Drugs and Dysphagia

  • Jose Santiago Estevez Alonso
  • Isabel Zapico Garcia


The effects of drugs on swallowing ability is a commonly overlooked issue in the assessment of dysphagic patients, possibly overshadowed by the characteristic pluripathology and the difficulties on management of polymedication in these patients.

This chapter aims to be a basic guide to drug-related dysphagia. An overview of the main mechanisms by which drugs can modify swallowing, either by triggering or worsening a dysphagia, or improving deglutition. A review of the effects of medication is also carried out in some of the pathologies that most frequently present dysphagia and, finally, a management review and possible drug adaptations when administering drugs to patients with dysphagia is made.


Drug Medication Drug-induced dysphagia Dysphagia Deglutition disorders Swallowing disorders Iatrogenic dysphagia Xerostomy Drooling 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Mahony DO, Sullivan DO, Byrne S, Connor MNO, Ryan C, Gallagher P. Corrigendum: STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing. 2018;47(3):489. Scholar
  2. 2.
    Miarons M, Campins L, Palomera E, Serra-Prat M, Cabré M, Rofes L. Drugs related to oropharyngeal dysphagia in older people. Dysphagia. 2016;31(5):697–705. Scholar
  3. 3.
    Wiffen PJ, Derry S, Moore RA. Impact of morphine, fentanyl, oxycodone or codeine on patient consciousness, appetite and thirst when used to treat cancer pain. Cochrane database Syst Rev. 2014;(5):CD011056.
  4. 4.
    Carl LL, Johnson PR. Drugs and dysphagia: how medications can affect eating and swallowing. Pro-Ed; 2006. 333p.Google Scholar
  5. 5.
    Miarons Font M, Rofes Salsench L. Antipsychotic medication and oropharyngeal dysphagia. Eur J Gastroenterol Hepatol. 2017;29(12):1332–9. Scholar
  6. 6.
    Al-Shehri A. Dysphagia as a drug side effect. Internet J Otorhinolaryngol. 2001;1(2). Available from:
  7. 7.
    Balzer K. Drug-induced dysphagia. Int J MS Care. 2000;2(1):40–50. Scholar
  8. 8.
    Florez J, Armijo JA, Mediavilla A. Farmacología Humana. 6th ed. Barcelona: Elsevier Masson; 2014.Google Scholar
  9. 9.
    Mor A, Mitnick HJ, Pillinger MH, Wortmann RL. Drug-induced myopathies. Bull NYU Hosp Jt Dis. 2009;67(4):358–69.PubMedGoogle Scholar
  10. 10.
    Scully C. Drug effects on salivary glands: dry mouth. Oral Dis. 2003;9(4):165–76.CrossRefGoogle Scholar
  11. 11.
    Hopcraft M, Tan C. Xerostomia: an update for clinicians. Aust Dent J. 2010;55(3):238–44. Scholar
  12. 12.
    Smidt D, Torpet LA, Nauntofte B, Heegaard KM, Pedersen AML. Associations between oral and ocular dryness, labial and whole salivary flow rates, systemic diseases and medications in a sample of older people. Community Dent Oral Epidemiol. 2011;39(3):276–88. Scholar
  13. 13.
    Fusco S, Cariati D, Schepisi R, Ganzetti R, Sestili M, et al. Management of oral drug therapy in elderly patients with dysphagia. J Gerontol Geriatr. 2016;64:9–20.. Available from: Scholar
  14. 14.
    Lalla RV, Bowen J, Barasch A, Elting L, Epstein J, Keefe DM, et al. MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer. 2014;120(10):1453–61. Scholar
  15. 15.
    Watters AL, Epstein JB, Agulnik M. Oral complications of targeted cancer therapies: a narrative literature review. Oral Oncol. 2011;47(6):441–8. Scholar
  16. 16.
    Jiménez S, Herrera Ca R, Blanco A, Re AA, Martinez M. Therapeutic management of xerostomy at Primary Care. Med Fam. 2004;1:42–9.. Available from: Scholar
  17. 17.
    Srivanitchapoom P, Pandey S, Hallett M. Drooling in Parkinson’s disease: a review. Parkinsonism Relat Disord. 2014;20(11):1109–18. Scholar
  18. 18.
    Burks TN, Andres-Mateos E, Marx R, Mejias R, Van Erp C, Simmers JL, et al. Losartan restores skeletal muscle remodeling and protects against disuse atrophy in sarcopenia. Sci Transl Med. 2011;3(82):82ra37. Scholar
  19. 19.
    Nakashima T, Hattori N, Okimoto M, Yanagida J, Kohno N. Nicergoline improves dysphagia by upregulating substance P in the elderly. Medicine (Baltimore). 2011;90(4):279–83. Scholar
  20. 20.
