Dysphagia & Medication Adherence: What We Need to Know

Supporting safe and convenient medicine administration with Novumgen's Orodispersible Tablet portfolio

Overview of Dysphagia

Dysphagia or difficulty swallowing is a major barrier to effective and safe medicines use in healthcare. It is associated with a wide range of health conditions.1

In general practice, understanding how to identify swallowing difficulties and select the most appropriate formulation is vital. Orodispersible tablets (ODTs) provide an important alternative to solid oral dosage forms & oral liquids, supporting swallowing safety, administration ease and medication adherence, particularly where liquid medicines, crushing, or splitting tablets may be unsafe or impractical.

This article provides an overview of dysphagia, key patient groups at risk, concerns around drug modification, and how Novumgen's ODT portfolio can support patient safety, adherence, and convenience.

Prevalence of Dysphagia2

Evidence from 27 studies shows Dysphagia is more common than usually recognised in general practice:

  • Global dysphagia prevalence is roughly 44%, with reported rates ranging from 7% to 96%.
  • Older adults show the highest prevalence, increasing steadily with age.
  • Markedly high rates occur in dementia, stroke, neurological conditions, and some paediatric groups.
  • Large regional variation, highest in Africa (~64%) and lowest in Australia (~7%).

Key Patient Groups at Risk3

1. Older adults

  • Age-related changes in swallowing function can reduce oral and oesophageal motility, increasing risk

2. Patients with oral or structural issues

  • Dental problems, jaw disorders, tumours of the mouth, pharynx, or larynx
  • Post head or neck surgery or radiotherapy causing fibrosis or mechanical deficits
  • Masses outside the pharynx or oesophagus (e.g. vertebral osteophytes)

3. Patients with neurological or neuromuscular disorders

  • Stroke, brain tumours, or neurodegenerative diseases (Parkinson's, ALS, multiple sclerosis)
  • Neuromuscular conditions like myasthenia gravis
  • Dementia or other cognitive impairments affecting swallow control

4. Patients with systemic or connective tissue diseases

  • Scleroderma or polymyositis causing tissue stiffening or muscle dysfunction
  • Immune-mediated conditions affecting swallowing muscles

5. Patients with oesophageal disorders

  • Structural narrowing (strictures, tumours, diverticula)
  • Motility disorders (achalasia, oesophageal spasm)
  • Inflammatory conditions (GERD, oesophagitis, eosinophilic oesophagitis)
  • Radiotherapy-induced fibrosis or stenosis

6. Patients with functional or psychosocial causes

  • Anxiety, PTSD, stress attacks, or other psychosocial disorders with no organic cause

7. Post-surgical patients

  • Especially following head, neck, oesophageal, or maxillofacial procedures.

8. Paediatric patients

  • Due to tablet size

Identifying swallowing difficulties is crucial, as unrecognized dysphagia can compromise adherence, medication effectiveness, and safety, potentially increasing healthcare utilization and burden. Research indicates that around 62% of older adults are either not screened or occasionally screened for swallowing difficulties, and that most healthcare professionals lack training to assess this.4 NICE guidance on medicines optimisation also underscores the need to account for adherence-related factors, such as a patient's capacity to swallow medications.5

Concerns around Solid Oral Dosage modifications6

Crushing tablets or opening capsules is common among patients with swallowing difficulties. However, it is of utmost importance to learn the risks associated with modifying solid oral dosage forms:

  • Increased toxicity (crushing extended-release products results in dose dumping & aggravated GI irritation)
  • Medication errors & incorrect dosage administration (loss of drug during crushing process)
  • Reduced efficacy (crushing enteric-coated tablets may result in the drug being destroyed by stomach acid)
  • Drug instability (pharmacokinetic changes like altered release, peak levels or absorption)
  • Unpalatability (resulting in non-adherence)
  • Potential risk to healthcare workers (exposure to cytotoxic drugs)
  • Cross-contamination (one crushing device being used for multiple patient's medicines, placing patients at risk of adverse effects such as allergic reactions)
  • Off-label or unlicensed drug use (opening a capsule or crushing a tablet before administration, unless specified in the SmPC)

ODTs: A Convenient and Safe Alternative

ODTs dissolve rapidly on the tongue without requiring water. For many patients with dysphagia or medication-specific swallowing problems, ODTs offer an ideal balance between:

  • Ease of administration
  • Improved adherence
  • Consistent dosing
  • No need for crushing, splitting or measuring
  • Convenience in community and home-care settings

How ODTs help address dysphagia and adherence challenges7,8

  • 1. Reduced swallowing effort: ODTs disintegrate quickly in the oral cavity, avoiding the need to swallow intact tablets.
  • 2. Suitable for patients who cannot use liquids: Liquid medicines may be unsuitable due to taste, viscosity or availability. ODTs offer a practical alternative.
  • 3. Improved adherence: Difficulty swallowing tablets is a well-known contributor to poor adherence. ODTs lower this barrier, especially in older adults and long-term therapy.
  • 4. No need for water: Beneficial for patients with restricted fluid intake, mobility limitations, or patients on-the-go.
  • 5. Reduced risk of inappropriate dosage form modification: ODTs eliminate the need for crushing or modifying tablets/capsules & dose measuring; maintaining medicine integrity, accuracy and safety.
  • 6. Convenient for carers and healthcare teams: Fast administration reduces workload and improves accuracy in community and residential settings.

Novumgen's Commitment to Supporting Dysphagia and Adherence

Novumgen offers a growing portfolio of high-quality orodispersible tablet formulations designed to support patients with swallowing difficulties while ensuring convenience, safety, and therapeutic consistency.

Our ODT range is formulated to:

  • Disperse rapidly in the mouth
  • Deliver reliable and consistent dosing
  • Improve patient acceptance and comfort
  • Avoid the risks associated with crushing, splitting, or manipulating tablets
  • Support adherence across a range of therapeutic areas

Best Practice Recommendations for HCPs

1. Screen regularly

Ask every patient (especially elderlies and those with neurological conditions) about swallowing difficulties or frequent missed doses with possible reason.

2. Refrain from making unsuitable modifications to solid dosage forms

Consult SPS, SmPCs, or local policy before modifying any formulation.

3. Consider licensed ODT formulations early

For patients with dysphagia or poor treatment compliance.

4. Counsel patients and carers

Highlight the risks of altering medicines at home & counsel on methods of ODT administration & its benefits.

5. Monitor Outcomes

Check if swallowing difficulty is resolved/worsening, medicine tolerability and adherence over follow-ups

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References