Treating medication-related dysphagia may involve reducing the dose or withdrawing the drug if possible. Capsules tend to be swallowed more effectively than tablets, and a larger tablet is more difficult to swallow than a smaller tablet.^24,32

Medicinal options can include artificial saliva to improve bolus formation and lubrication. To address oesophageal damage, it may be appropriate to use anti-reflux preparations or prokinetic drugs such as metoclopramide, bethanechol or domperidone.^23,33,34

The Specialist Pharmacy Service advises against using thickened liquid medicines routinely as it is difficult to check the consistency is right. Giving a solid medicine – either a crushed tablet or emptied capsule - may make it easier to consume if given in food of the appropriate consistency (although this may invalidate the medicine’s marketing authorisation, making it an off-label use, and compatibility needs consideration).³⁵

Many solid preparations will disperse in water, which can be done immediately before taking the medicine. It is unlikely that an enteric or sustained release preparation would be suitable for this sort of administration, so should be avoided. If administering a medicine is likely to mean going off-label, it may be appropriate to consider an unlicensed special-order ‘Specials’ product.³⁶