    Rofes L, Arreola V, Martin A, Clavé P. Natural capsaicinoids improve swallow response in older patients with oropharyngeal dysphagia. Gut. 2013;62(9):1280–7.CrossRefGoogle Scholar
  21. 21.
    Ebihara T, Sekizawa K, Nakazawa H, Sasaki H. Capsaicin and swallowing reflex. Lancet. 1993;341:432.CrossRefGoogle Scholar
  22. 22.
    Nozaki S, Kuno S. Improvement of swallowing function with capsaicin jelly in patients with parkinsonism: a multicenter study. Dysphagia. 2010;25(4):354. Scholar
  23. 23.
    Pfeiffer RF. Neurogenic dysphagia. In: Bradley’s neurology in clinical practice. 7th ed. Philadelphia, PA: Elsevier; 2015. p. 148–157.e2.Google Scholar
  24. 24.
    Mu L, Sobotka S, Chen J, Su H, Sanders I, Adler CH, et al. Altered pharyngeal muscles in Parkinson disease. J Neuropathol Exp Neurol. 2012;71(6):520–30.CrossRefGoogle Scholar
  25. 25.
    Mu L, Sobotka S, Chen J, Su H, Sanders I, Nyirenda T, et al. Parkinson disease affects peripheral sensory nerves in the pharynx. J Neuropathol Exp Neurol. 2013;72(7):614–23.CrossRefGoogle Scholar
  26. 26.
    Baijens LWJ, Speyer R. Effects of therapy for dysphagia in Parkinson’s disease: systematic review. Dysphagia. 2009;24(1):91–102.CrossRefGoogle Scholar
  27. 27.
    Menezes C, Melo A. Does levodopa improve swallowing dysfunction in Parkinson’s disease patients? J Clin Pharm Ther. 2009;34(6):673–6.CrossRefGoogle Scholar
  28. 28.
    Fonda D, Schwarz J, Clinnick S. Parkinsonian medication one hour before meals improves symptomatic swallowing: a case study. Dysphagia. 1995;10(3):165–6.CrossRefGoogle Scholar
  29. 29.
    Correa-Flores M, Arch-Tirado E, Villeda-Miranda A, Rocha-Cacho KE, Verduzco-Mendoza A, Hernandez-Lopez X. Analysis of oropharyngeal dysphagia through fibroendoscopy evaluation of swallowing in patients with Parkinson’s disease. Cir Cir. 2012;80(1):31–7.PubMedGoogle Scholar
  30. 30.
    Koopman WJ, Wiebe S, Colton-Hudson A, Moosa T, Smith D, Bach D, et al. Prediction of aspiration in myasthenia gravis. Muscle Nerve. 2004;29(2):256–60.CrossRefGoogle Scholar
  31. 31.
    Bird SJ. Treatment of myasthenia gravis. Up to date [Internet]. 2017. Available from:
  32. 32.
    Nagamine T. Serum substance P levels in patients with chronic schizophrenia treated with typical or atypical antipsychotics. Neuropsychiatr Dis Treat. 2008;4(1):289–94.CrossRefGoogle Scholar
  33. 33.
    Wright D, Begent D CH et al. Management of adults with swallowing difficulties. In: Chesham: MGP Ltd, editor. Hayeem N, editor. Guidelines—summarising clinical guidelines for primary care [Internet]. 66th ed. p. 70–3. Available from:
  34. 34.
    Kelly J, D’Cruz G, Wright D. Patients with dysphagia: experiences of taking medication. J Adv Nurs. 2010;66(1):82–91.CrossRefGoogle Scholar
  35. 35.
    Santos JMS, Poland F, Kelly J, Wright DJ. Drug administration guides in dysphagia. Nurs Times. 2012;108(21):15–7.. Available from: Scholar
  36. 36.
    Connor TH, MacKenzie BA, DG DB, Trout DB, O’Callaghan JP. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention NI for OS and H. NIOSH list of antineoplastic and other hazardous drugs in healthcare settings 2016. Fed Regist. 2016;77(124):41190.. Available from:, Scholar
  37. 37.
    JAY C. Thickening agents used for dysphagia management: effect on bioavailability of water, medication and feelings of satiety. Nutr J. 2013;12(1):54. Scholar
  38. 38.
    Schiele JT, Penner H, Schneider H, Quinzler R, Reich G, Wezler N, et al. Swallowing tablets and capsules increases the risk of penetration and aspiration in patients with stroke-induced dysphagia. Dysphagia. 2015;30(5):571–82.CrossRefGoogle Scholar
  39. 39.
    Pharmaceutical compounding-nonsterile preparations. In: United States Pharmacopeia and National Formulary (USP 37-NF 32) [Internet]. 2014. Available from:

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Jose Santiago Estevez Alonso
    • 1
  • Isabel Zapico Garcia
    • 2
  1. 1.ENT&HNS Department, IBSALUniversity Hospital of SalamancaSalamancaSpain
  2. 2.Pharmacy DepartmentCentral University Hospital of AsturiasOviedoSpain

Personalised recommendations