“Doc, I Just Can’t Swallow Pills”: HIV Infected Patients and Pill Phagophobia

Abstract

Transient or chronic pill phagophobia-fear of swallowing pills-affects many adults and can be associated with nonadherence or use of an alternative pill swallowing strategy such as breaking, crushing or chewing medications. Patients with HIV require the chronic use of antiretroviral therapy (ART) to maintain health, but factors such as psychogenic dysphagia for pills may affect their ability to adhere to these medications. Use of alternative strategies such as crushing medications to decrease overall pill size have been shown in several studies to result in altered medication absorption, which may result in incomplete virologic suppression, increased adverse effects, and a suboptimal health outcome. This article reviews potentially useful swallowing strategies for the adult patient without physiologic dysphagia who cannot swallow pills.