Safety of Racecadotril 100 mg TDS for Non-Bacterial Diarrhea
Racecadotril 100 mg three times daily for 5 days is generally safe and effective for reducing stool episodes in adults with non-bacterial diarrhea, with fewer side effects than antimotility agents like loperamide. 1
Mechanism and Efficacy
Racecadotril is an enkephalinase inhibitor with antisecretory properties that:
- Reduces intestinal hypersecretion of water and electrolytes 2
- Does not affect intestinal motility (unlike loperamide) 1, 2
- Works by inhibiting neutral endopeptidase (NEP), allowing enkephalins to exert their antisecretory effects 3
Safety Profile
Advantages over Loperamide
- Produces significantly less constipation (16% vs 25% with loperamide) 1
- Causes fewer adverse events overall (14.2% vs 23.9% with loperamide) 1
- Provides more rapid resolution of abdominal symptoms 1
- Does not prolong intestinal transit time 2
- Does not promote bacterial overgrowth in the small intestine 2
Side Effects
- Generally mild and transient 4
- No serious adverse events directly attributed to racecadotril have been reported 3
- No potential for neurotoxicity or physical dependence 2
Dosing Considerations
The recommended dosing of 100 mg three times daily for adults is appropriate and consistent with clinical studies 1. This dosage has been shown to be as effective as loperamide for resolving diarrhea (average resolution time of 55 hours) while causing fewer side effects 1.
Clinical Guidance
When to Use
- For acute watery non-bacterial diarrhea in adults 5
- As an adjunct to oral rehydration therapy 4
- When antimotility agents like loperamide are contraindicated or poorly tolerated 6
When to Avoid
- In cases of bloody diarrhea (dysentery) 5
- In suspected bacterial infections requiring antibiotic treatment 5
- In severe diarrhea with moderate to severe cramping, fever, or dehydration 6
Monitoring and Expected Outcomes
- Clinical improvement should be observed within 48 hours of initiating treatment 6
- If symptoms persist beyond this timeframe, reevaluation of the underlying cause is warranted 6
- The 5-day treatment course is appropriate for most cases of acute non-bacterial diarrhea 1
Comparison to Alternative Treatments
While the Infectious Diseases Society of America notes that racecadotril is not available in North America 5, it is widely used in many other countries as an effective alternative to loperamide 6. Clinical studies have demonstrated that racecadotril:
- Is as effective as loperamide in resolving diarrhea 1
- Has a better side effect profile than loperamide 1
- Does not cause the rebound constipation commonly seen with antimotility agents 1, 2
Conclusion
Racecadotril 100 mg three times daily for 5 days is a safe and effective treatment for reducing stool episodes in non-bacterial diarrhea. Its favorable safety profile makes it a good option for patients who cannot tolerate or have contraindications to antimotility agents like loperamide.