# Asacol - passing the whole pill



## ramittman (Aug 1, 2012)

My son is on 800 mg(2-400mg pills) of Asocal 3 times a day. He has been noticing a whole pill in his BMs every once in a while. Dr. says this is ok. I'm thinking, "What's the point if they are just "passing through!" Anyone else out there with the same issue? Just curious.


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## Patricia56 (Aug 1, 2012)

It's not uncommon. Drugs like this release into the intestines at different points depending on the drug. They are triggered by changes in pH usually.

Sometimes either the pH is never right or the transit or speed at which the pill moves through the intestines is too fast and it never releases all of the med.

I wouldn't worry about it unless he's seeing all or nearly all of the pills in his stool.


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## Tea (Aug 1, 2012)

My son had the same thing happening. Inspite of that the asacol appeared to be working for a while before we had to try Pentasa instead.


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## xmdmom (Aug 1, 2012)

I read on another thread that what seems to be the Asacol pill may just be the outside wrapper and that the med could have come out as it should.  My son was on Asacol for ileal Crohn's but then a second doctor told us it doesn't work for that...


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## ramittman (Aug 1, 2012)

Yes, there are some pills that have laser holes in them to let the medication out, but from what my sister, who is a pharmacist said, Asacol is not made that way. Thanks for your post.


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## David (Aug 10, 2012)

I used to think it was ok as well as I've read countless times that it's "normal".  However, I no longer believe that's always the case.  Asacol is formulated for release at pH ≥ 7.0.  The thing is, luminal pH varies from person to person.  And studies have found that IBD can alter pH, sometimes making it lower.  For example, this paper mentions Asacol may not work as well because of this.  The average pH values of the intestinal tract:

Stomach: 1-5
Duodenum: 6
Jejunum: 6
Ileum: 6-7
Terminal Ileum: 7.4
Cecum: 5.7
Large Intestine: 6.5
Rectum: 6.8 
(Source)

The thing is, in that first paper, here are some of the ranges:


> Gastrointestinal luminal pH data recorded by RTC in normal volunteers are shown in table 1. Luminal pH in the proximal small bowel ranges from 5.5 to 7.0 and gradually rises to 6.5–7.5 in the distal ileum. In almost every recording published there has been a fall in luminal pH from the terminal ileum to the caecum (range 5.5–7.5); pH then rises in the left colon and rectum to 6.1–7.5.


So if you are one of those people with a pH that never hits 7, you're going to be passing the whole pill.  I know it's may seem gross, but if you see the whole pill, fish it out and see if the medication is still in there.

ramittman, I hope you don't mind but I added info about passing the whole pill to the thread title so others can search for this if need be.



xmdmom said:


> I read on another thread that what seems to be the Asacol pill may just be the outside wrapper and that the med could have come out as it should.  My son was on Asacol for ileal Crohn's but then a second doctor told us it doesn't work for that...


It depends on the person's pH.  Since Mesalamine (the active ingredient of Asacol) is topical, if your son's pH allowed for early release in the intestines, then it may have helped _a little_.  If his pH is low, then it was worthless.  But even if the pH was allowing release in the ileum, crohn's affects the entire width of the intestine so topical treatments like Mesalamine don't do much whereas Ulcerative Colitis affects only the mucosa so it does work.  There's a reason not a single formulation of Mesalamine is approved for the treatment of Crohn's disease.  If doctors want to use it off label in conjunction with other treatments, fine.  But it drives me crazy when people show up here and it's the only treatment they're on.  And it happens a LOT.


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## Keepingfaith (Aug 10, 2012)

With my experiance, MANY GI's(and Asacol drug reps) have told me that it is normal to see the outer coating. It may appear that it is the whole pill but it could just be the outside coating. The pill is designed to be slowly released so your whole colon gets the benefits. That is why you see most of the pill. So, it's normal.


   I will say though, after 3 hours of taking my first Asacol, I saw the ENTIRE pill because it went way too fast through my GI tract. I fished it out, put it in a plastic bad and my Gi tried to mush it all up(in the plastic bag) and when he realized it was the entire pill I got admitted and stayed in the hospital for about a month(I had fistulas also and was extremely malnourished).


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## David (Aug 10, 2012)

Keepingfaith said:


> With my experiance, MANY GI's(and Asacol drug reps) have told me that it is normal to see the outer coating. It may appear that it is the whole pill but it could just be the outside coating. The pill is designed to be slowly released so your whole colon gets the benefits. That is why you see most of the pill. So, it's normal.


It's not normal.  From the Asacol prescribing information:


> In 2% to 3% of patients in clinical studies, intact or partially intact tablets have been reported in the stool. If this occurs repeatedly, patients should contact their physician.


NEVER trust a drug rep


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## ramittman (Aug 10, 2012)

I'm not grossed out about fishing out the pill...I might just go put on some gloves and go diving  to see for myself. 
Curiously, David, I just checked my son's pH and he's running pretty acidic. This makes more sense to me now.
My son is also on Imuran as well...


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## Keepingfaith (Aug 10, 2012)

C'mon David! When was that published? Should I believe a Pediatrician who went to Johns Hopkins and several other reputable GI's or a link? Or, which of the two makes more sense to believe ? Just saying... The Humira commercials also have very low remission rates but I've met more people who've gotten in remission with it than those who have not.


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## David (Aug 10, 2012)

I'm not sure if you're being serious or joking (sorry) but I'd personally trust pretty much the most esteemed international peer reviewed journal for health professionals and researchers in gastroenterology & hepatology.  Just me though.  

