A number of years ago, back when I took aspirin for a headache, I took an aspirin tablet and it got caught in my throat, which resulted in a very sore throat. My HMO at the time sent me right to an ENT who said this was common and when the pill got caught in my “pill catcher” (?) it dissolved and caused a chemical burn. I have no idea what a “pill catcher” structure is, but have used applesauce to take pills and it works well. I have a couple of pills I have to cut in half and the sharp corners seem to be a problem even though they are not large.

For many years now I have taken all my pills and capsules with a mouthful of moist food. Usually bran flakes at breakfast, a bite of a moist sandwich or chewed up mouthful of veggies at lunch and dinner does the trick.

It is always good for me to drink fluids after taking the pills and capsules with food stuffs.

I once aspirated a pill into a lung. Not any fun at all. The bitters they treat pills with makes you feel like you’re having a heart attack! I’ve been left with big-pill anxiety ever since. Had to invent a better way.

I’ve found that high-pulp orange juice really helps me to get it down the correct hatch. I’ll lube the big pill under my tongue with lots of saliva. Slither it as far back on my tongue I can get. I’ll then try to relax (very important). And then I’ll blast it down with a slug of high-pulp OJ. It works for me every time now. (If you hate OJ, tomato juice works but not as well.)

I generally do not have a problem swallowing pills, but for really large pills, I will place the pill in my mouth, add water or other liquid, curve my tongue upward at its edges and swing my head backwards while swallowing and using my tongue to flip the pill. This is a good solution when bending over a water fountain.

Swallowing the pills along and well-chewed food at the same time works great for me.

Finding out that pills and capsules should never be swallowed together changed my life. The person who mentioned lowering your chin to swallow a pill and raising it swallow a capsule has the right idea.

Water is one of the hardest things to swallow. Ask any health practitioner familiar with helping stroke victims. When relearning how to swallow anything, they add a thickening agent to liquids. This principle works for swallowing pills if you take them with something thick and slippery like almond milk, tomato juice, pineapple juice, apple juice with some apple sauce added, a bit of dissolved psyllium, etc. Usually the swallowing agent needs to be cold because warm liquids can dissolve the pill in the throat before it hits the stomach. Another trick that may help is to run the pill or capsule over butter or dip it into a good oil or yogurt to help it slip down your throat

Gelatin capsules get stuck half way down, no matter how much
liquid I drink. I always have to help it down with a small piece of food.
Yogurt is good but bananas are slippery and make any pill slide
down easily.

With Sjogren’s dry mouth, swallowing pills can be extra challenging. I’ve found it pays to ask if the Rx is available in a non-tablet form. For some reason, I find capsules go down easier than tablets. After choking on my potassium tabs several times, I asked to be switched to the extended release capsules, which can be taken whole or opened to sprinkle on applesauce.

I discovered that taking them with a water bottle instead of a glass of water made a huge difference.

My step father was an army medic he taught us to take a mouthful of water hold it then push the large pill into our mouth and then start drinking a glass of water as the pill goes down. It has worked for me all these years

Easy-peasy: Take a mouthful of food, and chew it until it really wants to be swallowed. Toss in your pills at the last moment, swallow, and you won’t even be aware them. I learned this from patients and nurses while working in a hospital. As a matter of fact, they used to have contests about who could swallow the most pills at once. Much easier than using water or any other liquid.

My friend’s assisted living facility puts her pills in apple sauce. One hospital put her pills in pudding. Both methods were successful.

I put the large pills, whole, in a spoon of applesauce. They slide right down. Then I follow with water.

We have learned from a previous nurse, who is now our patient, to take with name-brand whipped topping. It tastes good, and the pill usually slides right down.

Good suggestions. Please add doxycycline to list of drugs that can irritate the esophagus.

I also at age 89 have trouble swallowing large pills. My method get capsules when possible. If not possible I take a mouthful of water and “slip” the pill into my mouth. Swallow and follow with water.

Place a pill in your mouth and take some water. Lower your chin and swallow.

Except if it’s a capsule. Capsules float. Place a capsule in your mouth and take some water. Raise your chin and swallow.

I have ALWAYS had difficulty swallowing, even as a child. I even had a food impaction incident at age 10 when a piece of beef got lodged in my throat (not fun and yes, it did come out a couple of hours later). Sadly, because I was taken to an ENT (who announced to my mother than nothing at all was wrong with me) rather than to a gastroenteroloist, no one in my family believed I had a problem, even when the evidence was right in front of them. I was told the problem was “all in my head”.

It took getting a series of endoscopies at **age 63** to properly diagnose me with 2 Congenital Esophageal Strictures, 1/4 inch in diameter, plus Eosinophilic Esophagitis, an inflammatory condition of the lining of the esophagus which developed as an adult. Both equaled great difficulty swallowing and eating slowly.

People, there are multiple medical conditions that can adversely affect your ability to swallow, and the only way to be sure is to visit a gastroenterologist and have an endoscopy to properly diagnose. You are consciously sedated so you will not be aware of or feel anything. Some conditions may be present from birth; others may develop as you age, or a combination of both, as in my case. Some conditions involve a partial physical blockage; others are referred to as motility problems because the nerves that control swallowing are not properly coordinating the peristalsis in the muscles of the esophagus.

So if you have always had or gradually developed a problem swallowing, you may very well have a real medical problem. Go to a gastroenterologist, and find out for sure! Don’t just assume that you need to “train yourself” to swallow horse pills ;-|

I have a very hard time with large pills too. If it is an antibiotic, I ask for it to be prescribed in liquid form.

This is about help swallowing pills. I dip pills in a small amount of olive oil, and they go down easily with water.

I take prescription potassium pills with a tsp. of honey with no problem.

I take my supplements with coconut water. A thicker liquid helps the bigger caplets go down better than water, and I get the added advantage of the potassium in the coconut water.

I am not a good pill swallower. Taking my pills with a large gulp of ice water with my head tipped forward helps.

Thank you for all the suggestions, I too have always had this large pill swallowing problem . Apple sauce or honey taken with large pill on a spoon have been successful for me .

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