Meds hard to Swallow?

[Charles-2021]

I was recently prescribed Stribild. I’m having great difficulty in swallowing these large pills, they are very uncomfortable and sore on my throat. If it safe and just as effective, to cut in half, crush into smaller pieces or dissolve the whole tablet in water, and then consume with food?

[Jim Allen]

Hiya,

Welcome to the forum.

Sorry to hear that you are having problems taking the meds.
How are things going and how are you doing otherwise?

If it safe and just as effective, to cut in half, crush into smaller pieces or dissolve the whole tablet in water, and then consume with food?

I suspect most references will say to take Stibild whole or that there is insufficient data.
https://asp.nm.org/uploads/9/0/7/8/90789983/crush_do_not_crush_hiv_8.6.18.pdf
https://www.ema.europa.eu/en/documents/product-information/stribild-epar-product-information_en.pdf

However, there was a small study on this:

https://i-base.info/htb/31372 "The boosted integrase inhibitor-based fixed dose combination (FDC) Stribild (STB) can be safely crushed without affecting pharmacokinetics."

The best would be to talk to your clinic or doctor about these issues.

[Charles-2021]

Thank you for helpful reply Jim Allen. I'm doing fine, but unfortunately have found out that my current HIV Doctor/Clinic is not trustworthy or honest. That is the very reason I decided to post on here? Hoping, actual users of hard to swallow meds, will comment on this problem?

[Jim Allen]

I'm doing fine, but unfortunately have found out that my current HIV Doctor/Clinic is not trustworthy or honest.

If you don't trust your doctor then perhaps it's time to consider visiting a different clinic.

[J.R.E.]

Hi,

There was a thread here, years ago, discussing this issue. I found it, click on the link below, to see if any of the advice within the thread, may help you. Its always sad, bringing up a thread, where several members are no longer with us, but the advice still good and still remains. This thread was from 2007.

https://forums.poz.com/index.php?topic=17425.msg221234#msg221234

Also not sure where you are at, but drug stores sell devices, made specifically, for helping those, that have difficulty in swallowing large pills.

I posted a link it, in that thread to this device. but if you do a search, you will find more available.

https://www.youtube.com/watch?v=6XxB_yy8j0M&t=90s You may have to start this video from the beginning.

It does get easier in time...


Ray

[Charles-2021]

Thanks for that info J.R.E, much appreciated. However, seems to be mostly info on how to swallow.. I don't want to swallow lol I need to simply know if it is okay to disolve pills in a glass of water and comsume with food? Does no one do this?

[J.R.E.]

Thanks for that info J.R.E, much appreciated. However, seems to be mostly info on how to swallow.. I don't want to swallow lol I need to simply know if it is okay to disolve pills in a glass of water and comsume with food? Does no one do this?

  Ok,.. I understand. I would do a little more research into the link that Jim provided.  If possible, talk to a Pharmacist,  and see if you can get an opinion, or talk to another Doctor, on cutting the med into two pieces, and then taking them separately for the ease on throat. I doubt that medication is enteric coated, but I may be wrong. If it was, then cutting the pill in half, could possibly have a negative effect.



The only pill I have ever cut in half, is my cholesterol medication. It's 40mg, and my dose is 20mg. I personally don't know anyone, that cuts the HIV med or crushes them, but that doesn't mean it can't possibly be done in some cases.

Just curious,... Your not dealing with any esophageal issues are you. It's just the medication you having trouble with ?

Take care---Ray

[leatherman]

meds that are taken with food are taken that way as the food produces more acid, which changes the timing of the med dissolving and the absorption of the med. Definitely check with a pharmacist.

mostly info on how to swallow.. I don't want to swallow

as one who has had to swallow huge pills like kaletra, norvir, isentress, Sustiva, prezcobix, antibiotics, etc. the size of stribild is not much different from quite a number of ARVs and other meds.

this is the advice given me by my very first HIV doctor in 1992. Although I really disliked that doctor, I often think of him when I think about swallowing pills because of what he told me:
your mental thinking on swallowing could actually be the issue here. Next time you chomp off a bite of burger or stick a forkful of spaghetti in your mouth and chew, pay attention to how much you swallow. the volume of food will be much larger than your stribild pill. So it's not as much the volume of the pill that makes it hard to swallow as it is over-thinking swallowing a large pill.

