Articles written by me on Self-care and Palliative Medicine
On Self-Care & Palliative Medicine

A Bitter Pill

There are hundreds of medications and supplements in pill form these days. As we age, most of us will wind up taking at least one prescription medication on a regular basis and probably a host of short term drugs such as antibiotics, antihistamines, and pain relievers. Add to this list the growing number of vitamins, minerals, and herbal preparations that people choose to take, and the quantities of pills/capsules/tablets that go into our mouths every day can be substantial. Both for safety reasons and for proper efficacy of the medications, it’s important for you to understand how to take pills correctly.

Ideally, most pills should be taken when a person is standing upright. This posture creates a ‘straight shot’ from the mouth to the stomach. Pills should be popped into the mouth. . .followed by a minimum of 3 to 4 ounces of plain water. The habits of dry swallowing tablets and capsules or propping up on an elbow to take a medication at the bedside should both be avoided. Each of these habits can lead to an incomplete swallow–where the medication stops and dissolves somewhere in the esophagus rather than reaching the stomach. There are a variety of medications that can create painful ulcerations in the esophagus if this occurs. Additionally, adequate water intake with a medication will allow the pill to dissolve fully and begin its therapeutic benefit quicker. Especially if you have difficulty swallowing pills, avoid the tendency to tilt your head back as you try to wash the medication down. In fact, this posturing causes the pill to float up and into the front of the mouth, making it even more difficult to swallow. Instead, try taking the pill with a sip of water and then bow your head forward as you swallow. Generally, this manuveur will allow the pill to float backward over the base of the tongue and into the throat. If you follow this action with several more ounces of water, your medication should be well on its way.

Many pills should be taken on an empty stomach to ensure adequate absorption by the body and full potency. Optimally, “empty stomach” means at least one hour before eating or two hours after a meal. On the other hand, there are medications that are actually prescribed with food in efforts to minimize nausea, cramping, or to control the absorption of the drugs into the body. Though some pills may be crushed or mixed with food, jello, or ice cream, there are medications (especially time-release preparations) that are essentially inactivated by crushing or breaking. Pharmacists are generally quite good at providing instructions these days; please take the time to read them and/or ask your pharmacist or your physician for more specific advice if you are unsure. Milk and calcium-containing antacids and juices can completely inactivate some drugs. Alternately, alcohol and even grapefruit juice can intensify the effects of other medications by compounding side effects or altering the potency in the body. Be careful. Educate yourself not only about the purpose of your medications, but also about the correct way to take them. And above all. . .don’t take either my advice. . .or your pills. . .lying down.

Stephen L. Hines, M.D.
May 2000

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