Racecadotril is a peripherally-acting enkephalinase inhibitor used as an antisecretory agent for the symptomatic management of acute diarrhea. It acts locally in the intestinal mucosa without affecting gut motility, making it distinct from opioids like loperamide. It is a prodrug that is rapidly hydrolyzed to its active metabolite, thiorphan.
Adult: 1 capsule (15mg) three times daily, before or with meals. Continue for up to 7 days or until the first normal stool. Maximum treatment duration: 7 days.
Note: Swallow the capsule whole with a glass of water. Can be taken with or just before food. For pediatric sachets: Mix the granules with a small amount of water, milk, or soft food (like yogurt) and administer immediately. Always administer with ORS to maintain hydration.
Racecadotril is a prodrug hydrolyzed to thiorphan, which is a potent and selective inhibitor of membrane-bound enkephalinase (neprilysin) located on the brush border of the intestinal mucosa. Inhibition of this enzyme prevents the degradation of endogenous enkephalins. Enkephalins then bind to delta-opioid receptors on enterocytes, stimulating absorption of water and electrolytes and reducing hypersecretion induced by bacterial toxins (e.g., cholera toxin, E. coli heat-labile toxin) and viruses.
Pregnancy: Category B3 (as per some regulatory bodies). Animal studies show no direct harm, but human data is limited. Use only if clearly needed and benefit outweighs risk. Preferably avoid in first trimester.
Driving: May cause dizziness or drowsiness in some patients. Advise caution when driving or operating machinery until effect is known.
| ACE Inhibitors (e.g., Ramipril, Enalapril) | Theoretical risk of increased risk of angioedema (both drugs affect kinin metabolism). Clinical significance uncertain but caution advised. | Moderate |
| Diuretics (e.g., Furosemide, Hydrochlorothiazide) | Increased risk of dehydration and electrolyte imbalance (hyponatremia, hypokalemia). | Moderate |
| Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) (e.g., Ibuprofen, Diclofenac) | Increased risk of renal impairment, especially in dehydrated patients. | Moderate |
| Antibiotics (e.g., Ciprofloxacin, Metronidazole) | No direct PK interaction. Racecadotril is adjunctive; antibiotics treat the underlying infection if bacterial. | None |