No clinically significant interactions involving interference with drug metabolism have been reported with racecadotril

Vomiting was the most frequent adverse event associated with racecadotril in 2 studies which was comparable to loperamide.

In general it is better tolerated than loperamide and caused less constipation after resolution of diarrhea than loperamide.

Other reported adverse reactions include nausea, thirst, vertigo and headache.

Contraindications None reported

Special precautiions-

Renal insuficiency, pregnancy and lactation

Diarrhea of bacterial and viral etiology

Dosage

Adults- 100 - 300mg t.i.d.

Children- 1.5mg/kg t.i.d.

Pharmacology-

Racecadotril is lipophilic desterified prodrug of the enkephalinase inhibitor thiorphan. Thiophan, by inhibiting the membrane bound enkephalinase enzymes increases the avilability of endogenous opioids (enkephalins). These enkephalins activate data opiod receptors in the gastrointestinal tract . This in turn leads leads to the reduction of water and electrolytes into the intestinal lumen. This is in contrast to loperamide which is a receptor agonist and hence disrupts intestinal peristasis thereby allows more time for net absorption of fluids to occur.This could lead to bacterial overgrowth, invasion by by shigela and precipitation of megacolon.

Pharmacokinetics-

Orally administered racecadotril is rapidly absorbed from the GI tract. It is hydrolysed to thiopham in peripheral tissues. It reached peak plasma concentrations of 805-1055 nmol/L in 1 hour. Racecaditril has an elimination halflife of 3 hours and 92% of the drug is excreted from the body in 24 hours.

Caution to be excrecised during use pregnacy and lactation