Can I get through life without challenging my pill phobia?

October 17, 2006 6:53 AM

Can I get through life without having to swallow pills? This is not hypothetical.

I've had a pretty severe pill-swallowing phobia for about ten years. So far, I haven't had any major problems working around it - I take "headache powder" instead of Advil, chew up melatonin, and take liquid antibiotics. In the back of my mind, though, I'm pretty sure that there will be some circumstances where a liquid form of a medicine won't exist, or I'll have to take a time-release pill and won't be able to chew it. What are some of these circumstances? Some of the scenarios I've thought of, but am unsure about, are pregnancy and traveling to Africa/South America. Can you think of an emergency in which you had to swallow a pill (and not chew it)? Are there any common medications that aren't manufactured in any form besides time-release?

[Sidenote to anyone planning to contribute techniques/tricks on how to swallow pills - thank you and I appreciate your intentions, but I don't think this is something that can be conquered without therapy. The mere thought of swallowing a pill is terrifying to me, and many times when I've tried to overcome it, the pill ends up stuck in my throat. I don't try anymore. This is the scariest feeling in the world, and I'm asking the above question so I can find out whether it's necessary for me to challenge this phobia with some professional help.]

posted by tatiana wishbone to health & fitness (25 comments total)

You might not have encounted a situation yet where you had to swallow a pill, but you might later in life if you develop any conditions that require daily medication. High blood pressure, high cholesterol, etc. sometimes require taking a pill every to keep things in check.

So to answer your question, yes, I definitely think you should make the effort to learn it even if it requires therapy. Any phobia that can severely compromise your health later in life is worth the effort.
posted by boomchicka at 7:02 AM on October 17, 2006

^day. Every day.
posted by boomchicka at 7:03 AM on October 17, 2006

You probably don't want to chew up malaria meds...
posted by The Michael The at 7:03 AM on October 17, 2006

I had this same problem, and I investigated it, as near as I can tell its referred to in the medical community as dysphagia, which I understand to be a rather general term for esophagus disorders.

There's lots of techniques / strategies / magic potions and whatnot out there that can help you (do a little googling around, if you're curious), but my best suggestions would be to talk with a) your pharmacist and b) your primary care doc about the condition. I honestly don't know if there are certain pills you may need to swallow whole some day for some reason, and they might not either, but they should be able to speak generally to it, and their answers will depend on your particular situation (age, sex, pregnancy, travel plans, etc.) - as you've noted.

FWIW, I'm a pretty driven person and have been able to overcome roughly 80% of my problem with a combination of some deep breathing / intentional self-relaxing and a big glass of water. I still have trouble from time to time so I usually try to avoid swallowing pills shortly after I've eaten.
posted by allkindsoftime at 7:04 AM on October 17, 2006

Anything that's time release needs to be swallowed whole. Breaking it up or chewing it would release all the medicine at once.
posted by smackfu at 7:15 AM on October 17, 2006

Can I get through life without having to swallow pills?

Short answer, probably, but as you age, you'll need more meds, which are usually taken orally. Not being that old yet, I don't know if HAVE to be taken orally.

Also, don't mean to rude, but you mentioned not being able to overcome this without therapy, so maybe you could look into getting therapy. It'll be better to tackle this while you're younger as opposed to waiting to you're older and more set in your ways and thus have greater difficulty overcoming it.

Summing it all up, you might be able to get through life without taking pills but it MIGHT impact/shorten your life and/or quality of life at some point. In that case, it be helpful in the long run to seek professional help so you can live your life and fully and capably as you can.

Good luck!

on preview: What smackfu said
posted by Brandon Blatcher at 7:28 AM on October 17, 2006

I know you didn't ask for tips, but you must try this one. I used to be a pill-phobe just like you, and this changed my life:

Tip your head down (chin toward your chest) when you swallow. It opens up your throat and makes swallowing a LOT easier. If you don't want to try it with a pill (or something unthreatening...like a raisin, perhaps), at least try it the next time you drink something and see how much more open the back of your throat feels. I can barely tell I'm swallowing a pill when I do it this way -- and I have to swallow some monsters sometimes.

A lot of people tip their head back, but this just closes up the throat and makes it more difficult. I suppose they think that gravity helps, but your throat is strong enough to swallow without it.
posted by phatkitten at 7:43 AM on October 17, 2006 [2 favorites]

I had a lot of trouble swallowing pills for the first 20 years or so of my life (I can still only swallow one at a time and with lots of water) - so I can empathize.

I suspect you CAN get through life without having to swallow pills - but it will get increasingly more difficult. After all -if you must have a time-release pill, certainly you could take the small dose whenever it would have been released (say every 2 hours) - though probably with lesser results.

