How To Swallow Big Pills — & Not Want To Gag

Photographed by Megan Madden.
Remembering to take your medications every day is hard enough, but especially so when they're massive horse pills. You have to get a glass of water, brace yourself to gag, and it can become a whole thing. Even though you eat solid foods and can deal with having other objects in your mouth, swallowing pills can feel really unnatural, and even make you gag, heave, or vomit.
"We are generally not designed to swallow solid objects, and therefore can experience difficulty," says Stephen Ferrara, DNP, FNP-BC, associate dean of clinical affairs at Columbia Nursing. Even though you do swallow some solid objects (like food), swallowing a whole pill is a different story. Humans have a gag reflex, which helps to protect foreign objects from entering our airways, Dr. Ferrara says. "Some have more hyperactive gag reflexes than others, which can make swallowing pills a challenge," he says.
If that sounds like you, it can be frustrating, but it doesn't mean you shouldn't take your pills. About a third of people have difficulty swallowing pills, actually. You just have to figure out a method that works for you, and luckily, there are a few.
You can start by drinking water, which is advised for taking most medications, Dr. Ferrara says. "In fact, some medications require drinking a full eight ounces of water and maintaining an upright position for 30 minutes after swallowing the medication," he says. That may sound unnecessary, but certain medications can irritate the lining of your throat, so this helps to prevent that, he says. And you should take many pills with water specifically, not some other liquid, like coffee or tea, because other liquids can sometimes affect the medication's effectiveness, he says. If that doesn't work for you, it's time to get creative.
You might have considered just chopping up your pills or breaking them open, but that's not always a great idea, Dr. Ferrara says. "Many medications have coatings to be time released or to protect the integrity of the medication for passing through the gastrointestinal system," he says. "Patients should try a variety of techniques so that they can safely take their medication for the intended purpose." (Not sure what your doctor wants you to do? Just ask.)
There are a couple "techniques" for swallowing pills, but at the end of the day, they're just getting the pills into your body. These methods are basically tricking your mind into thinking you're doing something differently. Physiologically, though, they're doing the same thing as just swallowing.
The two main techniques are the pop-bottle method and the lean-forward method. For the pop-bottle method, you fill a water bottle, and then put the tablet on your tongue, and close your lips around the bottle opening. Keeping your lips on the bottle, you take a drink and use a "sucking motion" to swallow the water and pill. A 2014 study found people had a 60% improvement in swallowing compared to just taking a sip of water from a cup.
For the "lean-forward" method, you put a pill on your tongue, and take a sip of water without swallowing. Tilt your chin toward your chest and swallow while your head is down. People had a 89% improvement, in that same study.
These techniques might work like a charm for you, but Dr. Ferrara says you should be cautious while you're experimenting. "We must be careful to ensure that medication isn't accidentally aspirated — goes down our trachea or breathing tube — so it’s best to avoid any rapid movements of swallow attempts," Dr. Ferrara says.
If you absolutely have to take a big pill, such as a prenatal vitamin, and you're still struggling, it's worth it to talk to your doctor to see if they can give you smaller, partitioned dosages of the same medication. Prenatal vitamins, for example, are so huge because they're compounded with an assortment of vital minerals and substances, he says. "They tend to be larger to conform to the recommended dietary allowances." But, luckily, there are many new formulations that make it easier to take them, such as dissolvable powders, gummies, and even bars, Dr. Ferrara says.
At the end of the day, the most important thing is always that you get the medication inside of your body, however you make that happen, Dr. Ferrara says. Who knows? Your doctor might be able to substitute your horse pill with an easier-to-swallow version. If that's not doable for you, it's important to figure out how you're going to take your medication, even if it seems like the last thing you'd want to do.
Not surprisingly, Dr. Ferrara says that when you're actually able to swallow your pills, you're more likely to adhere to taking them, so if you can master one of these swallowing techniques, you'll be that much closer to checking this relatively unpleasant item off your to-do list.

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