Fifty muscles and many nerves activate every time we put food or liquid in our mouth and swallow. We swallow an amazing 500-700 times every day, and those same muscles and nerves work every time. It’s easier to notice the work they do when we eat and drink, but they’re also working throughout the day and night constantly moving saliva out of the mouth and into the stomach.
It’s not unusual for people with Parkinson disease to experience chewing and swallowing difficulties. PD can cause the muscles in the jaw and face to become stiff. It can also create excessive production of saliva, which may then become thicker and stickier in the mouth. It becomes more difficult to swallow certain foods or liquids. Choking, coughing, or clearing the throat becomes more frequent, and food can feel like it’s getting stuck and not easily “going down.”
Difficulty with swallowing is called Dysphagia. It can be caused by pain, cognitive, anatomical or physiological problems . . . and Parkinson’s. Additionally, fear of swallowing pills is a source of anxiety for some of us.
Dysphagia can be serious. Someone who can’t swallow safely may not be able to eat enough of the right foods to stay healthy or maintain an ideal weight. An unsuccessful swallow may send food and liquids down the wrong tube and into the lungs. The dilemma for people with PD is that the medication most often prescribed for their symptoms is carbidopa-levodopa pills that must be swallowed several times every day regardless of whether they’re On or Off, whether they have difficulty with swallowing or not.
Rytary® is carbidopa-levodopa medication in an extended-release form. Each dose comes in a capsule filled with a combination of both immediate –release and extended-release medication beads. When swallowed, some of these very small beads will be absorbed immediately and others release their medication over the next 4-5 hours. The result: a steadier delivery of carbidopa-levodopa medication that can reduce Off time, increase On time, and diminish bouts of dyskinesia.
For people who want to try an easier way “to make the medicine go down,” they may open a Rytary® capsule and sprinkle its beads over a few spoonfuls of applesauce, pudding, or other soft food. While this option can make swallowing Rytary® easier, it’s essential for anyone taking medications of any kind to ask their doctor if they can safely put a medication in food, break up the tablets or capsules, or in any way deviate from how the medication is prescribed.
Rytary®, like other carbidopa-levodopa medications, requires a prescription. When converting from an immediate-release carbidopa-levodopa pill to Rytary®, it’s likely the dosing will be both higher and more frequent. The usual list of carbidopa-levodopa side effects and cautions still apply.
Additionally, anyone with Parkinson’s who suspects swallowing problems, coughs or clears their throat frequently, has a “watery” sound to their voice, or chokes on food or their own saliva should discuss these symptoms with their healthcare provider. A referral to a speech-language pathologist or speech therapist may be in order. They’re the professionals who can conduct a full swallow evaluation and identify therapeutic strategies to make swallowing easier and safer.
