From the Guidelines
Pill esophagitis can be caused by several medications that irritate the esophageal lining when they become lodged or dissolve in the esophagus, including antibiotics like doxycycline, tetracycline, and clindamycin; nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, and naproxen; potassium chloride supplements; bisphosphonates for osteoporosis like alendronate (Fosamax) and risedronate (Actonel); iron supplements; quinidine; and certain cardiac medications like captopril.
Causes of Pill Esophagitis
Some of the medications that can cause pill esophagitis include:
- Antibiotics like doxycycline, tetracycline, and clindamycin 1
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, and naproxen
- Potassium chloride supplements
- Bisphosphonates for osteoporosis like alendronate (Fosamax) and risedronate (Actonel)
- Iron supplements
- Quinidine
- Certain cardiac medications like captopril
Prevention of Pill Esophagitis
To prevent pill esophagitis, it is recommended to:
- Take medications with at least 4 ounces of water while sitting or standing upright
- Remain upright for at least 30 minutes afterward
- Avoid taking multiple medications at the same time
- Be especially careful with pill administration techniques if you have existing esophageal disorders, are an older adult, or are taking multiple medications
High-Risk Groups
People with existing esophageal disorders, older adults, and those taking multiple medications are at higher risk for pill esophagitis and should be especially careful with pill administration techniques 1.
Recent Studies
Recent studies have shown that certain medications can increase the risk of pill esophagitis, including antibiotics and NSAIDs 1. It is essential to follow the recommended guidelines for medication administration to minimize the risk of pill esophagitis.
From the FDA Drug Label
Adverse Reactions ... Rare instances of esophagitis and esophageal ulcerations have been reported in patients receiving capsule and tablet forms of the drugs in the tetracycline class. Most of these patients took medications immediately before going to bed. ADVERSE REACTIONS ... Esophagitis and esophageal ulceration have been reported in patients receiving particularly the capsule and also the tablet forms of tetracyclines Most of the patients were reported to have taken medication immediately before going to bed
Medications that can cause pill esophagitis include:
- Tetracycline 2
- Doxycycline 3 Key factors that may contribute to the development of pill esophagitis include taking these medications immediately before going to bed.
From the Research
Medications that Cause Pill Esophagitis
Medications that can cause pill esophagitis include:
- Tetracycline and its variants, such as doxycycline 4, 5, 6, 7
- Non-steroidal anti-inflammatory drugs (NSAIDs) 4, 5
- Alendronate, an aminobisphosphonate used to treat osteoporosis 8
- Aspirin (acetylsalicylic acid) 5
- Potassium chloride 5
- Ferrous sulfate 5
- Quinidine 5
- Alprenolol 5
- Steroidal and nonsteroidal anti-inflammatory agents 5
- Clindamycin, an antibacterial 5
Characteristics of Pill Esophagitis
Pill esophagitis is often associated with:
- Insufficient water consumption while taking the pill 8, 6
- Taking the pill in a recumbent position 8, 6
- Delayed passage of capsules or tablets through the esophagus 5
- Highly caustic coatings or direct medication injury 5
- Poor esophageal clearance of pills 5
Prevention and Management
To prevent pill esophagitis, patients should be warned to: