Drug & supplement interaction

Peony + Mesalamine

Mesalamine brand names: Pentasa, Asacol, Canasa, Rowasa, Lialda, and others.

No Known Interaction
Medically reviewed by · Updated July 2026 · Pair last verified Sep 20, 2026
The bottom line No known interaction

We found no known interaction between Peony and Mesalamine in our sources. Absence of a documented interaction is not the same as proven safety, and does not guarantee one does not exist. Do not start, stop, or change a medication or supplement based on this page; confirm with your pharmacist or doctor first. Additionally, although there is no interaction, the label for Mesalamine states a food rule worth keeping to, and the two are separately associated with some of the same side effects, which would make a new symptom harder to attribute to one or the other.

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Interaction report

Peony and Mesalamine

We checked these two against our interaction database. Here is what we found.

No Known Interaction Found

We did not find a documented interaction between Mesalamine and Peony in our sources. This does not guarantee that the combination is completely free of risk — there is often limited research on supplements and herbal products, especially around drug interactions.

If you decide to take both, the practical routine is simple: add one new thing at a time and note the date you started it. If the combination is going to disagree with you, it usually shows in the first days to a couple of weeks — and a start date turns “I’ve been feeling off” into something a pharmacist can actually work with. Do not stop a prescribed medicine on your own.

Always talk with your pharmacist or doctor before making changes to your medications or supplements, particularly if you take several medications or have an ongoing health condition.

Peony safety at a glance

Peony overall Use caution Generally considered well tolerated for short-term use, but high-quality safety data are limited.
Pregnancy Possibly Unsafe When used orally. Preliminary research suggests that peony can cause uterine contractions. However, other preliminary research suggests a combination of peony a... Read the full pregnancy detail
Breastfeeding Avoid There is not enough reliable information to consider it safe while breastfeeding.

Pregnancy & breastfeeding ratings are from Natural Medicines (Therapeutic Research Center) — the full detail is in the Special populations card below. Safety guidance is general; always confirm with your pharmacist or doctor for your situation.

Still wondering about combining Mesalamine and Peony? Ask Dr. Brian Staiger, PharmD, BCPS directly ›
How we checked

Why No Interaction Is Listed for Mesalamine

Interactions in our licensed database are recorded against drug classes, not just single drug names. Mesalamine is filed under a single classification — oral drugs. Peony has documented interactions with 7 drug classes — the most serious being anticoagulant/antiplatelet drugs (moderate), clozapine (clozaril) (moderate) and contraceptive drugs (moderate) — and none of Mesalamine’s classifications are among them.

Classification data comes from our licensed Natural Medicines dataset. A medication can belong to classes beyond those recorded there, so this describes how the check was run — it is not a safety guarantee.

Keep it in perspective

Peony Does Interact With Other Medications

Peony has 811 moderate known drug interactions in our database — Mesalamine isn’t one of them. If you take anything else, check it against the full list below.

Moderate 811 No known interaction 2,019 (incl. Mesalamine)
Taking anything else?

Check Another of Your Medications Against Peony

Covers the 2,830 medications we’ve checked against Peony. Pick one to open its full report.

What to actually watch for

No Interaction Found — But Data Suggests Peony and Mesalamine May Share Several of the Same Side Effects

This is not an interaction. Neither one changes how your body handles the other, and nothing here says they react together. What our sources do show is that each has separately been linked to the effects below — so taking both can make those effects more likely to turn up, and harder to pin on one or the other if they do.

  • Bloating or gas / Diarrhea Additional detail

    Peony

    “Orally, peony and total glucosides of peony (TGP) have been reported to cause gastrointestinal discomfort, including abdominal distension, anorexia, diarrhea, and nausea, in some patients. In one clinical study, diarrhea was reported in 5% of patients taking TGP 600 mg three times daily for 24 weeks versus 1% of patients taking placebo.”

    Peony · Natural Medicines adverse-effect record, reported in anorexia.

    5 sources cited
    1. 13538. Anon. Monograph. Peony (Paeonia spp). Alt Med Rev 2001;6:495-9.
    2. 92785. Cai Y, Yuan Q, Xu K, et al. Assessment of the therapeutic effect of total glycosides of peony for juvenile idiopathic arthritis: a systematic review and meta-analysis. Evid Based Complement Alternat Med 2016;2016:8292486.
    3. 97949. Zhou Y, Jin L, Kong F, et al. Clinical and immunological consequences of total glucosides of paeony treatment in Sjögren's syndrome: A randomized controlled pilot trial. Int Immunopharmacol. 2016 Oct;39:314-319. doi: 10.1016/j.intimp.2016.08.006. PubMed
    4. 98466. Zhu Q, Qi X, Wu Y, Wang K. Clinical study of total glucosides of paeony for the treatment of diabetic kidney disease in patients with diabetes mellitus. Int Urol Nephrol. 2016 Nov;48(11):1873-1880. doi: 10.1007/s11255-016-1345-5. PubMed
    5. 100992. Liu X, Li X, Li X, et al. The efficacy and safety of total glucosides of peony in the treatment of primary Sjögren's syndrome: a multi-center, randomized, double-blinded, placebo-controlled clinical trial. Clin Rheumatol. 2019;38(3):657-64. Erratum i

