Posted August 21, 2019

Large Multivitamin, Calcium Pills Can Be a Choking Hazard for Older Adults

Approximately 19% of adverse events associated with dietary supplements involve swallowing problems, especially choking, and this is mostly likely to occur in adults age 65 or older, according to a new report published in the Annals of Internal Medicine.

The researchers examined adverse events submitted to the FDA Center for Food Safety and Applied Nutrition Adverse Event Reporting System (CAERS) over a 10-year period, from 2006 to 2015. Choking was the most frequently reported swallowing problem (86.0%), followed by foreign body trauma (7.8%). Three deaths attributed to supplement-induced airway obstruction or aspiration were reported.

Most incidents involved multivitamins (72.9%) or calcium supplements (17.3%), both of which are commonly sold in large pill sizes, followed by supplements for pain or arthritis relief (2.3%). A single multivitamin product marketed to older women was involved in 40.6% of swallowing problem reports. The average pill size of supplements associated with swallowing difficulty or choking was 19.3 mm -- longer than the FDA's recommended limit of 17 mm for generic drug pills, and close to its limit of 22 mm for all drug tablets and capsules. Currently there are no similar FDA guidelines for dietary supplement pills. 

The researchers suggested decreasing the dosage size or adding pill coatings might help to address the problem, and advised that consumers speak with their pharmacists or physicians about ways to address swallowing difficulties. Drinking ample water when swallowing pills can also help.

ConsumerLab's Reviews of Multivitamin and Multimineral Supplements, Calcium Supplements, Joint Health Supplements and other products include information about the pill sizes, and often include alternatives to tablet and capsule products, such as chewable tablets, powders, and liquids. 

See ConsumerLab's answer to the question Is it okay to break vitamin tablets, pills or capsules to change the dose or make them easier to swallow?

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