August 19, 2019
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Dietary supplements present preventable choking hazard in older adults

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Dietary supplements, particularly multivitamins, can cause choking and dysphagia in older adults, according to findings published in the Annals of Internal Medicine.

Currently, the FDA recommends that generic drug tablets and capsules should not exceed 17 mm in size, but no such guidance exists for dietary supplements.

“These products have been implicated in swallowing problems, particularly among adults aged 65 years and older,” Cecile Punzalan, MD, MPH, a medical officer at the FDA, and colleagues wrote.

Punzalan and colleagues reviewed adverse event reports submitted to the FDA Center for Food Safety and Applied Nutrition from 2006 through 2015 to identify and characterize swallowing problems associated with pill size.

Supplements 
Dietary supplements, particularly multivitamins, can cause choking and dysphagia in older adults, according to findings published in the Annals of Internal Medicine.
Source: Adobe Stock

A total of 20,791 supplement-related adverse events occurred during the study period, of which 3,962 (19.1%) were attributed to swallowing problems. Most reports of swallowing problems involved females (85.6%), and among reports with patient ages included, 76.8% involved adults aged 65 years and older.

The most common swallowing problems were choking (86%) and foreign body trauma (7.8%). After review, researchers found that 14.3% of reports of swallowing problems involved severe adverse events. Three deaths caused by a supplement obstructing the airway or aspiration occurred during the study period.

The two types of supplements most frequently cited in adverse event reports with swallowing difficulty were multivitamins (72.9%) and calcium supplements (17.3%).

The 10 most frequently reported supplement products were attributed to 76.4% (3,026) of reports of swallowing problems. The products all had a dimension greater than 17 mm and had a mean length of 19.3 mm, width of 9.8 mm, and height of 7.8 mm.

Researchers found that one multivitamin marketed for older women was cited in 40.6% of all reports of swallowing problems.

Punzalan and colleagues explained that swallowing problems could be prevented if supplement products were modified to have smaller dosage forms or added coating. They also recommended that patients should be encouraged to discuss swallowing difficulties with their physician or a pharmacist.

“These data identify a specific harm — choking — that may be preventable, particularly in older adults who regularly consume dietary supplements,” they wrote. – by Erin Michael

Disclosures: The authors report no relevant financial disclosures.