Conflicting Medical Advice

One of the drugs I’ve been pre­scribed for my col­i­tis, Asacol, is delay-released, which means it has a spe­cial coat­ing that makes it trav­el through the stom­ach, and absorbed only in the colon. This spe­cif­ic brand is released in the left and end of the colon, which is where my col­i­tis is. I often get con­flict­ing advice about how to take the drug:

  • The instruc­tions that came with the med­ica­tion say it can be tak­en with or with­out food
  • The first phar­ma­cist told me to wait an hour after eat­ing before tak­ing the pills
  • The sec­ond phar­ma­cist told me I did­n’t need to wait and could have it with food and oth­er med­ica­tions
  • The third phar­ma­cist told me that delayed release drugs should be tak­en on an emp­ty stom­ach, and may have con­flicts with oth­er drugs
  • My gas­troin­testi­nal spe­cial­ist told me I could take it with food

It’s gen­er­al­ly tak­en that the doc­tor’s advice takes prece­dence over any­thing else. But as a per­son who works in the med­ical indus­try, where doc­tors are fre­quent­ly revealed to be incom­pe­tent, I know that not all of them know what they’re talk­ing about.

Scary, for an indus­try in which we put so much blind faith. Who am I sup­posed to believe?


  1. i agree with first and third phar­ma­cists. mesalamine should be tak­en on an emp­ty stom­ach but hav­ing said this, the advice that it be tak­en an hour post-meal/­food is real­ly going on the idea that your diges­tive sys­tem should have cleared from a meal by then. both phar­ma­cists 1 and 3 are just encour­ag­ing that you don’t take the med­ica­tion with food as it slows the absorp­tion and there­fore decrease the effec­tive­ness of the pills.

    addi­tion­al­ly, dif­fer­ent for­mu­la­tions of the drug mesalamine can dic­tate how it is best tak­en. we don’t have asacol in aus­tralia so i’m not sure how it is for­mu­lat­ed. all i know is that you can’t chew/crush the tablets because of the coat­ing! but i’m sure your phar­ma­cist went through that with you..

    i feel quite nerdy now :)

    how had you been tak­ing it?

    • Wow, thanks for the great infor­ma­tion!

      I try to take them every eight hours, so 7am, 3pm, 11pm. That way, it’s also on an emp­ty stom­ach. The thing is, I eat break­fast around 8am and a snack around 4pm (i.e. about an hour after I take the pills). Would that decrease the effec­tive­ness of the med­ica­tions?

      Also, I asked my doc­tor if I should wor­ry about see­ing whole tablets in the toi­let, and he said no, it’s just the left­over when it’s been absorbed already. You have any advice about that? Bet that was way more infor­ma­tion than you want­ed on a Monday morn­ing!

      • hey again jeff,

        your regime sounds good and well spread out enough for good absorp­tion of your tablets. hav­ing food an hour after your tablets is okay; it’s more­so if you take the food after food that decreas­es the effi­ca­cy. anoth­er thing is that, so long as you’re being com­pli­ant and doing the best you can then this should enhance your over­all man­age­ment. com­pli­ance is a huge issue, espe­cial­ly with long term and fre­quent dos­ing. judg­ing by what you’ve just told me, you seem to be doing very well!

        i have to be hon­est though; i’m not too sure about the whole tablets in the toi­let as i’ve nev­er come across that in prac­tice (and sub­se­quent­ly have nev­er had a patient tell me this has hap­pened). i would­n’t want to give you any false infor­ma­tion so i might have to do some research on that one for you ;)

      • I’m guess­ing you meant tak­ing the “med­ica­tion” after the food. ;)

        The instruc­tions that came with the pills said that I should men­tion to my doc­tor if I notice whole pills in the stool, because that may mean my body isn’t absorb­ing them enough. Of course, you already don’t agree with the instruc­tions or the doc­tor on the tak­ing-with-food issue. My doc­tor said that it real­ly does­n’t mat­ter if there end up being whole tablets, because it just means my body has absorbed enough of it. It’s all so con­fus­ing!

  2. I’ve par­tic­u­lar­ly won­dered about how they decide that drugs all work with each oth­er and how much they actu­al­ly know about it, since my dad is prob­a­bly on about 15 kinds per day. That just seems impos­si­bly coun­ter­pro­duc­tive to a restora­tion of the nor­mal human sys­tem to me.

    • I believe that it takes a long time for a drug to be con­sid­ered safe, on the order of decades. As for how they work togeth­er, that’s prob­a­bly even longer.

      Drugs do seem unnat­ur­al to me, but I sup­pose that so does abor­tion and stem cell research, and I’m all for those.

  3. Yes tak­ing this med­i­cine on emp­ty stom­ach is bet­ter as i am tak­ing so with best results of the med.

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