    Mesalamine

    Listed in the ADVERSE REACTIONS section of the FDA label for Mesalamine. Read the label on DailyMed ›

Reported for Peony but not commonly for Mesalamine: stomach upset, a skin rash, bleeding or bruising and reduced appetite.

Effects for Mesalamine come from the ADVERSE REACTIONS section of its FDA label; effects for Peony come from the Natural Medicines adverse-effect record, quoted above. Wording is matched across sources by our own clinical vocabulary, so treat this as a prompt to pay attention, not a diagnosis.

Special populations

Peony in Pregnancy & Breastfeeding

Pregnancy Possibly Unsafe

When used orally. Preliminary research suggests that peony can cause uterine contractions. However, other preliminary research suggests a combination of peony and angelica with or without motherwort, banksias rose, and ligustica, might be safe. Until more is known, avoid use.

DISCLAIMER: This tool is intended for informational purposes only, and should not be interpreted as specific medical advice. Patients should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.© 2026 Therapeutic Research Center

How to take them

Some Mesalamine Products Have a Food Rule — Peony Should Not Break It

At least one FDA label for a product containing Mesalamine says to take it with food. If you take Peony on an empty stomach out of habit, keep them separate — and take Mesalamine with a meal where the label says to.

This may not be true of your version. Food instructions belong to the product, not the ingredient: two Mesalamine products can carry different directions, and extended-release forms often differ from immediate-release ones. The label we read is quoted below — check the directions on your own box or bottle, or ask your pharmacist, for how to take the exact product you were given.

( 2 ) Administer mesalamine delayed-release tablets with food.

From the Dosage and Administration section of the FDA label we read for Mesalamine — where that label names a specific product, the instruction is that product's. Read the label on DailyMed ›

A food rule is not an interaction — it is about how much of the medicine you absorb. The directions that came with your own product, and your pharmacist, outrank anything on this page.

From our Q&A

Questions About Peony or Mesalamine

These are real questions from readers, answered by the pharmacists at HelloPharmacist — written by a person, not generated from a database. Each one covers Peony or Mesalamine, not necessarily both, but if one is close to what you were about to ask it will usually go further than a database entry can:

Not quite your question? Ask our pharmacists directly — it is free, there is no account required, and answers usually come back within 24 hours.

Everything else you take

See Every Supplement That Interacts With Mesalamine

This page covers Peony only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Mesalamine page lists 17 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), Coffee Charcoal (moderate), European Mandrake (moderate), Glucomannan (moderate) and Guar Gum (moderate).

By severity: 1 major · 7 moderate · 9 minor.

From our pharmacist’s overview on the Mesalamine page

“Activated charcoal is the one entry here I would treat as a genuine problem for anyone taking mesalamine (Asacol, Lialda, Pentasa, and others). It is the lone major-rated interaction among the 17 on file, because charcoal soaks up drugs in the gut and can pull mesalamine out of the picture before it does its job.”

Reviewed by 2 · Jul 18, 2026

Open the Mesalamine interaction page

One more smart check

Taking Peony as Part of a Dietary Supplement Product? Check It for Interactions

We hold 71 real supplement products containing Peony, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Peony. Even though Peony itself has no known interaction with Mesalamine, another ingredient on your label might. Find your product and we’ll check every ingredient on its label:

How much people look this up

Where Peony and Mesalamine Sit Against Everything Else

Out of every supplement and medication people look up on HelloPharmacist, here is where these two land this week — and which way each has been moving.

Supplement Peony
Top 25%

#210 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Mesalamine
Top 25%

#453 of 2,830 medications looked up here in the last 7 days

29 days ago today

Position among everything looked up on this site, not a measure of how commonly either one is used or how important it is. A supplement can climb this list because of a news story. It counts every request to the page, automated ones included, and nothing here identifies anyone.