[Grasshopper]

your mental thinking on swallowing could actually be the issue here........ So it's not as much the volume of the pill that makes it hard to swallow as it is over-thinking swallowing a large pill.

Well said

I've been swallowing since 1992.   ;-)))))))

[fabio]

You could ground it up and have it with some yogurt so it will be easier to swallow, since you need to take it with food. Do contact your healthcare professional, he/she might suggest something better.

[Almost2late]

I remember having issues that when I attempted to swallow my triumeq, they'd get stuck in my throat. Not sure why but it was like my throat got narrow. I had to gag it back out, and then took a razor to the monstrosity and cut it in half. Then swallow it with really huge gulps of water. Eventually my throat issue had resolved itself, and I went back to swallowing it whole.
But I did make sure to wash it down with plenty of water.. big gulps.

[wardp]

Maybe you should see an ent specialist and let him examine your throat tonsills etc etc

[crisbarcelona]

Hello Charles-2021 and to hello to everybody

First of all, sorry for my Englis that is not my mother language.

I want to tell you that I had the same problem when I was diagnosed. I had problems to swallow the meds.

Do you Know what I do ??
I cut the pill in little pieces in my mouth with my teeth and I take them with liquid.
 I am doing this for 2 years and I dont have any problem. The meds are working very well and my doctor say that is ok. Virus is undetectable and my CD4 are very high.
Dont be worried and you can try this. Will help you very well.

[leatherman]

Maybe you should see an ent specialist and let him examine your throat tonsills etc etc

good thought

Charles if you've had thrush, you may want to consider this:
in the past when more people reached advanced HIV/AIDS condition, thrush seemed to be more of a problem than these days. Thrush spreads easily and quickly, and when you see thrush in your mouth, it's probably already spread down into your throat. This can lead to scar tissue which can lead to swallowing issues. A Balloon endoscopy (a tube with a balloon end is inserted through the mouth and down the throat) can stretch the throat open. This procedure may need to be done again as needed.

[PozChilean]

I cut the pill in little pieces in my mouth with my teeth and I take them with liquid.

Now THIS I need to see! You sound like quite a skilled man. 

[Charles-2021]

Hello Again,,,

Thank you, for all comments everyone. I have absolutely no history of esophageal issues or thrush etc . I think 'crisbarcelona's' actual hands on experience with this, should be respected and I think I will crush my Meds into powder and mix with water, and comsume with food. Also 'fabio's' yogurt method seems to be a good idea too!

I have been experimenting with disolving Stribild in water, very interesting! The tablet splits into two parts, and the GSI imprint continues ALL the way through the tablet, not just scratched into the surface.

If anyone would advise against desolving meds in water, please give reasons etc
If there are others like crisbarcelona and fabio, who actual take meds crushed into powder etc, please leave a comment.

[bocker3]

I would not try this without speaking with my doctor - or a pharmacist, at least.

Just because someone else does it with their pill doesn't mean that it would be OK with your pill.  crisbarcelona didn't say what pill he was taking.

It's actually a pretty good idea, in general, to not just do what others do.  Everyone's situation is different - a doctor or pharmacist can help you be sure your situation is similar (or not).

Mike

[fabio]

I would not try this without speaking with my doctor - or a pharmacist, at least.

Just because someone else does it with their pill doesn't mean that it would be OK with your pill.  crisbarcelona didn't say what pill he was taking.

It's actually a pretty good idea, in general, to not just do what others do.  Everyone's situation is different - a doctor or pharmacist can help you be sure your situation is similar (or not).

Mike

Exactly what Mike says. You should first ask your doctor . You could also check your med leaflet where it might say whether you can take  a med a certain way in case you can't swallow.

