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When Pills Are Hard to Swallow, Find Alternatives

Feb 23, 2016

Woman, 67 years of age, newly diagnosed with type 2 diabetes with an A1C of 7.8%. Met with PCP who prescribed metformin ER and referred patient for diabetes education. Patient made some dietary and physical activity changes at first, but upon return visit her A1C was 8.5%. She reported she did not take the metformin. “I can’t swallow big pills. The bottle said not to crush or break the tablets. They were just too big to swallow. So then I just gave up on everything.” The PCP showed her other forms of metformin, some pills were smaller and even offered her a liquid version, as well as several SGLT-2s. She thought she could swallow one of the SGLT-2s she was shown. That particular medication was prescribed. She returned in a month with an A1C of 7.2% and a weight loss of 5 pounds. She was back to making some dietary and physical activity improvements as well as taking her medicine every day.

Lessons Learned:


  • When discussing medications with patients, ask them how they do with swallowing pills.
  • If patients tell you they can’t swallow pills at all or can’t swallow big pills, look for alternatives.
  • Have samples of medicines available to show those patients who have difficulty swallowing pills. They can usually tell you by first sight if it’s something they can swallow or not.
  • A medication that is not taken has no chance to work.
  • Remember shared decision making. Allow the patient to decide whether or not he or she thinks they can or will take their medicine.


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