I'm sure you know the trick of grinding up your pills,and mixing them with something palatable (applesauce or jam, say) - which should work for about 95% of whatever you can't find in liquid form. Of course - no promises on these being available in Africa or South America.

IANAD but many medications meant for older folks come in a form for people who experience nausea (meaning an injection or a suppository) - so thats also an option.

I'm currently five months pregnant and there have so far been no time-release pills in my treatment. Since many pregnant women experience morning sickness, I'd feel pretty certain there are alternative delivery methods for all of these.

All this said - there is a lot of convenience to be found in being able to swallow pills. Only you can decide exactly how traumatic the therapy experience is for you (try it before you judge !) - so you'll have to make your own decision about what it is worth to you in time and convenience going forward.
posted by AuntLisa at 7:45 AM on October 17, 2006

To answer the main part of your question, I have heard that for many pills, you can buy twice as much as you need, and cut the pills in half. But, there are a few medications for which cutting is highly not-recommended because it breaks the coating of the pill. For these, Id imagine that chewing would be out of the question.

My apologies in advance for willfully defying your sidenote, but have you ever tried to take children's swallowable tylenol? Those pills are about a quarter of the size of regular pills.
posted by Maxwell_Smart at 8:00 AM on October 17, 2006

I had a friend who had trouble swallowing pills and she would deal with it one of two methods-- either get a mortar and pestle and grind up the pills and ingest the powder with some food (you will have to put up with some intense bitterness sometimes) or chew on a cracker and pop the pill in and allow the pill to go down with the mush.

Good luck!
posted by perpetualstroll at 8:20 AM on October 17, 2006

Virtually all medications can be made into a suspension by a pharmacist. For non-time-release over-the-counter medications, one can always grind the pill, stir it up in some water, and take it down. The water isn't going to do anything to the medication that your digestive tract isn't. As far as bitterness goes, there are flavor powders designed to be mixed into oral suspensions. Ask your pharmacist.

Also, some things that are take-every-day or time-release are available in patch form. For instance, birth control, hormones, some narcotics, and nausea medication.

As mentioned above, there are liquid or suppository versions of almost everything that's given to the elderly, the very ill, or children. Some of the few things that don't fall into those categories (e.g., birth control) are available in non-pill form as well.

I really wouldn't sweat it.
posted by jedicus at 8:53 AM on October 17, 2006

Okay "patch form" was supposed to be this link: patch form.
posted by jedicus at 8:54 AM on October 17, 2006

One thing you might want to think about is that, while it's entirely possible to get through life without swallowing any pills, it may come up at the worst possible time.

It'd be inopportune if you continue merrily along without pills, but then suddenly needed to take a pill because of a medical emergency and couldn't do so.
posted by anildash at 9:55 AM on October 17, 2006 [1 favorite]

I just got back from Africa, and the malaria pills i'm taking are capsules, so you could probably take them apart and dump the powder into a spoon and mix it with a little water.

But that's just malaria pills.
posted by clh at 10:06 AM on October 17, 2006

It'd be inopportune if you continue merrily along without pills, but then suddenly needed to take a pill because of a medical emergency and couldn't do so.

This is good, avuncular advice. But - I'm curious - is there an example of a medical emergency where the medication could not be quickly provided in a non-pill form? It seems this goes to the heart of what the OP is asking.
posted by vacapinta at 10:25 AM on October 17, 2006

For some medications there are suppository formulations. This is particularly useful for nausea medications and for people who require some medications that cannot be crushed for swallowing, but cannot swallow due to various medical conditions.
posted by battlecj at 10:26 AM on October 17, 2006

This is good, avuncular advice. But - I'm curious - is there an example of a medical emergency where the medication could not be quickly provided in a non-pill form? It seems this goes to the heart of what the OP is asking.

Thanks vacapinta - this is exactly what I'm asking (and I also agree that anildash's advice is good.) Going through therapy for this will be a huge source of anxiety for me, and if I can avoid it, I'd like to. On the other hand, if there are foreseeable medical events in which I will have to swallow a pill, it would be very unwise to just live with this problem.
posted by tatiana wishbone at 11:10 AM on October 17, 2006

I think your question is "Has anyone encountered a pill that couldn't be ingested any other way?"

If that is your question, I can offer this:
About 15 years ago, when I was in high school, I contracted chicken pox. They had just come out with pills that were very helpful to adults (and teens) sufferring from chicken pox, which hits harder the older you are. I had never swallowed a pill before, but I had to learn in order to take these.

