Do you have difficulty swallowing medications?
Difficulty swallowing, also known in the medical community as Dysphagia, effects about one million Australian patients, with over 40-50% residing in aged care facilities. [https://www.racgp.org.au/download/documents/Guidelines/silverbook.pdf]
Difficulty swallowing is usually a sign of pain in the oesophagus – the muscular tube that connects your mouth to your stomach. This tube (the oesophagus) moves food and drink down into your stomach.
Difficulty swallowing can also be due to brain or nerve disorders. It can also be caused by tonsil or mouth pain.
If you are a pharmacist or have loved ones with dysphagia or difficulty swallowing, there are several causes and remedies you should be aware of.
How does prescription compounding help dysphagic patients?
Compounding pharmacists are well equipped to help patients with dysphagia by providing a range of different medication delivery methods. These can vary in application and method.
Compounding pharmacists can create orally disintegrating tablets (ODTs) – ODTs require far less effort to swallow as they dissolve rapidly in the mouth and in the gullet. These types of tablets are not available “off the shelf.”
Transdermal (through the skin) delivery such as topical gels or patches are also an option for treating people with difficulty swallowing. This means they will not have to take the medication by mouth. More and more medications are using transdermal delivery, which improves the benefits of medications in patients with difficulties swallowing.
Altered-thickness oral liquids also help in people swallow their medication. Some liquid solutions may be too thick or viscous to be swallowed. A compounding pharmacist can alter the viscosity of medications and reduce any adverse swallowing reaction by the patient.
Some other new products on the market are medication lubricants. This resolves the need to “crush” pills or open capsules when other methods are unavailable. Crushing pills can also alter the effectiveness of some medications, as it breaks down slow release coatings. Though they can be effective, compounding can factor in the release of medications without the need for lubricants. Compounding can also include many types of medications in one deliverable, reducing the overall need for separate, multiple pills or capsules.
Working together with doctors for patient care solutions
With all compounding, pharmacists working together with doctors can help formulate a compounding solution that not only is effective in treating the patient’s other illnesses but provides comfort and long-term benefits. Dysphagia can often be a point of anxiety for many patients – including family and friends – and working on novel ways to deliver medicine to dysphagic patients is helped along by doctor and pharmacist teamwork.
For more information on compounding and whether it can help you or a loved one with dysphagia or difficulty swallowing, contact the eCompounding Chemist here.
Types and causes of swallowing difficulties
There are two main types of dysphagia: oesophageal dysphasia and oropharyngeal dysphagia. Both have common symptoms: pain while swallowing, the inability to physically swallow medications, or sensations of incomplete swallowing.
Oesophageal dysphagia often feels like food is stuck in your throat. This type of dysphagia may be associated with inflammation, scarring, irritation, or muscle spasms. A person may have a condition that could cause these symptoms for a long time such as Gastroesophageal reflux disease (GORD.)
Oropharyngeal dysphagia is the most common form of dysphagia in older people. The most common causes are neurological disorders such as stroke, motor neurone disease, brain damage, Parkinson’s disease, and dementia. It can also be caused by temporary issues such as throat or palate pain.
Nerve damage or other disorders such as multiple sclerosis can make difficulty swallowing even worse. Blockages like lymph nodes or cysts can also cause difficulty swallowing.
Tooth or gum pain, gum disease, and badly fitted dentures can all effect swallowing. A dry mouth can also make dysphagia worse. These can all result in attempts to swallow large food pieces that are not chewed completely.
Signs and symptoms of difficulty swallowing
The usual symptoms of swallowing difficulties include food sticking in the throat, coughing, or choking, as well as nasal or oral regurgitation (vomiting.) Other symptoms of swallowing difficulties can be due to viral inflammation of the tonsils or soft palate and/or injury to the throat itself.
The signs are often obvious, and symptoms such as sore throats or tonsillitis can be treated using conventional methods.
However, if the swallowing difficulty becomes chronic or long-term, this can cause further complications.
Chronic dysphagia can lead to pneumonia, sinusitis, choking, and injury. For patients with neurological disorders, this can also lead to anxiety and distress.
Swallowing difficulties can also be a side effect of GORD, which feels like an incomplete emptying of the oesophagus (a feeling of being “stuck in the throat”).
Stomach acid of a low pH can cause low-grade but persistent damage to the oesophagus or trachea; it’s much like waves crashing on rocks that, over time, erode them completely.
What to look for and who to contact
Pharmacists are often the first point of contact and the first to identify patients with short- or long-term swallowing difficulties.
Patients may often ask the pharmacist for a more easily swallowed form of medication, e.g. a liquid instead of a pill or tablet.
Swallowing difficulties in patients using a proton pump inhibitor or other medications may be an indicator of an incomplete or unsuccessful therapy. Endoscopy or review may be required.
Aged care staff and pharmacists should be aware of the warning signs for difficulty swallowing so they can treat the disorder early.
These signs are:
- Coughing or choking on food and drink
- Refusing to take oral medicine
- Concerns about swallowing difficulties made to doctors, friends, or family
Family members should be brought into the sphere of treatment, as it’s often easier for patients to talk to those that they are familiar with.
Common treatments and diagnoses
Usual treatments and strategies for relieving difficulty swallowing attack the causes of pain itself. These might be topical products like gels or creams, anti-viral or anti-inflammatory treatments, and local anaesthetics. Sometimes a regimen of swallowing muscle exercises can help people with difficulty swallowing.
However, these may only be temporary solutions. Other treatments include minimising sedative and painkiller use, changing one’s diet, and supervision or education on safe swallowing methods. Sometimes, surgery is required.
It is important to diagnose swallowing difficulties early so it can be treated appropriately. A GP may need to diagnose it, as it can get worse over time if left alone.
A doctor or specialist can confer with pharmacists on the best strategy to treat difficulty swallowing. An ear, nose, and throat doctor can help, as can neurologists or speech/language pathologists, who can also evaluate and treat swallowing problems.[/vc_column_text][/vc_column][/vc_row]