Racecadotril--is there enough evidence to recommend it for treatment of acute diarrhea? [editorial]

Racecadotril is being proposed as a new “wonder” drug for the treatment of acute diarrhea in children. It is a synthetic enkephalinase inhibitor and its anti diarrheal effects are attributed to its anti secretory properties mediated by inactivating endogenous opioid peptides enkephalins secreted by myenteric and submucus plexus in the digestive tract. Enkephalins act as neurotransmitters and are rapidly broken down by the enkephalinase present throughout the gastro intestinal tract. Racecadotril therefore potentiates the physiological anti-secretory properties of the enkephalins. Studies in animal models have shown that the effects of racecadotril are antagonized by the opioid receptor antagonists nalaxone therefore further confirming involvement of endogenous opioid peptides. (excerpt)