However, it's some internet guy who shouldn't be trusted very much (me) who is extrapolating the data and theorizing that passing a full pill may be bad.  In the end, it's about fishing out the pill and seeing if the medicine is still in it or not.


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## Keepingfaith (Aug 10, 2012)

It was a little bit of both sarcasm and complete seriousness on my part.

  To clarify my first post, if you are passing a whole pill of course that is not normal but passing just the coating is completely normal. By coating, I mean that if you just see the marroon film of the pill and you can not see any of it's contents inside, that is the coating. Just my 2 cents as someone who has taken the medication and dug through there poop to get it out.


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## my little penguin (Aug 10, 2012)

Went fishing found two pills with most of there white contents inside:stinks:

Maybe thats why that med isn't working
I had just given his nightly med a hour or so before and the stool was "green"


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## Keepingfaith (Aug 10, 2012)

Sorry MLP :ywow: I would comfort you & say 'Well maybe a little bit of powder is okay' but I think given that your child isn't where he should be, the poop was filled assumably with bile & _most_ of the Asacol contents are inside, it's time to make a switch! :hug: None of the meslamines have helped me like Apriso/Sulfasalazine. I can't digest most pills so my GI RX me Apriso- A medication he typically RX to his younger pediatric patients who can't swallow pills-because I just broke open the capsules and sprinkled it on my tounge/in apple sauce. You WILL see it in your poop and that is completely normal because it bipassed digestion by not having a capsule to hold its contents.That's something to look into. It literally tastes like vanilla! I guess that's why his younger patients like it as well :ysmile:

Take care!


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## my little penguin (Aug 10, 2012)

Thanks keepingfaith

We are switching to Remicade in two weeks so not sure it matters at this point but good to know if it ever comes up again.:wink:


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## Keepingfaith (Aug 10, 2012)

My Rhuemy/GI has always made sure I was on a meslamine for my colon regardless of the biologic I'm on at the time because without the combo of the two(and of course ol' Prednisone)my colon would be a mess so I didn't know if you guys were doing combo therapy or not. Good luck with the Remicade! Seems like a lot of people on the forum recently are loving it! :heart:


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## TangieC (Aug 12, 2012)

Hmmm...now I'm wondering about my little one. He's on Pentasa 250mg/3x daily and in the past week and a half I've noticed that I see the granules in his poo on a regular basis (not every one, but most of the time). His doctor said that happens with Pentasa at times. The pharmacist also confirmed that there are several meds that will leave the outer shell or that your body wicks out the medicine. I am still not comfortable with it and I haven't heard anything from the head of the peds GI department (who has up to this point been great about answering emails and seems to know his meds.) Should I be concerned? My four year old is recently diagnosed with Crohn's so I'm definitely a newbie!


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## Keepingfaith (Aug 12, 2012)

I doubt he's having problems with the Pentasa(Don't take my word for it!). Pentasa is absorbed in the TI so it is very common to see it in the toilet. Asacol is absorbed in the Colon and has to travel a lot more space to work. Pentasa just needs to work in the TI and ocassiy the right colon. Not nearly as far as Asacol needs to work. The pharmacist/GI probably know what they're talking about. I wouldn't worry too much and if the GI hasnt answered your email/calls that's a good sign. He/she probably isn't worried about it either since they aren't rushing to call back.  Again, this is just from what I've heard from my friends who take Pentasa and from my own research.


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## Keepingfaith (Aug 12, 2012)

Ignore the TI part/where it is absorbed. My computer glitched and pasted part of my post from a previous thread


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## lola99 (Aug 13, 2012)

When I first got put on asacol i did pass a few pills whole when i had bad diarrhea. But as my bowel movements became more solid. I only notice the shell of the bill now. I too am also on imuran.


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## Cat-a-Tonic (Aug 14, 2012)

Okay, I'm a little freaked out.  (Sorry for posting this in the parents subforum, but this thread totally applies to me right now and I'd rather tack this onto an existing thread than start a new one.)  For the longest time - months and months - I've been seeing what I thought were undigested bits of tomato in my stool.  The color was exactly that of tomato, and I stubbornly refused to stop eating tomato, so I never inspected more closely.  But recently I stopped eating tomato and still saw what I thought was undigested tomato in my stool.  Finally today I put 2 and 2 together - it's Asacol tablets I'm seeing.  The tablets must have faded in color from passing through me (so now they're the color of tomato instead of reddish-brownish) and are embedded in my stool and I never looked very closely at them to see that they're tablet-shaped, which is why I didn't realize it until now.  This is something I'm seeing regularly, as in multiple times per week and sometimes even multiple times per day.  I'm in remission and now I'm wondering what's keeping me in remission if I'm not absorbing Asacol very well!

On David's note about ph, I'm actually going in soon to get my stomach acid ph tested as I have stubborn GERD/reflux issues that refuse to be controlled by Nexium/Prilosec/Zantac/Tums.  I'm just not sure what to do though - should I call my GI now and let him know what's going on, maybe ask to switch to Pentasa?  (I'm technically undiagnosed but unofficially diagnosed with IBD, although they don't know quite where it is located - I tend to have LRQ pains so it's always been my thought that there's probably TI involvement.)  Or should I wait for the ph testing and see if that sheds some light onto this situation?  I'm confused and upset, can somebody help?


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## dannysmom (Aug 14, 2012)

Hi Cat - Have you checked if the contents of the pill are still inside? (like David suggested above)


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## DustyKat (Aug 17, 2012)

Bump for Cat.


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