Re: What happens when pills get stuck?

[Guest guest]

Hi Jan,

Anything that you eat including pills gets digested in the stomach. Acids are

not suppose to be present in the esophagus to break down food and medicine.

But if your food is not going down, the pills may partially dissolve by just being exposed to

saliva and other food and may after a longer period of time get through to your stomach

and absorbed. If you find that the pills are no longer working then perhaps they

are not making it to your stomach and not getting absorbed.

This is my opinion. There may be a better explanation. I would ask your MD.

and see what he or she thinks.

Bobbie

[Guest guest]

Jan wrote:

>Does the medicine have to get to the stomach to be effective?

>Strange question, I guess, but I was wondering about this.

It depends on the type of medicine as to how much of a problem it is. Some

medicines can be absorbed in the mouth or anywhere after that, so they are

not a problem. Some medicines will burn the esophagus if they get stuck

there. (Aspirin comes to mind). Time released medications may dissolve but

not be absorbed in the esophagus and hit you all at once after they leave

the esophagus. I have a time released pill that I am suppose to take before

bed. The reason it is time released and taken before bed is so you have a

chance to be asleep and not have to feel the effects, and if you do feel

it, at least it is spread over time. Sometimes it does not hit until I get

up and then I get hit wammo! To avoid that I take it early and wait for it

to start doing its thing before I go to sleep. But, it is tricky. Sometimes

I have stayed up hours late and it did not kick in until I gave up and went

to bed and got the wammo in the morning.

notan

[Guest guest]

Jan,Unfortunately every drug is designed for differing release parameters. The bioavailability is set for the optimal clinical effectiveness. Some medication are immediate release and will release in gastric fluid, others are rapid release and release in the oral cavity, while still others are modified release which are targeted for intestinal fluid release. Many of these oral dosage forms are very sensitive to the pH of the fluid that they are exposed to. Your doctor can look up the release characteristics of this particular dosage form.The prescription to take before bedtime may not work correctly with achalasics. You need to discuss this with your doctor. One option which I think is a good choice for anyone with swallowing problems is liquid dosage forms. Elavil is available as a suspension. Ask your doctor if you can try it.Boston Pete----------------------------------------------------------------------------- Date: Mon, 17 May 2004 23:41:36 -0000 From: "msjanb2001" <JMB000001@...>Subject: What happens when pills get stuck?Hi Everyone,I usually come up with the strangest questions and here comes anotherone. For several hours after dinner and when I go to bed I most oftenstill feel the food stuck in my throat. I need to take Elavil(lowdose anti-depressant) to help with insommnia.Usually I take it right before I go to sleep. Often times(most of thetime!) it seems to be stuck right there on top of the heap of food,and lately, I don't feel the medicine "kicking in" to help me get tosleep.What happens when a person has food stuck in the esophagus, and thentakes a medication in the form of pills?Does the medicine have to get to the stomach to be effective?Strange question, I guess, but I was wondering about this.Thanks,Jan in Northern KY

[Guest guest]

Thanks, Bobbi

I always think of the strangest questions!

Jan in NKY

[Guest guest]

Jan, I asked my gastroenterologist whether anything was absorbed from the oesophagus. I was also concerned about medicine which was probably just sitting there and not going into the stomach. His answer was that nothing whatsoever is absorbed from the oesophagus and that the medication and food had to reach the stomach before this happens.

I had that awful full feeling before I had the dilatation. My barium x-rays showed a huge build up of food in a lump filling the lower end of the oesophagus so there was little room for anything I swallowed. The doc had to physically remove the food when he did the endoscopy before he could get to the LES to stretch it.

The longer food stays there the more the oesophagus stretches and does not return much to its old shape.

Joan

Johannesburg South Africajpearse@...

What happens when pills get stuck?

