From the Guidelines

Racecadotril (Acetorphan) is used to reduce stool volume in patients with diarrhea.

It is an antisecretory agent that works by inhibiting the enzyme enkephalinase, which breaks down endogenous opioids in the gut, thereby reducing intestinal secretion and stool output 1.
Racecadotril has been shown to be effective in reducing stool volume in patients with acute diarrhea, including those with traveler's diarrhea and cancer treatment-induced diarrhea 1.
However, its use is not recommended for routine treatment of acute gastroenteritis in children under 4 years of age or in adults, and it is not available in North America 1.

The recommended dose of racecadotril is 100 mg three times a day for 15 days, although this may vary depending on the specific clinical context and patient population 1.
It is essential to note that racecadotril should only be used under medical supervision, as it may have adverse effects, such as increased stool volume, and may interact with other medications.

The European Society for Medical Oncology (ESMO) clinical practice guidelines recommend the use of racecadotril for the treatment of grade 1 immunotherapy-induced diarrhea in adult cancer patients, in combination with oral rehydration and antidiarrheal treatment 1.
However, the guidelines also note that loperamide and opioids should be avoided in patients with grade 3 and 4 diarrhea, and that infliximab or vedolizumab may be considered as alternative treatments in these cases 1.

From the Research

Racecadotril is an inhibitor of the enzyme neutral endopeptidase (NEP), which increases exposure to NEP substrates including enkephalins and atrial natriuretic peptide (ANP) 2
It has been mainly tested in animal models and patients with three therapeutic areas: as an analgesic, in cardiovascular diseases, and in acute diarrhea 2
In acute diarrhea, racecadotril was consistently effective in animal models and patients by inhibiting pathologic secretion from the gut without changing gastro-intestinal transit time or motility 2
It has been shown to be at least as effective as loperamide in adults and children, with fewer adverse events, particularly less rebound constipation 2, 3, 4
Several guidelines recommend the use of racecadotril as an addition to oral rehydration treatment in children with acute diarrhea 2, 3

Analgesic: The effects of racecadotril as an analgesic were inconsistent across animal models 2
Cardiovascular diseases: Results from animal studies were promising, but clinical results have not shown substantial therapeutic benefit over existing treatment options in cardiovascular disease 2
Acute diarrhea: Racecadotril was consistently effective in animal models and patients, and is recommended as an addition to oral rehydration treatment in children with acute diarrhea 2, 5, 3, 6, 4

Racecadotril has been shown to be more efficacious than placebo or other treatments, except for loperamide, in reducing the duration of diarrhea and stool output in children and adults 5, 3, 6, 4
It has a tolerability similar to that of placebo or Saccharomyces boulardii, and better than that of loperamide, particularly with regard to risk of rebound constipation 3, 4