What are the options for managing dysphagia (difficulty swallowing) in patients with Attention Deficit Hyperactivity Disorder (ADHD) who have trouble swallowing pills?

From the Guidelines

For individuals with ADHD who struggle with swallowing pills, the most effective option is to use alternative formulations such as liquid medications, chewable tablets, or transdermal patches, as they provide the same therapeutic benefits without requiring pill swallowing. When considering alternative formulations, it is essential to evaluate the patient's specific needs and preferences, as well as the severity of their ADHD symptoms 1. Some available options include:

• Liquid medications like methylphenidate oral solution (Quillivant XR) or amphetamine oral solution (Dyanavel XR)
• Chewable tablets such as methylphenidate chewable (Methylin) or amphetamine chewable (Adzenys XR-ODT)
• Capsules that can be opened and sprinkled onto a small amount of soft food like applesauce or yogurt, such as Adderall XR, Ritalin LA, and Focalin XR
• Transdermal patches like the methylphenidate transdermal system (Daytrana) These alternatives can help improve medication adherence and reduce the risk of adverse events associated with difficulty swallowing pills 1. It is crucial to follow specific administration instructions carefully to ensure proper dosing and effectiveness, and to regularly assess medication adherence and potential issues in adherence openly with the patient 1. Additionally, factors such as attitudes of patients and parents toward pharmacological treatment, a trustful physician-patient relationship, family support, and knowledge about the disorder and the intended medication should be evaluated and improved if possible to increase medication adherence 1.

From the Research

ADHD Treatment Options for Difficulty Swallowing Pills

• Patients with ADHD who have difficulty swallowing pills have several options available to them, including chewable tablets, capsules that can be sprinkled on soft food, liquids, and transdermal patches 2, 3.
• These alternative formulations can help improve treatment adherence and reduce difficulties associated with swallowing traditional pills 2, 3.
• Clinicians can choose from a variety of methylphenidate and amphetamine formulations to meet individual patient needs, including liquid, chewable, sprinkled capsule, wearable patch, and orally disintegrating tablet formulations 3.
• Behavioral training may also be an effective approach for teaching pill-swallowing skills to young children with ADHD or autistic disorder, with some studies showing successful outcomes 4.

Available Formulations

• Chewable tablets: available for some amphetamine compounds 2.
• Capsules that can be sprinkled on soft food: available for some amphetamine compounds 2.
• Liquids: available for some methylphenidate and amphetamine formulations 3.
• Transdermal patches: available for some methylphenidate formulations 3.
• Orally disintegrating tablets: available for some methylphenidate and amphetamine formulations 3.

Considerations for Clinicians

• Clinicians should consider individual patient needs and preferences when selecting a formulation 2, 3.
• Patients who have difficulty swallowing pills may require alternative formulations to improve treatment adherence 2, 3.
• Behavioral training may be a useful approach for teaching pill-swallowing skills to young children with ADHD or autistic disorder 4.