Racecadotril Treatment Regimen for Acute Diarrhea
Racecadotril (acetorphan) is an effective antisecretory agent for acute diarrhea that reduces stool volume but is not widely available in North America. 1
Dosing Regimen
For adults with acute diarrhea:
- Initial dose: 100 mg orally 2
- Maintenance: 100 mg three times daily 2
- Continue until diarrhea resolves (typically 3-5 days) 2
For children with acute diarrhea:
- Dosage: 1.5 mg/kg body weight orally three times daily 3, 4
- Continue until diarrhea resolves (typically 28-72 hours) 4
Place in Therapy
Adults
- Racecadotril is an effective alternative to loperamide with similar efficacy but fewer side effects, particularly less rebound constipation 2
- Should be used as an adjunct to oral rehydration therapy, not as a replacement 1
- Most effective when started early in the course of acute watery diarrhea 2
Children
- Can be used in children as young as 3 months of age 3, 4
- Reduces stool output by approximately 46-50% compared to placebo 3, 4
- Reduces duration of diarrhea significantly compared to placebo 4, 5
Clinical Considerations
- Ensure adequate hydration before initiating treatment 1
- Racecadotril works by inhibiting enkephalinase, reducing intestinal hypersecretion without affecting intestinal transit time 1
- Unlike loperamide, racecadotril does not cause significant slowing of gastrointestinal transit 1
- Contraindicated in cases of bloody diarrhea or high fever (>38.5°C) suggesting invasive bacterial infection 1
Efficacy Parameters
- Reduces time to cure from approximately 106 hours to 78 hours (mean reduction of 28 hours) 5
- Comparable efficacy to loperamide but with better tolerability profile 2
- More effective than placebo and Saccharomyces boulardii 2
- Less effective than octreotide in severe cases requiring hospitalization 2
Safety Profile
- Tolerability similar to placebo (approximately 10.4% vs. 10.6% adverse events incidence) 5
- Better tolerated than loperamide, particularly regarding rebound constipation 2
- Most adverse events are mild to moderate 6
- Safe for use in children over 3 months of age 3, 4
When to Seek Medical Care
- No improvement after 48 hours of treatment 1
- Signs of dehydration persist despite oral rehydration 1
- Development of bloody stools or high fever (>38.5°C) 1
- For vulnerable populations including the elderly (>75 years), those with chronic diseases, and children under medical supervision 1
Common Pitfalls and Caveats
- Racecadotril is not a substitute for proper hydration therapy 1
- Not widely available in North America despite evidence of efficacy 1
- Should not be used in cases of suspected inflammatory or bacterial diarrhea with fever 1
- Evidence for use in children under 5 years is mixed, with some reviews suggesting limited benefit beyond standard care 6
- Treatment should be discontinued if symptoms worsen or new symptoms develop 1