Hi Everyone,I usually come up with the strangest questions and here comes another one. For several hours after dinner and when I go to bed I most often still feel the food stuck in my throat. I need to take Elavil(low dose anti-depressant) to help with insommnia.Usually I take it right before I go to sleep. Often times(most of the time!) it seems to be stuck right there on top of the heap of food, and lately, I don't feel the medicine "kicking in" to help me get to sleep.What happens when a person has food stuck in the esophagus, and then takes a medication in the form of pills?Does the medicine have to get to the stomach to be effective?Strange question, I guess, but I was wondering about this.Thanks,Jan in Northern KY

[Guest guest]

Thanks, notan!

It's always great to put up a question to see what great minds will come up with.

It occurred to me recently that the elavil I take to help me sleep is not doing it's thing.

So, lately Ive been trying to take it earlier in the evening.

Still, mostly of late, it doesn't seem to be working and I guess it's because it's stuck on top of my food.

Jan in NKY

[Guest guest]

Thanks Pete!

If things continue as they have been, I will be asking for liquid form of elavil.

Two days of 3-4 hrs of sleep, and I become a zombie. Not too safe on the road with my daugther or the adult M.R. clients I work with.

Jan in NKY

[Guest guest]

Thanks, Joan.

I guess this is an odd question, but one that must be considered if one is on other important medication.

Jan in NKY

[Guest guest]

Joan Pearse wrote:

Jan, I

asked my gastroenterologist whether anything was absorbed from the

oesophagus. I was also concerned about medicine which was probably just

sitting there and not going into the stomach. His answer was that nothing

whatsoever is absorbed from the oesophagus and that the medication and

food had to reach the stomach before this

happens.

I find his statement unbelievable. If he had said something like,

" virtually nothing is absorbed in the normal esophagus, "

I could understand it better. In the normal esophagus things are moved

through quickly and for most things you would swallow there is not enough

time spent in the esophagus to be absorbed. Also the esophagus does not

contain features found in other parts of the gut that are there to speed

absorption. However, if the size of the molecules are small enough, with

the right characteristics, and enough time is spent in the esophagus,

things, including some medications, can be absorbed. Medications can be

designed to be absorbed in the esophagus. See:

http://www.kvpharmaceutical.com/tech/1_1_transep.html

..

Perhaps Pete has some thoughts on this.

Notan

[Guest guest]

That doesn't make sense Every time I have to take Meds for anything I call my GI dr I know I can't take ASA and others They would irritate the"E" And cause ulcers

-- Re: What happens when pills get stuck?

Joan Pearse wrote:

Jan, I asked my gastroenterologist whether anything was absorbed from the oesophagus. I was also concerned about medicine which was probably just sitting there and not going into the stomach. His answer was that nothing whatsoever is absorbed from the oesophagus and that the medication and food had to reach the stomach before this happens.I find his statement unbelievable. If he had said something like, "virtually nothing is absorbed in the normal esophagus," I could understand it better. In the normal esophagus things are moved through quickly and for most things you would swallow there is not enough time spent in the esophagus to be absorbed. Also the esophagus does not contain features found in other parts of the gut that are there to speed absorption. However, if the size of the molecules are small enough, with the right characteristics, and enough time is spent in the esophagus, things, including some medications, can be absorbed. Medications can be designed to be absorbed in the esophagus. See: http://www.kvpharmaceutical.com/tech/1_1_transep.html .. Perhaps Pete has some thoughts on this.Notan

____________________________________________________ IncrediMail - Email has finally evolved - Click Here

[Guest guest]

notan wrote:I find his statement unbelievable. If he had said something like, "virtually nothing is absorbed in the normal esophagus," I could understand it better.

I agree, notan -- "virtually" nothing is much more accurate than "absolutely" nothing. Pretty much every part of the body is permeable to some degree.... that's why we have medications that are delivered through the skin via a patch, sublingual (under the tongue) drugs, drugs that are applied to the nose (including the new flu vaccine and some pain meds), drops that are applied to the eyes, analgesic creams and ointments for the skin.... heck, even the new IUDs (or IUS or "coil" for our UK members) deliver extremely low-dose hormones to the uterus for birth control, and of course there are those "Norplant" rods that are surgically implanted in the arm.