[leatherman]

hands on experience with this, should be respected

one thing that hasn't been mentioned in this thread, and why a pharmacist or doctor should be consulted, is absorption rate. Pills are made in certain forms to be absorbed by your body at certain rates. Meds that require food do it because more food produces more stomach acid which dissolves the medication at a higher rate. Dissolving a pill in water could change the absorption rate. More medication absorbed faster could perhaps cause negative side effects or even change the length of time the chemicals stay in your body, degrading your treatment to subpar levels.

[Almost2late]

Pills are made in certain forms to be absorbed by your body at certain rates.

Good point, and I actually thought about this when I split Triumeq in half, and had no intentions on continued use like this.

Now I don't actually take Triumeq any more but the same drug equivalent is in Tivicay & Epzicom after ADAP asked me to switch to cut cost.. they did me a favor cause Tivicay is a tiny pill, and Epzicom isn't tiny but certainly not as big as Triumeq.. so the switch worked for me.

@Charles2021 maybe you can ask your doctor to prescribe a 2 or 3 pill combination with the same components as Stribild or a combination that's just as effective without having to swallow a huge pill. There's so many options and your doctor can help you find the right solution.

[Charles-2021]

I would not try this without speaking with my doctor - or a pharmacist, at least.

I thought Forums like this were for asking questions to get other opinions outside the advise of your doctor or pharmicist?

Why does everyone, just stop posting on forums and ask your doctor instead?

It seems Doctors have ALL the answers to everything! I do not trust Doctors lol

[Charles-2021]

I would not try this without speaking with my doctor - or a pharmacist, at least.

I thought Forums like this were for asking questions to get other opinions outside the advise of your doctor or pharmicist?

Why does everyone, just stop posting on forums and ask your doctor instead?

It seems Doctors have ALL the answers to everything! I do not trust Doctors lol

[crisbarcelona]

Hello,

I want to tell that I am taking "Bictarvy" and from the first day I am doing the same: I cut this in pieces in my mouth with the teeth and it works very very well. This is my experience.

I am U and very high CD4.

The doctor told me "the important thing is that you take the pill".

I have from little boy problems to take pills and this always helped me and worked well.

[bocker3]

I thought Forums like this were for asking questions to get other opinions outside the advise of your doctor or pharmicist?

Why does everyone, just stop posting on forums and ask your doctor instead?

I never said that you should ask people what their experience is -- I just pointed out that you should not take what I or someone else does, as permission for you to do the same.  Everyone's situation is different.
Ask away -- just remember that we aren't doctors, so all we have is our own anecdotal information.

Mike

[leatherman]

I thought Forums like this were for asking questions to get other opinions outside the advise of your doctor or pharmicist?
.....
It seems Doctors have ALL the answers to everything! I do not trust Doctors lol

Doctors don't have ALL the answers and who would expect them to anyway? everybody is different and what works for one person may not work for another. (that's why it's called "practicing medicine") But doctors are certainly better educated that most lay-people (ain't none of us here HIV doctors  ), and that education is exactly why you should trust your doctor to have SOME of the answers.

All people here can do is give their experiences; however you do not have the same genetics, age, lifestyle, health etc and probably don't take the same medications so whatever "advice" you think we might give you, especially if it's medical advice, should be taken with a grain of salt

You have said that you have an issue swallowing pills, and have gotten suggestions of how to deal with this issue. But you've also been advised/warned that you should speak to a professional who could, because of their educations/qualifications, give you more reliable information about what would happen if you took your pill by a different method (cutting, dissolving) or who could write a prescription for a different type/form of medication that might be easier for you to take.

[Almost2late]

It seems Doctors have ALL the answers to everything! I do not trust Doctors lol

I have yet to run into any doctor who says "they have ALL the answers", and I would not trust too if they made such a rediculous claim.
But I'm still here because I trusted my doctor after they prescribe me life saving medications, and listened and worked with me when my medication caused me adversed effects and tried something else that was a better fit for me.

Not sure why you distrust doctors.. you're in quite a situation bc you will have to deal with them for pretty much the rest of your life. I suggest you find one you do trust.

