At least half a dozen times a day, pharmacist Ryan Chinn fields questions from customers about how to swallow their medicine.
"You don't think about how big (pills) are until you have to take them," says Chinn, who works at Longs Drug Stores, Tarzana. "Some of these are big honkers--horse pills."
The people most likely to have difficulty swallowing pills are those over age 50 and children, Chinn finds. But people in other age groups may also have trouble. "Probably 10% of young adults have a problem," estimates Loyd Allen, a pharmaceutics professor at the University of Oklahoma Health Sciences Center, emphasizing that the percentage is a guess.
Some drug industry research suggests that up to 20% of all pill-takers might have difficulty. Problems often develop with age, Allen says, and are more likely to occur with such medical conditions as a stroke or inadequate saliva.
Soon the pill-swallowing problem might be passe. On the horizon are pills that melt in your mouth as easily as cotton candy--without the sticky residue.
Allen, the Oklahoma professor, is working on a melt-in-your-mouth remedy and expects his research to become reality within three to five years.
He's fairly close-mouthed about his work, but explains that a melting pill will include "a mixture of ingredients in a physical state that allows rapid dissolution."
The mixture could be useful, he says, on everything from cough syrup to vitamins and antibiotics.
The process would probably be applied to children's medicines first, he says, since children often have greatest difficulty swallowing pills. "Our goal is to dissolve medicine in less than 10 seconds," he says.
Allen also plans to include flavoring, which increases salivary flow and helps to dissolve the tablet and ease swallowing, he says.
Compliance might improve with melt-in-your-mouth medicine, Allen says, because people who have difficulty swallowing pills often don't take their medicine on the prescribed schedule.
Hammer and Knife
Until melt-in-your-mouth medicine is here, there are other ways to make the medicine go down--without resorting to tooth-rotting spoonfuls of sugar.
There is, for instance, the EZ-Swallow Pill Crusher-Splitter, a small plastic canister with a built-in surgical stainless-steel blade for cutting tablets and a built-in crusher on the bottom for smashing them.
The combination device, introduced about two years ago, sells in drugstores for about $13 to $15, says Dan Anderson, spokesman for American Medical Industries in Dell Rapids, S.D., the manufacturer. Older models that just crush or split are also available.
A simple mortar and pestle work just as well, says one pharmacist who quit stocking pill crushers because they didn't sell well.
Marble mortars and pestles, priced at $9.99, sell briskly at Lechters Home Store in Burbank, says a sales associate. People use them to crush both herbs and medicines, she says.
Whichever the crush method of choice, it's no cure-all.
"There are some pills that should not be crushed," says Jeff Jellin, publisher of the Pharmacist's Letter, a professional newsletter in Stockton, Calif.
(Pharmacists who want a list of non-crush medicines may request it from Jellin, P.O. Box 8190, Stockton, Calif. 95208.)
There are several reasons not to crush some pills, agrees Pam Rasmussen, a spokeswoman for Chicago-based Searle, a major pharmaceutical firm.
"Some pills have a coating to cover an unpleasant taste," she says.
Other pills, if crushed, may irritate the mouth lining.
In other instances, crushing pills may eliminate their sustained-release action, Rasmussen says, citing Calan SR (verapamil), a blood pressure medicine.
"Some tablets and capsules are engineered so the medicine is released fast or slow," Jellin says.
"And some medications have Ph-controlled coatings to release at a certain site in the body, such as the intestine."
Better than guessing?
"Don't crush pills without first asking your pharmacist," says a spokeswoman for the American Pharmaceutical Assn.
The Natural Route
There are low-tech ways to make medicine go down more easily, says Jellin.
* Drink a glass of water first to make the tongue slippery.
* Put the tablet far back on the tongue to speed its journey.
* Stand up while taking the pill so you work with gravity, not against it.
* Eat ice cream or something equally cold first. "This is hearsay," Jellin acknowledges.
"There's no scientific data this works. But I think it makes sense and, frankly, I have tried it (successfully) with my own kids."