Racecadotril is an antisecretory drug (an enkephalinase inhibitor) that decreases intestinal hypersecretion but not motility. It exerts its antidirrheal effects by preventing the breakdown of endogenous encephalins in the GI tract. Racecadotril has antisecretory actions only when hypersecretion is present and not in the basal state. Role of racecadotril has been documented in several studies in reducing water and electolyte losses in acute watery diarrhea in children.

Dosage:- 1.5 mg/kg/dose upto 4 doses per day for children above 3 months and above. It is not to be used in children with renal, hepatic impairment as its safety has not been established in them. It is contraindicated in patients with fructose intolerance, glucose malabsorption syndrome saccharase - isomaltase deficiency as it contains saccharose. Duration in clinical trials was 5 days of therapy. Treatment should be continued till two normal stools are recorded and treatment should not exceed 7 days.

Adverse effects:- Vomiting, fever, hypokalemia, ileus, bronchospasm, skin rashes.

Loperamide versus racecadotril
Loperamide acts largely on µ-opiate receptors in the intestine leading to an increase in intestinal transmit time as a result of disruption of normal peristaltic motion. Thus side effects such as constipation, bacterial overgrowth and toxic megacolon can occur. Racecadotril instead inhibits enkaphalinase thus prevents inactivation of endogenous encephalitis which activate delta-opiate receptors. This results in decrease secretion of water and electrolytes without any detectable effect intestinal mobility.

References

	1.		Cezard JP et al. Efficacy and Tolerability of Racecadotril in acute diarrhea in children. Gastroenterology 2001; 120:799-805.
	2.		Salazar-Lindo E et al. Racecadotril in the treatment of acute watery diarrhea in children. NEJM 2000;343:463-467.
	3.		Cojacaru et al. Effect of Racecadotril in acute diarrhea in infants and children. Archives Pediatr (Paris) 2002;8:779-779.

Last Updated: 1st September 2009