(A special thanks to Dr. Joel Herskowitz for sharing his expertise on a health topic that is rarely discussed but has serious implications for our elderly loved ones.
Be sure to check the Author’s Box at the end of this article and visit Dr. Herskowitz’s site at www.SwallowSafely.com)
DANGER! MEDICATION AHEAD
No, we’re not talking about the Titanic headed for a pill the size of an iceberg. We’re talking about medications and how they can cause dangerous – even life-threatening — swallowing problems.
How can swallowing problems threaten life? Three main ways:
(1) by choking to death,
(2) through fatal pneumonia that results from food, liquid, pills, or saliva getting into the wrong tube (the windpipe instead of the esophagus)
(3) through malnutrition that weakens a person’s resistance to infection and interferes with strength and healing.
Let’s look at swallowing step by step. Swallowing is a process. The first step is Preparatory. You chew your food and mix it with saliva. The second step is Oral. Your tongue transports a ball of pasty food to the throat (pharynx). The third step is Pharyngeal. The swallowing reflex takes over and pushes the food down. The fourth and final step is Esophageal. That carries the food (or other material) to the stomach.
How do medications cause problems? In several ways. One of the most important is by interfering with the supply of saliva. Elderly persons often don’t drink enough water. So right away they’re in trouble when it comes to having a nice supply of saliva. That makes it hard to form a pasty ball of food that sticks together. It makes it difficult for food to slide easily to the back of the mouth. It allows food particles to stick in the throat where they can be accidentally breathed into the lungs after the swallow has been completed. Lack of saliva can also cause pills – especially gelatinous capsules – to stick to the esophagus. That can literally burn the lining of the esophagus to cause pain and scarring.
The appetizing smell of food gets our saliva flowing. Some drugs, however, interfere with the sense of smell, hence with the flow of saliva. These include cholestyramine (Questar), cimetidine (Tagamet), gentamicin (Gentacin), levodopa (Sinemet), nifedipine (Procardia), phenylephrine (Neo-Synephrine), promethazine (Phenergan), and propylthiouracil (PTU).
Some medications interfere with saliva production more directly. This is the famous category of anticholinergic drugs. These include diphenhydramine (Benadryl), hydroxyzine (Atarax), oxybutynin (Ditropan), any belladonna preparation (such as Donnatal), amitriptyline (Elavil), cyproheptadine (Periactin), hyoscyamine (Levsin), propantheline (Pro-Banthine), doxepin (Sinequan), quinidine (Quinidex), chlorpromazine (Thorazine), hydroxyzine (Vistaril), and tiotropium (Spiriva).
These anticholinergic drugs can cause problems not just by reducing the supply of saliva but also by causing fever, confusion, blurred vision (leading to falls), and memory disturbance.
Any medication that interferes with alertness and attentiveness can interfere with safe swallowing. These include drugs used for agitation, allergies, anxiety, sleep, pain, or psychosis such as alprazolam (Xanax), chlordiazepoxide (Librium), clonazepam (Klonopin), diazepam (Valium), flurazepam (Dalmane), lorazepam (Ativan), oxazepam (Serax), triazolam (Halcion), buspirone (Buspar), zalepion (Sonata), zolpidem (Ambien), and diphenhydramine (Benadryl).
Major tranquilizes of the phenothiazine class – such as chlorpromazine (Thorazine) and thioridazine (Mellaril) – and haloperidol (Haldol) can interfere with swallowing by causing stiffening of swallowing muscles in the throat.
Other medications allow for reflux of acidic stomach contents back into the esophagus. That can cause symptoms of GERD (gastroesophageal reflux disease) such as heartburn, chest pain, or a bitter taste in the mouth. Medications to be on the lookout for include benzodiazepines (such as Valium), aminophylline, albuterol (Proventil, Ventolin), ipratropium (Atrovent), and terbutaline (Brethine).
Use your favorite search engine to check out side effects and interactions of prescribed and over-the-counter drugs your loved one is taking. If you think there might be a swallowing problem due to medications or any other cause, be sure to discuss your findings and concerns with your doctor.
About the author:
Joel Herskowitz, M.D., is a member of the Boston University School of Medicine faculty. Roya Sayadi, Ph.D., CCC-SLP, his wife, is a speech-language pathologist with the Natick (Massachusetts) Visiting Nurses Association.
They are co-authors of SWALLOW SAFELY: How Swallowing Problems Threaten the Elderly and Others. A Caregiver’s Guide to Recognition, Treatment, and Prevention (publication date August 2010) available through www.SwallowSafely.com and Amazon.com.
