After poring over 10 years of adverse event reports, government
researchers found that more than three-fourths of cases involving
swallowing problems were in patients aged 65 and older, according to
the study published in the Annals of Internal Medicine.
"Multivitamins are used by up to 35% and calcium supplements by up
to 24% of older adults, who have higher rates (of swallowing
issues)" than younger persons," noted the team of researchers from
the Food and Drug Administration and the Centers for Disease Control
While the authors were not available to comment, the FDA did offer
some advice for seniors taking supplements.
"Older adults should be mindful of possible choking or other
swallowing problems from taking supplements," said Lindsay Haake, a
spokesperson for the FDA. "They should avoid taking several pills at
once, avoid extra-large pills or capsules, and swallow supplements
with plenty of water or other fluid."
If the supplement is on the large size, the FDA advises senior
patients talk to their doctor.
"Tell your physician you are having difficulty swallowing pills and
ask him/her or your pharmacist for other options or if you can cut
the supplement in half," Haake said in an email. "The FDA advises
all consumers to talk to their doctor, pharmacist, or other health
care professional before deciding to purchase or use a dietary
To take a closer look at pill swallowing problems among seniors, the
research team, led by FDA scientist Dr. Cecile Punzalan, turned to
reports submitted to the FDA's Center for Food Safety and Applied
Nutrition Adverse Event Reporting System.
The team focused on reports filed from 2006 through 2015 that
described cases involving problems swallowing supplement pills. Of
the 3,932 reports, 64% included the patient's age. Of those reports,
76.8% involved adults aged 65 and older.
[to top of second column]
The most frequent swallowing problem reported was choking, at 86.0%.
And 14.3% described a serious adverse event, including three deaths,
that were attributed to supplement-induced airway obstruction or
Most of the reports of swallowing problems, 72.9%, involved
multivitamins, while 17.3% involved calcium supplements. The ten
supplements that were most commonly involved in swallowing reports
had a length, on average, of three quarters of an inch (19.3 mm), a
width of more than a third of an inch (9.8mm) and a height of nearly
a third of an inch (7.8 mm).
Dr. Rupa Mokkapatti seconds the FDA advice to seniors to check with
their doctors to find a better alternative.
"Patients need to know there are alternatives to large-sized pills
for most supplements and medications," Mokkapatti, an internist at
UPMC Passavant Hospital in Pittsburgh, said in an email. "There are
liquid forms, pills that come in small sizes, like calcium
'petites,' chewable forms, and supplements that can be crushed or
dissolved in water. For supplements, given they are often purchased
without a prescription, the in-store pharmacist may be able to guide
the patient about alternatives that are easier to swallow. For
prescription medications, if you are having difficulty swallowing
prescription pills, it's important to notify your doctor of any
swallowing issues so alternatives can be ordered."
SOURCE: http://bit.ly/2OpPUY2 Annals of Internal Medicine, online
August 19, 2019.
[© 2019 Thomson Reuters. All rights
Copyright 2019 Reuters. All rights reserved. This material may not be published,
broadcast, rewritten or redistributed.
Thompson Reuters is solely responsible for this content.