[TGun]

take them with a warm liquid, i use morning coffee,, dont even notice them anymore.  in fact i take all my meds, including vitamins in one shot now with this method.

[Almost2late]

Option to Take Crushed Stribild Tablets With Food or Enteral Nutrition

The boosted integrase inhibitor-based fixed dose combination (FDC) Stribild (STB) can be safely crushed without affecting pharmacokinetics. Mieke Jongbloed-de Hoon et al from Radboud University Medical Center, Nijmegen carried out this open-label, three-period, single dose, randomised, cross-over, trial in 24 HIV-negative volunteers to asses the safety and absorbance of the four constituent drugs in the FDC, when taken with a standard breakfast meal or with enteral nutrition.

Stribild is an FDC of elvitegravir (EVG), cobicistat (COBI) booster, emtricitabine (FTC) and tenofovir-DF (TDF).

For people who are severely ill or have difficulty swallowing, taking whole tablets can be difficult. While crushing tablets helps with administration in such cases, it can also adversely affect the pharmokinetics (PK) of the drug, leading to decreased or increased drug levels, and in turn drug resistance or toxicity. In addition, the integrase inhibitor elvitegravir can form complexes with cations contained in enteral nutrition, reducing its absorbance. As no information is currently available about crushing STB, this study aimed to determine the bio-equivalence of crushed STB taken with a standardised breakfast or with enteral nutrition, in comparison to administration of the whole tablet.

The study consisted of three treatment regimens:

Reference treatment: a single dose of a whole tablet of STB combined with breakfast.
Intervention 1: a single dose of a crushed and suspended tablet of STB combined with breakfast.
Intervention 2: a single dose of a crushed and suspended tablet of STB combined with enteral nutrition.
Volunteers were randomised to one of the six possible sequences: ABC, ACB, BCA, BAC, CAB, or CBA, with each treatment period followed by a seven-day wash out. The standardised 350 kcal breakfast contained two slices of buttered wheat bread (one slice with 40+ cheese and one with luncheon meat or cervelat) and one cup of tea; 350 mL of enteral nutrition, Nutrison (Nutricia), contained also 350 kcal and was orally ingested.

Three standard PK curves were produced for each participant with frequent blood samples taken over a 32-hour period following observed intake. Liquid chromatography was used to measure plasma concentrations of EVG, COBI, TFV and FTC.

Half the participants were women, median age was 37 and all were Caucasian except one who was mixed race. Intervention 1 (crushed STB with standardised breakfast) versus reference treatment (whole tablet) for time 0 to 32 hours AUC was bio-equivalent. All the 90% confidence intervals for EVG, COBI, TFV and FTC fell between 80-125%. In contrast, bio-equivalence for Cmax of EVG, COBI and TFV could not be shown between intervention 1 and the reference treatment (whole tablet). For EVG the 90% CI was above the required limit of 80-125% at 105-127%. For COBI and TFV the 90% CI was under the required limits, at 76-91% and 71-92% respectively. For intervention 2 (crushed STB with enteral nutrition) versus reference treatment, all 90% CIs were within the required limits, meaning that the AUC and Cmax of crushed STB with enteral nutrition was bio-equivalent with reference treatment.

While crushed STB with breakfast had no influence on the total AUC, (compared with a whole tablet with breakfast), it did have a small influence on the Cmax. The Cmax of EVG was increased by 16% and the Cmax of TFV was decreased by 19%. The authors state that these differences between Cmax of crushed STB and a whole STB are small and considered to be less relevant in clinical practice, as inter-patient variation is much larger.

https://www.thebodypro.com/article/option-to-take-crushed-stribild-tablets-with-food-

[BubbaPat]

I've had problems taking ANY pills.  I drink mine with a glass of milk.

[snoofle]

I am an ID doctor at a large HIV clinic in the South and the data suggests that Stribild/Genvoya can be crushed and mixed with breakfast or parental nutrition. That being said, it is highly recommended you discuss this with your medical provider.m

There are also smaller tablet or liquid regimen options.