Billions of dollars are spent worldwide by pharmaceutical companies developing new drug therapies. But little thought has been given to the difficulties many people experience swallowing their medications. A tablet such as Lipitor®, taken by around 5% of the Australian population, is the same size as a cashew nut. Caltrate® (calcium - osteoporosis) and fish oil capsules (cardiovascular disease) are a similar size.

Dr Lisa Nissen and Dr Kathryn Steadman of the School of Pharmacy, University of Queensland, have written a paper on the subject. Their research tells them that 60% of aged care residents and 40% of the general population find it difficult to swallow their daily medications. What are the options? Crush the tablet? Open the capsule? Add food? Not always a good idea. Jam, honey, yoghurt or thickened fluid may make it even worse for the patient. To alter some tablets might make the medication toxic to the patient or reduce the drug safety, stability or efficacy.

Thickened fluids
Adding jam or thickened fluids to crushed tablets can delay the release of medication in the stomach. Less so honey, but still not perfect. Also of concern are the quantities of the medication that can remain in the medication cup even with careful scraping. To date, altering medications is inevitable if people with swallowing issues, particularly in aged care facilities, are to take their daily medications.

Pharmacists can provide information on the appropriateness of medication alteration and should be consulted by patients, carers and nursing staff.

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