Medications and Dysphagia

Why Should Clinicians Care?

The patient’s medication is often overlooked as a source of a problem contributing to the patient’s symptoms of dysphagia. This type of dysphagia, one of the most readily corrected, is known as drug-induced dysphagia. Three major drug-induced dysphagia mechanisms have been identified (Balzer, 2000):

• Dysphagia as a side effect

• Dysphagia as a complication of therapeutic action

• Medication-induced esophageal injury

Identifying Medication-Induced Dysphagia

• Complete a thorough chart review and history of the patient’s medications.

• Identify any significant past medical history or current symptoms that may place patient at risk for dysphagia.

• Determine if the patient is on any medications commonly associated with dysphagia.

(American Epilepsy Society, 2006; Balzer, PharmD, 2000; Boyce, 1998; Feinberg, 1994; Gelman, Rumack, & Hutchinson, (2017); Hibbs & Zambon, 2011; Lacy, Armstrong, Goldman, & Lance, 1999–2000; Larijani, Gratz, Silverberg, & Jacobi, 1991; McLean & Ariano, 2017; National Institutes of Health [NIH], 2017; Sliwa & Lis, 1993; Stoschus & Allescher, 1993)

Disease States Associated with Dysphagia

• Neurologic disease

• Parkinson’s disease

• Dementia

• Seizure Disorders

• Muscular disease

• Psychiatric disease

• Anxiety

• Depression

• Bipolar Disorder

• Schizophrenia

Common Medications That Can Induce Dysphagia

• Anticholinergics

• Antipsychotics

• Antidepressants/Anti-anxiety and insomnia medications

• Anticonvulsants

• Neuromuscular Blocking and Muscle Relaxers

• Immunosuppressant Medications

Clinician’s Note

Anticholinergics are used to treat excessive drooling, excess secretions, some allergies, nausea, and urinary incontinence. Some common over the counter antihistamines (Benadryl) and Tylenol PM may produce these (as well as other) central effects, such as sedation and inability to concentrate

Anticholinergic Medications

Common Anticholinergic Medications

Source: Adapted from “Drug-Induced Dysphagia” by K. M. Balzer, PharmD, 2000, International Journal of MS Care, 2(1), p. 6.

How Anticholinergics Cause Dysphagia

• Anticholinergics suppress gastrointestinal (GI) secretions and motility.

• Reduced GI motility can affect the oral phase, pharyngeal phase, and esophageal phase of swallowing.

• Decreased saliva can also affect taste, appetite, and the anticipatory stage of the swallow.

• Xerostomia may disrupt the oral preparatory and oral stages of the swallow, subsequently affecting bolus formation and transport.

• Reduced lubrication in nasal passages may affect smell and taste, and may also impacts the anticipatory stage of swallowing.

Antipsychotic Medications

Antipsychotic medicines are used to manage psychosis (conditions that affect the mind). In most cases, there has been some loss of contact with reality, and often includes delusions (false, fixed beliefs), or hallucinations, (hearing or seeing things that are not really there). Antipsychotic medications are often used in combination with other medications to treat delirium, dementia, and mental health conditions.

Antipsychotic/Neuroleptic Medications

Source: Adapted from “Drug-Induced Dysphagia” by K. M. Balzer, 2000, International Journal of MS Care, 2(1), page 6.

Antidepressant/Anti-Anxiety Medications

Antidepressants are medications commonly used to treat depression. Antidepressants are also used for other health conditions, such as anxiety, pain, and insomnia.