Where does our data come from?
  • Source: the Natural Medicines (TRC Healthcare) clinical database — the evidence-graded professional reference for herb & supplement interactions.
  • Citation library: 103,510 references behind our interaction content, 65,311 of them resolved to verified PubMed/DOI sources. See every Peony reference on this page ↓
  • Freshness: we automatically re-check this combination every week — this pair was last verified September 20, 2026. The Peony and Mesalamine records this page draws on were last updated July 11, 2026.
  • What “no known interaction” means: no documented interaction in the sources above — not a guarantee of safety. Supplements are studied far less than prescription drugs, so we say exactly what the evidence supports, and nothing more.
Data structure & sourcing designed and verified by .
Supplement

About Peony

What is Peony?

Peony
  • Menstrual cramps and irregular periods
  • Muscle cramps and spasms
  • Anxiety and stress
  • Inflammation and pain
  • Polycystic ovary syndrome (PCOS)

Peony root is a traditional Chinese medicine herb often used for menstrual problems, cramps, and inflammation, frequently as part of combination formulas. Human evidence for most uses is limited or preliminary, so it should not replace proven treatments. Talk to your pharmacist or doctor before using it, especially if you are pregnant, breastfeeding, or taking other medicines.

Paeonia lactiflora · Paeoniaceae · Root (and sometimes the root bark, flower, and seeds) · Dried root, powders, capsules, tinctures, teas, and combination herbal formulas

An interaction check asks whether these two react with each other — it does not ask whether Peony is a good idea for someone in your situation. Here is what our Peony record says about it on its own.

Peony: dosing

There is no well-established standardized dose for peony. The amount used varies depending on the form (dried root, powder, capsule, tincture, or tea) and whether it is used alone or in a combination formula.The safest approach is to follow the directions on the product label and to choose products from reputable manufacturers.

From our Peony monograph — the full record covers uses, side effects and every documented interaction.

Read the full Peony monograph & all interactions
Medication

About Mesalamine

What Is Mesalamine Used For?

Brand names: Pentasa, Asacol, Canasa, Rowasa, Lialda, Delzicol

Mesalamine is used to treat mildly to moderately active ulcerative colitis — a condition where the lining of the large intestine becomes inflamed and ulcerated. Depending on the product and formulation, it can be used to bring the disease under control (induction of remission) and/or to keep it from coming back (maintenance of remission).

Different products target different parts of the lower digestive tract. Oral forms (tablets and capsules) treat the colon more broadly. Rectal forms — including enemas (ROWASA, sfROWASA, mesalamine rectal suspension) — are used for distal ulcerative colitis, proctosigmoiditis, or proctitis (inflammation limited to the lower end of the colon or rectum). Rectal suppositories (CANASA, mesalamine rectal suppositories) are specifically for ulcerative proctitis (inflammation of the rectum only).

See full Mesalamine drug information
Keep checking

Other Drugs & Peony

Browse every other medication we’ve checked against Peony — both the ones with a known interaction and the ones without. Select any drug for the full detail.

0Major
811Moderate
0Minor
2,018No known interaction
811 Moderate 2,018 No interaction
Moderate

811 interactions

Showing 60 of 811 moderate interactions — see all 811 on the Peony page.

No interaction 2,018 drugs checked — show the list

We also checked Peony against these medications and found no known interaction in our sources. Open any page to confirm.

Showing the 60 most looked-up of 2,018 medications checked with no known interaction — see the full Peony list.

See the full Peony interactions page
See every supplement checked against Mesalamine, ranked by severity
Evidence & sources

Peony References

The 15 references that drive our Peony monograph and interaction data, from the evidence-graded Natural Medicines (TRC Healthcare) database. Citations with a link open the study on PubMed or the publisher’s site.

