Using our advice

Before considering the options outlined here, an assessment of whether the patient still needs the medication should be carried out. Healthcare professionals may find our selection of tools and resources helpful when undertaking medication review.

It is important to understand the clinical context and issues to consider when providing safe pharmaceutical care for patients with swallowing difficulties. Our Swallowing difficulties page contains all our advice on using medicines safely and effectively in this group of patients.

Alternative formulation of same medicine

Some patients may benefit from having their medication in a different formulation such as a liquid instead of capsules or tablets if one is available and a medication review is an ideal time to discuss this with the patient. Licensed medicines are preferred over unlicensed specials. Special consideration should be given to the potentially high costs of unlicensed medicines. 

Further information on the options available can be found on our Swallowing difficulties page and our Using unlicensed medicines page.

Pill swallowing aids  

Patients may find it hard to swallow pills. The NHS has published patient videos on good swallowing techniques for adults and children (Kidsmedz) which may help.  

If tablets or capsules are the only formulations available and the patient has minor difficulty swallowing them then a pill swallowing aid may be helpful.  These are cup shaped structures which are used to contain the pills and make swallowing easier. They encourage a natural drinking position and there are also options that fit into the neck of a water bottle.  

There are many options available. Search online for ‘pill swallowing aid’.    

Devices to support preparing medicines

There must be someone willing and able to use the device. In order to make a safe and appropriate choice about which device to choose, identify:

• who will be giving the medicine (the patient themselves or a carer)
• their manual dexterity, and
• their ability to follow instructions to administer the medicine correctly

Tablet cutters

Consideration should be given to whether it is safe to cut tablets. Tablets that are scored with a line or indentation down the middle are usually acceptable to split in half.

The following are examples of medications that should not be cut (this list is not exhaustive):

• enteric-coated tablets or tablets that are slowly released in your body
• orally-disintegrating tablets
• irregularly shaped tablets
• tablets that are too small to be split evenly
• capsules (some can be opened and sprinkled on food for easier swallowing)
• chemotherapeutic agents
• some combination drugs (one tablet that contains two or more medicines)
• oral contraceptive tablets
• any tablets that contain drugs with a narrow therapeutic index

There are a range of tablet cutters widely available to purchase. Search ‘tablet cutters’ online. They cut a range of tablet sizes but are not suitable for capsules. Some devices are tablet cutter and crushers in one.

Some devices double as a pill box but all generally require a good level of manual dexterity to operate and contain sharp blades.

Tablet crushers

There is a wide range of portable tablet crushers available to purchase. Search ‘tablet crushers’ online. Other options include using a pestle and mortar to grind the tablets to a fine powder.

They generally require less manual dexterity than tablet splitters.  They are usually operated in a twisting motion in a similar way to a salt grinder. Care is needed to ensure all contents are emptied out, so the correct dose is taken.

Not all tablets can be crushed. Enteric coated, sustained release and cancer medications are not suitable for crushing.  Some tablets also have a bad taste or are a mucosal irritant so are unsuitable for swallowing when crushed but may be suitable for use via a feeding tube.

Further information can be found on our Preparing medicines for administration to adults with swallowing difficulties page.

Pharmacies providing split tablets

Pharmacies may be able to provide patients with halved or quartered tablets if they cannot use a tablet cutter. The patient should be assessed by a member of the pharmacy team as having a need for these.