View Full Version : Son can't swallow pills

01-29-17, 08:21 PM
My 8 year old is starting Straterra and refuses to swallow the pill. He is anxious about choking and I can hear him swallowing but he is somehow blocking the pill from going down. We have tried water, apple sauce, yogurt, whip cream, etc. We have tried bribing with rewards. He has practiced with small candies without any problems. There are a lot of tears and screaming and I feel like he is being traumatized every night we try and of course this is setting us back further and further. Any tips on how to get him to take the pill without a fight every night??

01-30-17, 05:14 AM
I have ADHD, and I fought pills exactly like that when I was his age. I wonder if that's "a thing" with ADHD sometimes.

I never had ADHD meds as a kid - it was the 1970s, no one in my town knew what ADHD was. I just remember not being able to take other pills because they made me feel like I was choking. My parents tried everything they could think of - nothing really worked. They got an antibiotic as a liquid one time because they told the doctor about the pill problem, but the liquid tasted terrible and I fought that too.

Maybe your doctor can recommend a non-pill option though. The fighting is very frustrating and traumatic for all concerned.

01-30-17, 06:09 PM
I was like this as well, till an advanced age.

Well into my teens I used to break Tylenols into quarters. Yes, I said quarters.

I don't THINK it matters if you break Strattera in half. It's not like Adderall XR or Concerta etc. Ask your doc tho.

01-30-17, 06:20 PM
Can I ask why it's been given at night, rather than in the morning?

You may be able to try a patch equivalent. Ritalin has a patch version (Daytrana), not sure about Straterra however.

02-13-17, 06:40 AM
Years ago I was unhappy with the idea of burdening my liver unnecessarily by being on long-term oral that time it was just anti-depressants and hormone replacement.

I had read about topical compounds, often made up by a compounding pharmacist in consultation with the doctor and the drug manufacturer to achieve the dosage prescribed by the doctor. The usual result is significantly decreased ovarall dosage and burden on the liver, because the medication enters the bloodstream through the skin, and that first trip through the digestive system is eliminated. I mention all this because my reasons had nothing to do with not being able to take a pill. I actually had unexplained high liver enzymes and it just seemed like a good idea to go easy on the old liver.

When I approached my psychiatrist about it (since the pharmacist might theoretically be able to compound an equivalent Rx without reference to the doctor, but ethically needs to be able to contact her directly) she was willing to give it a whirl. Over time we did this satisfactorily with several different drugs (usually after titrating the proper dosage first with pills). The resulting cream or gel might be measured or delivered in several different ways, usually to be rubbed on the skin, or in one case the pill was just used as a suppository (at 50% of the oral dose).

The point of my story , though, is that my doctor later told me that she was so happy to learn about compounding topicals because there were so many patients (hers and everyone else's) who had trouble taking pills, and it had been a godsend to know about another way to deliver medication.

02-13-17, 01:39 PM
I don't THINK it matters if you break Strattera in half. It's not like Adderall XR or Concerta etc. Ask your doc tho.
Strattera is not a medication that's meant to be split, unfortunately.

In addition to the difficulty of doing so precisely, something in the capsule can apparently be a skin or eye irritant.

From the manufacturer's "How to Take Strattera" information:

Do not chew, crush, or open Strattera capsules. Tell your healthcare professional if you cannot swallow Strattera whole
Avoid contact with a broken capsule. Wash hands and surfaces that touch an open Strattera capsule. If you get any powder in your eyes, rinse well with water and call your healthcare professional

For a lot of kids (and even some adults) with smaller throats, aversions to weird textures, and/or coordination difficulties (common in ADHD), pill-swallowing can be a real challenge.

Practicing with small candy like Tic-Tacs was going to be my first suggestion, but it sounds like you've already tried that. Hmm... :scratch:

I agree that forcing the pill down his throat would be unlikely to help matters -- even if it were physically possible or ethical.

Be aware that one of the common side-effects of Strattera is nausea/stomach upset; he may be more likely to notice that if he's already gagging and stressed from trying to swallow the pills. (In my personal experience, the stomach upset can often be mitigated by taking the medication at night and/or on a full stomach with a high-protein meal.)

I don't know whether compounding pharmacies could prepare something from atomoxetine that's either small enough to swallow or in liquid or patch form, nor how much such a service would cost, nor what safeguards ther are around those processes. Still, it may be worth looking into if none of the medications that come in liquid form (methylphenidate/Quillivant XR) or patch form (methylphenidate/Daytrana), nor the capsules that can be opened safely and mixed with yogurt/pudding/etc., are available in Canada, or if there's a medical reason to avoid them (already tried them, bad reaction to several stimulants, etc.). If these other medications are an option, they might be better places to start than a pill he simply doesn't yet have the ability to swallow (for whatever reason).

Do you know how your son feels about the ADHD diagnosis, and about taking medication, in general? (Besides physically swallowing a pill.) If he's resistant to the idea in any way -- and many kids are, for fear of being made fun of, because they think it means they're "bad" or "stupid", for fear of side effects, etc. -- that may make it all the more difficult to swallow a pill.

If you haven't already had a conversation like this, helping him understand both the diagnosis and the purpose of the medication, it's a worthwhile one to have. Being clear that you want his feedback -- since this is for him, not for you and not for his teachers -- may also help to open up the communication, and make finding out about both desired effects and side effects easier for you.

(Of course, if he can't swallow the medication and you can't find an alternative, some of that will be moot...)

Have you discussed this with his doctor yet? I'd guess that any doctor that treats a lot of kids is bound ot have seen this before, and may have tips and tricks (or be willing to prescribe a different medication).

Best wishes!

02-16-17, 02:09 AM
I remember I had a hard time with pills when I was a kid. I figured it was related to the other coordination issues I had (I took longer than most to ride a bike, tie shoe laces, etc) but sensory issues and anxiety probably didn't help.

If you end up looking into other meds because of this...

Instant-release methylphenidate (Ritalin), amphetamine salt (Adderall), and dextroamphetamine (Dexedrine) are okay to break or crush. The pills are that uncomfortable chalky texture.
Extended release methylphenidate as an OROS tablet (Concerta) needs to be swallowed whole.
I believe there is ER methylphenidate in a non-OROS capsule, but I'm not sure if that's okay to split. It should also be available as a patch (Daytrana), oral suspension (Quillivant XR), or chewable tablet (QuilliChew).
Extended release Amphetamine salt (Adderall XR) actually is okay to open, as long as you ingest all of the contents at once. I recall the patient info pamphlet saying to mix it with a spoonful of apple sauce in this situation. It made it sound like the apple sauce was mandatory.
Not sure about Vyvanse. I know it's a capsule (like Straterra).

02-16-17, 06:20 PM
Not sure about Vyvanse. I know it's a capsule (like Straterra).

The Vyvanse capsule can be opened and mixed with water or yoghurt. The brochure the paediatrician gave us showed that this was completely fine with this medication. That is the only way my daughter can take it as she can't/won't swallow capsules.

02-23-17, 05:08 AM
I couldn't swallow pills until I was 9 or 10. Looking back, I don't think there is anything I or someone else could have done to get me to learn faster.

I would look into a medication that doesn't require you to swallow pills such as the ones people have mentioned above.