Should Racecadotril (acetorphan) be taken before or after food for maximum benefit?

Racecadotril Administration Timing for Maximum Benefit

Racecadotril should be taken with food for maximum benefit. 1

Evidence-Based Recommendation

The FDA drug label specifically indicates that racecadotril should be taken with food 1. This recommendation is supported by pharmacokinetic principles, as taking the medication with food helps optimize its absorption and effectiveness.

Mechanism of Action and Clinical Use

Racecadotril (acetorphan) is an enkephalinase inhibitor with antisecretory properties that:

• Prevents degradation of endogenous opioids (enkephalins)
• Reduces hypersecretion of water and electrolytes into the intestinal lumen
• Does not affect intestinal transit time (unlike loperamide)

Dosing Guidelines

• Standard adult dose: 100 mg three times daily 2, 3
• Pediatric dose: 1.5 mg/kg orally every eight hours 4, 5
• Administration timing: Take with food 1
• Duration: Continue until resolution of diarrhea or up to 7 days 3

Clinical Efficacy

Racecadotril has demonstrated effectiveness in:

• Reducing stool weight by approximately 46% compared to placebo 4
• Decreasing the number of diarrheal stools 2
• Shortening the duration of diarrhea 4, 5
• Having similar efficacy to loperamide but with fewer side effects, particularly less rebound constipation (9.8% vs 18.7%) 3, 6

Use in Specific Clinical Scenarios

• Grade 1 diarrhea: Racecadotril can be used as first-line treatment along with oral rehydration 7
• Immunotherapy-induced diarrhea: Recommended for grade 1 diarrhea along with oral rehydration 7
• Travelers' diarrhea: May be considered for use, though evidence is more limited compared to loperamide 7

Advantages Over Other Antidiarrheals

• Similar efficacy to loperamide but with fewer side effects 3, 6
• Less rebound constipation compared to loperamide 3, 6
• Maintains normal intestinal transit time while reducing secretions 6

Cautions and Contraindications

• Not recommended for prophylactic use in chemotherapy-induced diarrhea 7
• Should be avoided in cases of bloody diarrhea
• Use with caution in patients with hepatic or renal impairment

Practical Administration Tips

1. Take each dose with a meal or snack
2. Maintain adequate hydration with oral rehydration solution
3. Continue treatment until resolution of symptoms
4. Monitor for improvement within 24-48 hours

By taking racecadotril with food as directed, patients can maximize the drug's bioavailability and effectiveness while potentially minimizing gastrointestinal side effects.