  1. Chen LC, Chou MH, Lin MF, Yang LL. Effects of Paeoniae Radix, a traditional Chinese medicine, on the pharmacokinetics of phenytoin. J Clin Pharm Ther 2001;26:271-8. PubMed
  2. Guo TL, Zhou XW. [Clinical observations on the treatment of the gestational hypertension syndrome with Angelica and Paeonia powder]. Zhong Xi Yi Jie He Za Zhi 1986;6:714-6, 707.
  3. Xie HJ, Yasar U, Sandberg M, Rane A. Paeoniae Radix, a traditional Chinese medicine, and CYP2C9 activity. J Clin Pharm Ther 2002;27:229-30. . PubMed
  4. Harada M, Suzuki M, Ozaki Y. Effect of Japanese Angelica root and peony root on uterine contraction in the rabbit in situ. J Pharmacobiodyn 1984;7:304-11. PubMed
  5. Anon. Monograph. Peony (Paeonia spp). Alt Med Rev 2001;6:495-9.
  6. Bruynzeel DP. Contact Dermatitis Due to Paeonia (Peony). Contact Dermatitis 1989; 20:152-3..
  7. Bian, X., Xu, Y., Zhu, L., Gao, P., Liu, X., Liu, S., Qian, M., Gai, M., Yang, J., and Wu, Y. Prevention of maternal-fetal blood group incompatibility with traditional Chinese herbal medicine. Chin Med J (Engl.) 1998;111(7):585-587.
  8. Wong, A. L. and Chan, T. Y. Interaction between warfarin and the herbal product quilinggao. Ann Pharmacother 2003;37(6):836-838.
  9. Cai Y, Yuan Q, Xu K, et al. Assessment of the therapeutic effect of total glycosides of peony for juvenile idiopathic arthritis: a systematic review and meta-analysis. Evid Based Complement Alternat Med 2016;2016:8292486.
  10. Koo YK, Kim JM, Koo JY, et al. Platelet anti-aggregatory and blood anti-coagulant effects of compounds isolated from Paeonia lactiflora and Paeonia suffruticosa. Pharmazie 2010;65(8):624-8.
  11. Wang W, Tian DD, Zheng B, et al. Peony-glycyrrhiza decoction, an herbal preparation, inhibits clozapine metabolism via cytochrome P450s, but not flavin-containing monooxygenase in in vitro models. Drug Metab Dispos 2015;43(7):1147-53. PubMed
  12. Zhou Y, Jin L, Kong F, et al. Clinical and immunological consequences of total glucosides of paeony treatment in Sjögren's syndrome: A randomized controlled pilot trial. Int Immunopharmacol. 2016 Oct;39:314-319. doi: 10.1016/j.intimp.2016.08.006. PubMed
  13. Zhu Q, Qi X, Wu Y, Wang K. Clinical study of total glucosides of paeony for the treatment of diabetic kidney disease in patients with diabetes mellitus. Int Urol Nephrol. 2016 Nov;48(11):1873-1880. doi: 10.1007/s11255-016-1345-5. PubMed
  14. Xu Y, Li X, Chen T, et al. Radix Paeoniae Alba increases serum estrogen level and up-regulates estrogen receptor expression in uterus and vagina of immature/ovariectomized mice. Phytother Res. 2019;33(1):117-29. [RETRACTED].
  15. Liu X, Li X, Li X, et al. The efficacy and safety of total glucosides of peony in the treatment of primary Sjögren's syndrome: a multi-center, randomized, double-blinded, placebo-controlled clinical trial. Clin Rheumatol. 2019;38(3):657-64. Erratum i

Medication overviews come from MedlinePlus (NIH); supplement label data from the NIH Dietary Supplement Label Database. Content is written and reviewed by licensed HelloPharmacist pharmacists — see our data sources and editorial standards.

Pharmacist Counseling Corner

Taking Peony and Mesalamine Together: Common Questions

Is it safe to take Peony with Mesalamine?
We do not list a known interaction between Peony and Mesalamine. That does not guarantee the combination is risk-free, so confirm with your pharmacist or doctor — especially if you take other medications or have a health condition.
Do Peony and Mesalamine have any of the same side effects?
Yes — our sources link each of them separately to 2 of the same effects. That is not an interaction: neither changes how your body handles the other. It does mean that if one of those effects turns up, it can be harder to tell which one is behind it. They are listed on this page with the source behind each.
Should I take Peony and Mesalamine at the same time of day?
At least one FDA label for a product containing Mesalamine says to take it with food. If you take Peony on an empty stomach out of habit, keep them separate and take Mesalamine with a meal where the label says to. Food instructions belong to the product rather than the ingredient — two Mesalamine products can differ — so check the directions on your own box. This is about absorption, not an interaction.
How was the Peony and Mesalamine combination checked?
Interactions in our licensed database are recorded against drug classes. Mesalamine is filed under 1 classification, and Peony has documented interactions with 7 drug classes — none of Mesalamine's classifications are among them. A medication can belong to classes beyond those recorded in our dataset, so this describes how the check was run rather than guaranteeing safety.
Does Peony interact with any other medications?
Yes. Peony has 811 documented drug interactions in our database — Mesalamine is simply not one of them. If you take anything else, it is worth checking each one; they are all listed on this page.
Does Mesalamine interact with any supplements?
Yes. Mesalamine has documented interactions with 17 supplements in our database — Peony is not one of them. The Mesalamine interaction page linked on this page lists every one, ranked by severity.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

Where next

Keep Exploring

Peony monograph Uses, safety profile, and every drug interaction in one place Mesalamine drug information The full plain-English guide to this medication Mesalamine supplement interactions Every supplement checked against Mesalamine, ranked by severity Supplement interaction checker Check any supplement or product against your medications Browse medications A–Z Every drug we’ve checked against herbs & supplements References The 15 citations behind this page Ask a pharmacist Free, personal answer from our licensed team

Still Have a Question About Mesalamine and Peony?

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This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.