Toggle Main Menu Toggle Search

Open Access padlockePrints

Identifying and addressing pill aversion in adults without physiological-related dysphagia: A narrative review

Lookup NU author(s): Dr Alice McCloskey, Dr Yincent TseORCiD, Dr Emma Lim



This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).


© 2022 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society. Solid oral dosage forms (SODFs) (often called pills by patients) are the default formulation to treat medical ailments. Beneficial therapeutic outcomes rely on patients taking them as directed. Up to 40% of the population experience difficulties swallowing SODFs, resulting in reduced adherence and impaired therapeutic efficacy. Often associated with children, this also presents in adults with dysphagia, and without any organic dysphagia (non-physiological-related or functional dysphagia). This review aims to identify and appraise current interventions used to screen for and overcome pill aversion in adults with functional dysphagia. A comprehensive search of the literature was conducted. Articles reporting pill aversion in adults aged ≥18 years with no underlying cause, history of, or existing dysphagia were included. Study quality was determined using the STROBE tool for observational studies. A narrative synthesis of the findings was prepared. We identified 18 relevant cohort studies, which demonstrate that pill aversion is a global problem. Perceived ease of and/or SODF swallowability appears to be influenced by female gender, younger age, co-morbidities (e.g., depression), and physical SODF properties. Patients often modify their medicines rather than raise this issue with their healthcare team. Screening for pill aversion is haphazard but controlled postural adjustments, coating SODFs and behavioural interventions appear to be successful solutions. SODF swallowing difficulties are a barrier to effective medication use. Healthcare professionals must recognise that pill aversion is a problem requiring identification through effective screening and resolution by training interventions, appropriate formulation selection or specialist referral.

Publication metadata

Author(s): McCloskey AP, Penson PE, Tse Y, Abdelhafiz MA, Ahmed SN, Lim EJ

Publication type: Review

Publication status: Published

Journal: British Journal of Clinical Pharmacology

Year: 2022

Volume: 88

Issue: 12

Pages: 5128-5148

Print publication date: 01/12/2022

Online publication date: 18/07/2022

Acceptance date: 27/06/2022

ISSN (print): 0306-5251

ISSN (electronic): 1365-2125

Publisher: John Wiley and Sons Inc


DOI: 10.1111/bcp.15463

PubMed id: 35849849