Rethinking Tablet Administration in Poststroke Dysphagia: Whole vs. Crushed

Researchers from Austria report that administering whole tablets with a small soft bolus—rather than crushing them—appears safer and better absorbed for many patients with post-stroke dysphagia.

Intended to reduce aspiration, crushing can increase pharyngeal residue and create dosing uncertainty. The new data challenge that assumption and argue for a more differentiated approach to oral medication in stroke rehabilitation.

In a randomized, within-subject study of 60 poststroke dysphagia patients, fiberoptic endoscopic evaluation of swallowing compared whole tablets given with a small soft bolus to crushed tablets. Whole tablets with a soft bolus passed to the stomach without signs of penetration or aspiration in this cohort. Crushed tablets produced significantly more pharyngeal residue—particularly in the valleculae—and residue magnitude raised concerns about reduced mucosal contact and impaired drug absorption. The protocol tested three common placebo tablet types and used applesauce as the soft bolus to mirror bedside practice, increasing the study's practical relevance.

Pharyngeal residue reduces mucosal contact and can impair absorption, risking subtherapeutic dosing and downstream complications such as pneumonia or treatment failure. Experts frame the results as interpretive perspective rather than definitive outcome data and urge measured guideline reconsideration rather than abrupt practice change.