Pill popping and medication munching: how we manage the swallowing of medications

PURPOSE OF REVIEW: Difficulties swallowing medicines is common, even in those with no other swallow issues. Yet, for many, daily safe and optimized ingestion and absorption of medicines is critical. In this review, we explore current evidence regarding pill swallowing patterns and recommendations for optimising pill swallowing. RECENT FINDINGS: Pill swallowing difficulties are common and are associated with factors such as polypharmacy and larger dosage forms. Patient-reported screening tools for pill dysphagia are emerging as a valuable approach for identifying pill swallowing difficulties. However, the clinical evaluation and management of pill dysphagia remain variable, highlighting the need for standardized assessment protocols and clinical practice guidelines. Integrating pill swallow challenges into instrumental swallowing assessments will help to inform clinically appropriate management pathways. Dosage form characteristics, including pill size, shape, and formulation, remain key determinants of swallowing performance. Use of pill-swallowing aids such as lubricants may improve patients' perceived ease and confidence with pill intake. SUMMARY: Routine screening and integration of pill-swallowing assessments into dysphagia management should become standard practice. Future research should prioritize robust evaluation of pill characteristics, pill-swallowing aids and educational interventions focused on safe medication administration practices, to optimize pill swallowing safety, adherence, and therapeutic outcomes.