How Bad Is It Really to Swallow Pills Without Water?

At some point, we've probably all popped a pill without water. But this seemingly harmless habit can have some unintentional consequences for your health.

Here, Pauline J. Jose, MD, medical education director at pH Labs and clinical instructor in the department of family medicine at UCLA, explains what can happen when you dry swallow a pill on the fly (spoiler alert: it's not pleasant) and provides proper tips for taking tablets.

Without water to help a capsule seamlessly slide down your throat, it's possible for a pill to become lodged there.

Tablets tend to get caught in the cricopharyngeus, a ring-like muscle at the top of the esophagus, according to University of Rochester Medical Center. And when this happens, it can be a choking hazard.

The risk of choking is higher in some populations, including elderly folks, individuals with swallowing issues (such as those recovering from a stroke) and people with neurological problems like Parkinson's disease, Dr. Jose says.

But even if you're in overall good health, dry swallowing pills can trigger certain reflexes that hinder swallowing and result in choking.

For example, to successfully swallow a pill, you must first overcome the chewing reflex, which gets prompted with the presence of something on the tongue, Dr. Jose says. Then there's the gag reflex. This is activated when the base of the tongue or tonsils are touched, she says.

If a pill gets stuck in the esophagus, it can disintegrate there. As it dissolves, its acidity may burn your throat's lining, Dr. Jose says. And this can make the delicate area irritated and inflamed.

In certain cases, a lodged capsule can even lead to esophageal tissue damage, Dr. Jose says. This is known as drug-induced esophagitis, a condition that causes uncomfortable symptoms such as painful swallowing, chest pain, heartburn and acid regurgitation, per the Mayo Clinic.

And when a pill sits in your throat for too long, almost any type of medication can produce problems for your esophagus (including ulcers), according to a small April 2014 study published in the ‌Turkish Journal of Gastroenterology‌‌.‌

The most common culprits in your medicine cabinet include, per the Mayo Clinic:

• Over-the-counter pain-relievers, such as aspirin, ibuprofen and naproxen sodium
• Antibiotics, such as tetracycline and doxycycline
• Potassium chloride (used to treat potassium deficiency)
• Bisphosphonates (used to treat osteoporosis)
• Quinidine (used to treat heart problems)

Swallowing pills sans water can also bring about a bad or bitter taste on your tongue, Dr. Jose says. Again, this relates to the idea that your medication may melt a little and leave behind some residue before making its journey down to your stomach.

While not harmful per se, a terrible tasting tablet can negatively affect your overall pill-swallowing experience. And this might discourage you from taking your pills as prescribed, which can be potentially detrimental to your health.

Try these tips to make sure your capsules go down easily every time:

• ‌Drink some water.‌ Taking your tablets with lots of liquid will help prep your throat to push a pill past your esophagus, according to the University of Rochester Medical Center. "The minimum amount of water for swallowing pills is 50 to 60 milliliters [just about 1.5 to 2 ounces]," Dr. Jose says. "Amounts less than 30 milliliters may impede a pill's transport, getting it stuck in the esophagus," she adds.
• ‌Move your head:‌ Adjusting your head and body position can help make the pill-swallowing process easier, Dr. Jose says. Try the chin-down position: Put the pill on your tongue, and take a sip of water then bend your head forward, tucking the chin toward the chest and swallowing the pill with the water. Or, try the chin-up position, putting the pill on the tongue, tilting the head back, taking a sip of water and then swallowing.
• ‌Take your tablet with food:‌ Adding a little applesauce to your medicine may assist your swallowing muscles and make taking tablets less troublesome, per the University of Rochester Medical Center. However, certain medicines are meant to be taken on an empty stomach. Thus, mixing pills with food may increase the risk of a food-to-drug interaction, Dr. Jose says. This can potentially decrease the absorption and therapeutic effect of your medication. Always ask the pharmacist or your medical provider what you can add to your medication, she says.
• ‌Crush the pill:‌ Mashing up your meds and taking them with water can also be helpful. Again, always consult your pharmacist first. Certain pills, like long-acting or slow-release drugs, will work less effectively when crushed, per the University of Rochester Medical Center.

Even if you've taken every precaution, sometimes a stubborn pill will still get stuck. Here are some simple strategies to help dislodge it:

• ‌Bite a banana:‌ You should always discuss whether it's OK to take your pills with food. But if you're in a pinch with a pill lodged in your throat, eating a banana will help push the pill down, Dr. Jose says.
• ‌Drink water:‌ Yep, sipping on some more H2O will eventually displace a sticky capsule from your throat.

While tossing back a tablet without water from time to time probably won't harm you, don't make it a habit. The potential downsides of dry swallowing pills outweigh any convenience. And a dry pill popping practice can prove especially dangerous for people with certain health conditions that hinder swallowing.

All this to say, better to be safe than sorry: If you need to take a pill, get off your butt and go get a glass of water to wash it down.