I think maybe Joan's doctor just didn't make the best choice in words to use.... we'll have to send him a thesaurus! LOLDebbi

[Guest guest]

Notan, I promise you I did question his statement and he repeated it emphatically, but that does not mean that drugs etc. are not absorbed in other places such as the mucous membranes of the mouth, vagina and lungs as well as skin. I also heard it from another doctor who was discussing birth control pills with me long before I knew about achalasia, saying that if The Pill was not taken with enough water it could stay in the oesophagus and not be doing it's work until much later when it had reached the stomach hours later and that could be too late!!! SO if any one is going to see their GI doctor or has a hot line to a source of information please ask the question!!!

Joan

Johannesburg South Africajpearse@...

Re: What happens when pills get stuck?

notan wrote:I find his statement unbelievable. If he had said something like, "virtually nothing is absorbed in the normal esophagus," I could understand it better.

I agree, notan -- "virtually" nothing is much more accurate than "absolutely" nothing. Pretty much every part of the body is permeable to some degree.... that's why we have medications that are delivered through the skin via a patch, sublingual (under the tongue) drugs, drugs that are applied to the nose (including the new flu vaccine and some pain meds), drops that are applied to the eyes, analgesic creams and ointments for the skin.... heck, even the new IUDs (or IUS or "coil" for our UK members) deliver extremely low-dose hormones to the uterus for birth control, and of course there are those "Norplant" rods that are surgically implanted in the arm.

I think maybe Joan's doctor just didn't make the best choice in words to use.... we'll have to send him a thesaurus! LOLDebbi

[Guest guest]

Notan,

Wow, that is great to have a list of medications which poor motility will affect or visa versa.

I'm really glad I asked something that I first thought was a silly question.

Jan inNKY

[Guest guest]

Joan Pearse wrote:

Notan,

I promise you I did question his statement and he repeated it

emphatically

I believe you. I just don't believe him.

I

also heard it from another doctor who was discussing birth control pills

with me long before I knew about achalasia, saying that if The Pill was

not taken with enough water it could stay in the oesophagus and not be

doing it's work until much later when it had reached the stomach hours

later and that could be too late!!!

What he said may be true for that pill, and many

others. As Pete indicted, different pills are made in different ways to

allow them to dissolve at different places in the gut. A pill may have a

coating that will prevent it from dissolving in the esophagus. It could

be possible that if such a pill was stuck in the esophagus for days that

it would not dissolve in that time. Not all pills have such coatings.

Even if a pill does not have such a coating and does dissolve in the

esophagus, the molecules of the medications may need to be broken down or

modified in some way by digestive juices not normally found in the

esophagus before they can be absorbed, or before they will work as

intended. However, I am sure some molecules, drugs or whatever, if they

have the right properties will be absorbed by the esophagus if given

enough time in the esophagus and if the molecules are not prevented from

doing so by something like a coating on a pill.

SO

if any one is going to see their GI doctor or has a hot line to a

source of information please ask the question!!!

I think people are going to need answers for the

specific forms of medications they take.

Can medications that are to take effect at a given time not act in a

timely fashion, if the pill takes to long to get to where it is suppose

to dissolve and be absorbed.

Can medications that are to be taken alone, on an empty stomach, be

hindered by other contents in the esophagus, such as, fat and other

substances eaten long before that remain and block absorption.

Some medications may irritate the esophagus if they do not pass through

it quickly and cause ulcers and strictures.

Can Time-released medications produce a spike if they predissolve in the

esophagus without being absorbed there.

Many medications will work just fine.

I did some searching for information on medication that could be a

problem with achalasia, such as contraindications. There are a lot of

warnings about the bisphosphonates, Fosamax (alendronate) and

Actonel/Fortipan

(Risedronate Sodium), which are esophageal irritants. Other esophageal

irritants are aspirin and other NSAIDs, tracycline, doxycycline,

quinidine, potassium chloride, vitamin C, and iron. The esophageal

irritants can cause esophageal ulcers, strictures and esophagitis if they

get stuck in the esophagus.

