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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.
Horse Pills Make Her Gag: How to Swallow Big Pills
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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