Large-sized supplements have been implicated as choking hazards in older adults, according to a recent FDA analysis of adverse event reports.
Researchers at the agency examined data from nearly 20,800 reported adverse events that involved dietary supplements occurring from 2006 through 2015. Nineteen percent of the incidents involved swallowing difficulties, mostly among adults 65 and older. Choking accounted for 86 percent of supplement-swallowing problems, and 14 percent of those were described as serious events, including three people who died from airway obstruction or aspiration (breathing in a foreign object). The findings were published in November 2019 in the Annals of Internal Medicine.
Multivitamins and calcium supplements proved to cause the most problems, likely because they tend to be large. The FDA recommends that drug manufacturers limit the largest dimension of their pharmaceutical tablets and capsules to 22 millimeters—about 7/8 of an inch—to ease swallowing, but it has no jurisdiction over the size of dietary supplements. The most troublesome dietary supplements for swallowing were marketed to older women and older adults.
What you should do
You can take precautions to lower your risk of choking on a supplement or any other pill, tablet, or capsule. Try different techniques to see what works for you:
- Before you take your pill, take a deep breath and exhale. This action may help you relax and inhibit your gag reflex.
- Swallow some water before taking your pill to lubricate your mouth and throat to stop the pill from sticking.
- If you’re taking a capsule with water, tilt your chin slightly toward your chest before you swallow. Keeping your head bent forward, swallow the pill and the water. (Using a thicker fluid, like milk, may also help.)
- If you’re taking a tablet with water, tilt your head back, wait one or two seconds, then swallow.
- Drink from a flexible, plastic water bottle with the standard narrow opening. After placing the pill on your tongue, close your lips tightly around the bottle, which sets up a sucking action that makes the pill go down easily. Swallow the pill and the water right away. (You should feel the bottle collapsing in on itself.)
- Don’t try to take a pill with soda. Carbonation makes it harder to swallow quickly.
- Put a pill in applesauce or pudding. The texture can make it easier to swallow pills whole.
This article first appeared in the February 2020 issue of UC Berkeley Health After 50.