Something that has nothing to do with pills getting stuck is that

achalasia is listed as a contraindication for

Anticholinergics/Antimuscarinics,

including: Atropine (atropine sulfate), LEVSIN/NuLev (hyoscyamine

sulfate), Norflex/Norgesic/Orphengesic (Orphenadrine citrate),

Urispas (Flavoxate hydrochloride), Robinul (Glycopyrrolate), Donnatal

(Belladonna Alkaloids), PRO-BANTHINE (Propantheline bromide). This is

interesting because some of these drugs are used to treat achalasia as an

alternative to dilation, and surgery, and for spasms. But, they decrease

motility which many of us could use more of.

And I found this curious item:

" Fiber in pill form is contraindicated in

esophageal disorders. Drink plenty of water when taking fiber

supplements. Large amounts of fiber may cause impaired absorption of some

minerals. Fiber can also inhibit the absorption of certain drugs, so the

fiber should not be ingested around the time of drug

ingestion. "

So, how far apart should

an achalasic take medications and fiber?

I started a list of possible problem

medications and supplements for people with achalasia. Note that I only

said " possible problems. " People should check out their

medications with their doctors and pharmacists to see if they are a

problem for them. Anyone want to add to it? Feel free.

Bisphosphonates -- Esophageal

Irritants

Fosamax (alendronate)

Actonel/Fortipan (Risedronate Sodium)

Other Esophageal Irritants

aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs)

tetracycline

doxycycline

quinidine

potassium chloride

vitamin C, and iron

Anticholinergics/Antimuscarinic

Atropine (atropine sulfate)

LEVSIN/NuLev (hyoscyamine sulfate)

Norflex/Norgesic/Orphengesic (Orphenadrine citrate)

Urispas (Flavoxate hydrochloride)

Robinul (Glycopyrrolate)

Donnatal (Belladonna Alkaloids)

PRO-BANTHINE (Propantheline bromide)

Time dependant -- Timing may be

delayed

birth control pills

Time-Released -- May dissolve or partially dissolve in the

esophagus changing the release pattern

Niaspan (may cause intense flushing when rising after sleeping)

Fiber

" Fiber in pill form is contraindicated in esophageal disorders.

Drink plenty of water when taking fiber supplements. Large amounts of

fiber may cause impaired absorption of some minerals. Fiber can also

inhibit the absorption of certain drugs, so the fiber should not be

ingested around the time of drug ingestion. "

See also:

http://www.rosemont.com.au/harmful.htm#esophagus

notan

[Guest guest]

notan,

You got me thinking about all the

medications that I take, so I started doing a little search. One of the meds I

take for my blood pressure is Clonidine. I decided to do a search using clonidine and esophagus and this is what I came up with. There’s some lovely photos. Haha!

(Just click on to enlarge)

http://www.vh.org/adult/provider/internalmedicine/GICases/Esophageal/Complexity/Complexity.html

Well I’d much rather be doing this,

but I need to study. I have an important exam in the morning.

Sandi

I started a

list of possible problem medications and supplements for people with achalasia.

Note that I only said " possible problems. " People should check out

their medications with their doctors and pharmacists to see if they are a

problem for them. Anyone want to add to it? Feel free.

Bisphosphonates

-- Esophageal Irritants

Fosamax (alendronate)

Actonel/Fortipan

(Risedronate Sodium)

Other Esophageal Irritants

aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs)

tetracycline

doxycycline

quinidine

potassium chloride

vitamin C, and iron

Anticholinergics/Antimuscarinic

Atropine (atropine sulfate)

LEVSIN/NuLev (hyoscyamine sulfate)

Norflex/Norgesic/Orphengesic (Orphenadrine citrate)

Urispas (Flavoxate hydrochloride)

Robinul (Glycopyrrolate)

Donnatal (Belladonna Alkaloids)

PRO-BANTHINE (Propantheline bromide)

Time dependant -- Timing may be delayed

birth control pills

Time-Released -- May dissolve or

partially dissolve in the esophagus changing the release pattern

Niaspan (may cause intense flushing when rising after sleeping)

Fiber

" Fiber in pill form is contraindicated in esophageal disorders.

