Racecadotril vs Loperamide

 

Racecadotril vs. Loperamide for Adult Infectious Diarrhoea: A Comparative Analysis

Infectious Diseases

General Medicine

Internal Medicine

About

Diarrhoea, defined as three or more loose stools per day, remains a global health concern, especially in its infectious form, which contributes significantly to mortality. Causes may be infectious (bacteria, viruses) or non-infectious. Treatment includes antibiotics, probiotics, and antimotility agents like Loperamide and Racecadotril. While Loperamide is widely used, it may cause adverse effects, such as constipation and is contraindicated in dysentery or bacterial enterocolitis. Racecadotril, a newer anti-secretory agent, reduces fluid loss without affecting motility. Studies and meta-analyses show Racecadotril offers comparable efficacy to Loperamide but with fewer side effects and broader safety, making it a preferable alternative.

Racecadotril vs. Loperamide for adult infectious diarrhoea: A comparative analysis

Diarrhoea is a prevalent condition characterised by a minimum frequency of 3 episodes per day. Such episodes might be accompanied by stomach discomfort, cramps, and a feeling of urgency. Compared to any other gastrointestinal disease, infectious diarrhoea is a prime cause of mortality globally.

Aetiological factors for diarrhoea in adults can be of infectious or non-infectious origin. Bacteria, viruses, and other microorganisms may lead to infectious diarrhoea, while non-infectious diarrhoea may stem from various causes.

Current treatment options for acute diarrhoea include antibiotics, probiotics, and antimotility agents, such as Loperamide and Racecadotril. Nonetheless, Loperamide is commonly prescribed by clinicians for the management of adult infectious diarrhoea.

However, in recent years, it has been substantiated that Loperamide may be associated with adverse effects such as abdominal cramps, constipation, and bloating. Also, the drug is contraindicated in patients with dysentery or bacterial enterocolitis owing to the risk of megacolon. Racecadotril, a newer anti-secretory agent, works by inhibiting the enzyme enkephalinase, which leads to increased levels of endogenous opioids that help reduce intestinal fluid secretion. Racecadotril has been shown to be effective in the treatment of acute diarrhoea and possesses few adverse effects when compared to Loperamide.

Racecadotril and Loperamide: Approval and dosage regimens

Racecadotril vs. Loperamide in adult infectious diarrhoea: Safety and efficacy

Recently, a meta-analysis of 5 randomised controlled trials (RCTs) was performed to assess the effectiveness of Racecadotril and Loperamide for adult infectious diarrhoea.

When compared to Loperamide, Racecadotril significantly improved the clinical response in patients. Essentially, both Racecadotril and Loperamide demonstrated comparable efficacy in terms of the clinical response; however, Racecadotril was associated with a more significant improvement in the reduction of therapy-emergent constipation.

Another study highlighted that Racecadotril led to a quicker resolution of diarrhoea compared to Loperamide, along with a lower incidence of adverse effects. Unlike Loperamide, Racecadotril has no contraindications and can be safely prescribed for patients with dysentery or bacterial enterocolitis.

Therefore, Racecadotril may be a better alternative to Loperamide for the treatment of acute diarrhoea.