Of course, that was 15 years ago; these days, they can make some medicines into lollipops. I suggest you try stopping by your local pharmacy when it's bound to be a slow time, and have a chat with the pharmacist about alternatives.

I think you can generally expect to get by without having to swallow a pill; I wouldn't worry about it. If the time ever does come, I'm sure the alternative will be so much worse that the pill thing won't look so bad.
posted by Sprout the Vulgarian at 11:31 AM on October 17, 2006

Oooh, I just thought of a possible emergency scenario where you might need a pill: anaphylactic shock.
If you go into anaphylactic shock, the first step is epinephrene, but then usually they treat you with Benadryl. The problem here is that they probably don't carry liquid Benadryl on the ambulance, and if someone called 911 for you from someone's house, for instance, it's even less likely that that place has it in liquid form, even though lots of people have Benadryl in pill form.

Even so, I think this fits into my you'll-get-over-it-when-you're-forced-to hypothesis.
posted by Sprout the Vulgarian at 11:45 AM on October 17, 2006

You need to get over this, because there are many, many medicines that are available only in pill or IV forms, and a large number of those are whole pill only, because of the enteric coating required to get past the stomach.

You'll only go through life without taking pills if you have no health problems whatsoever. The contrary advice others have given is not correct.
posted by Mr. Gunn at 12:24 PM on October 17, 2006

Some antidepressants, like Wellbutrin, are in time release formulas. You can get past that by getting the non-time release formulations, but then you don't have the slow, constant release of chemical into your system, which is the point of the pill.

These pills also can't be cut in half; I have a container of 200 MG pills I can't take, even though I only take 100 MG daily, because cutting the pill in half would destroy the time release aspect.
posted by spinifex23 at 1:36 PM on October 17, 2006

You might want to talk to a compounding pharmacy. Places that specialize in compounding are getting rarer, but they do exist, and they're more likely than anyone to know what can and can't be taken in non-pill form.

(If there's one in your area, it sounds like they'd be good folks to get to know anyway, given the nature of your problem.)
posted by nebulawindphone at 1:44 PM on October 17, 2006

This question is difficult to answer, since new medications come out pretty much continuously.

One thing I can tell you is that there is no concerted effort made by the pharmaceutical companies to make sure that every medication is available in non-pill form. Pharmacists are able to close a lot of the gap with liquid suspensions, but that isn't going to cover 100%.

The biggest problem, as other people have said, is likely to come during an emergency. Even if it is possible to get a particular medication in liquid form, EMTs and rural hospitals are going to have whatever they have on hand, and a lot of it is going to be in pill form.

If you were going to be staying exclusively in large cities in first world countries, I think you could probably risk it. If you plan to spend time elsewhere (say, Africa) I think you will be better off dealing with the situation now -- even if you never need medical treatment in a third world country, the possibility will be forever hanging over you and freaking you out.

It is a bummer of a phobia, I have to say. I hope you do decide to tackle it, but good luck either way.
posted by tkolar at 1:51 PM on October 17, 2006

One suggestion that I give to friends who can't swallow pills with water is to try swallowing it with a mouthful of food. Chew a bite of bread, and just before you swallow it, pop the pill in, mix it up, and swallow. It's a lot easier than swallowing with water, and should be fine for most pills (although you'll need to check of course).

I'm not sure if I'm contravening your sidenote, because you don't say if this is entirely triggered by the mere thought of the pill, or by the sensation. If it's the sensation that's the problem, try this technique. If it's the thought, you probably want to get help overcoming the fear. The food+pill technique may help you deal with the psychological issues of swallowing a pill, but that's just supposition on my part.
posted by ajp at 1:56 PM on October 17, 2006

One quick word about Benadryl: in addition to liquid formulations, there are also now dissolve-on-the-tongue sheets kind of like the breath fresheners (Listerine pocket packs or whatever). Between those and the new chewable Tylenol, it would appear that OTC drug manufacturers are targetting adults with swallowing problems and the elderly more and more.

Also, if you're being treated for anaphylactic shock, they may use Benadryl as a first line, but I'm sure they wouldn't hesitate to inject you with something if you couldn't take the pill (which, if you were suffering from anaphylactic shock, would seem quite likely whether you had a swallowing problem or not).

The point about coated tablets that have to survive getting through the stomach more or less whole (and thus cannot be ground up or made into a liquid) is well taken. However, for essential medications, those can be taken in IV or patch form. And again, in an emergency, the ER is going to want to give things IV most of the time anyway: it's faster, more controlled, has fewer risks, and simpler.
posted by jedicus at 5:56 PM on October 19, 2006