Drink plenty of water when taking fiber supplements. Large amounts of fiber may

cause impaired absorption of some minerals. Fiber can also inhibit the

absorption of certain drugs, so the fiber should not be ingested around the

time of drug ingestion. "

See also:

http://www.rosemont.com.au/harmful.htm#esophagus

Holt-

Los Medanos College/ Voyagers

Travel Club

Secretary/Publishing

Manager of “The Bonni-e”

www.centram.org

[Guest guest]

And I found this curious item: "Fiber in pill form is contraindicated in esophageal disorders. Drink plenty of water when taking fiber supplements. Large amounts of fiber may cause impaired absorption of some minerals. Fiber can also inhibit the absorption of certain drugs, so the fiber should not be ingested around the time of drug ingestion." So, how far apart should an achalasic take medications and fiber?

One thing I'm curious about is, do they consider "pill form" fiber a contraindicated in esophageal disorders due to impaired absorption, or due to problems with peristalsis? The way I read this, it sounds like NOBODY should take fiber at the same time as certain drugs, not just those with esophageal disorders.

The contraindication I've seen with fiber supplements and those with swallowing problems wasn't due to absorption, but simply to keep from choking you to death. Things like Metamucil get thick over time, kinda like Jello, or cement. Pill-form fibers like Fiber-Con are meant to "swell up" in the stomach (when they are in the moist environment) -- in fact, I remember 15-20 years ago when Fiber-Con first came on the market (before "high fiber" diets and such were all the rage for medical reasons) and the actual way they marketed it was NOT to increase fiber intake, but rather as a WEIGHT LOSS program -- you swallowed half a dozen Fiber-Con pills and drank a glass of water and they swelled up in your stomach to make you feel full.

If an achalasian or anyone else w/ impaired peristalsis were to drink something that swells up / gets thick, there's the danger of it happening in the ESOPHAGUS rather than in the stomach (where it is supposed to swell/thicken), and then you have the choking/aspiration hazard. Metamucil and similar products have a warning right on the package that they are not to be taken by people w/ impaired swallowing. Newer fiber supplements like Bene-Fiber (a powder you mix in liquid that doesn't get thick) and Fiber-Choice (a chewable tablet -- tastes like Orange Tang Breakfast Drink!) actually market themselves as a safe alternative for those who can't swallow the thickening/swelling types of supplements.

Man, it's always SOMEthing with this disease, isn't it? LOLDebbi in Michigan

[Guest guest]

Debbi Heiser wrote:

One

thing I'm curious about is, do they consider " pill form " fiber

a contraindicated in esophageal disorders due to impaired absorption, or

due to problems with peristalsis? The way I read this, it sounds

like NOBODY should take fiber at the same time as certain drugs, not just

those with esophageal

disorders.

The quote was all there was. It

was kind of a sidebar. My guess is the portion about impaired absorption

was not specific to esophageal disorders, and as you pointed out the

contraindication would be because of possibly blocking the esophagus.

However, if the fiber takes longer to leave the esophagus, more time is

going to be needed before taking medications that have absorption

impaired by fiber.

notan

[Guest guest]

There is a chewable brand of orange flavor fiber that does not swell in your

esophagus. It's called " fiber choice. " I got it at Walgreens. It says you

don't even need to drink water with it. It pretty much dissolves in your mouth

when you chew it. I got it at Walgreens, but they have a website,

www.fiberchoice.com. It works, too, lol.

LInda

>

[Guest guest]

There is a chewable brand of orange flavor fiber that does not swell in your

esophagus. It's called " fiber choice. " I got it at Walgreens. It says you

don't even need to drink water with it. It pretty much dissolves in your mouth

when you chew it. I got it at Walgreens, but they have a website,

www.fiberchoice.com. It works, too, lol.

LInda

>