Antihypertensive · Antidiarrheal
Also known as acetorphan
Racecadotril is a prodrug that is rapidly converted to its active metabolite, thiorphan, an enkephalinase inhibitor. Thiorphan prevents the degradation of endogenous enkephalins, which in turn reinforces their effects on delta-opioid receptors to inhibit intestinal secretion, thereby producing an anti-diarrheal effect.
Manufacturer advises caution.
Significantly increased risk of angioedema due to excessive bradykinin accumulation.
Concomitant use is contraindicated. A washout period is required between stopping one drug and starting the other (e.g., 36 hours for sacubitril/valsartan before starting racecadotril, and vice versa).
Increased risk of angioedema (swelling of face, lips, tongue, throat), cough, and other bradykinin-mediated adverse effects.
Monitor patients closely for signs of angioedema, especially at the start of therapy. Consider alternative antidiarrheal agents if the patient is at high risk or has a history of angioedema with ACE inhibitors. Educate patients on symptoms of angioedema and to seek immediate medical attention if they occur.
No direct interaction, but in patients with IBD, managing diarrhea with racecadotril while on corticosteroids requires careful assessment to ensure underlying inflammation is not masked or worsened.
Use with caution in patients with IBD. Racecadotril is for symptomatic relief of acute diarrhea and should not be used to treat chronic diarrhea without addressing the underlying cause. Monitor for worsening of IBD symptoms.
Increased risk of dehydration and electrolyte disturbances (e.g., hypokalemia, hyponatremia) if diarrhea is severe or prolonged.
Monitor fluid and electrolyte status, especially in elderly patients or those with pre-existing renal impairment. Ensure adequate hydration. Adjust diuretic dose if necessary, or consider temporary discontinuation if diarrhea is severe.
Reduced efficacy of oral contraceptives, potentially leading to unintended pregnancy.
Advise patients to use additional barrier contraception (e.g., condoms) during severe diarrhea and for 7 days after recovery. This is a general precaution for any severe diarrhea, not specific to racecadotril's direct interaction.
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Sources: KD Tripathi 7e, Goodman & Gilman 14e, BNF·Verified: 2026-05-13 · House clinical team