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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