Racecadotril for Acute Diarrhoea in Children
Effective symptomatic treatment for acute diarrhoea in children over 3 months, used alongside rehydration to reduce symptoms and duration.
Hidrasec
Peer reviewed content on racecadotril for managing acute diarrhoea symptoms in children. Last updated based on recent clinical reviews.
Racecadotril reduces the symptoms of acute diarrhoea in children. It is taken three times a day at regular intervals until the diarrhoea stops. It is crucial that your child also has plenty to drink and tries to eat as normally as possible to prevent dehydration.
About racecadotril
| Type of medicine | An antidiarrhoeal medicine – an enkephalinase inhibitor |
|---|---|
| Used for | Acute diarrhoea in adolescents and in children over 3 months of age |
| Also called | Hidrasec® |
| Available as | Sachets of granules for oral suspension |
Racecadotril is an antidiarrhoeal medicine that works by inhibiting enkephalinase, an enzyme in the gut. It is a prodrug rapidly converted to its active metabolite, thiorphan, which reduces excessive intestinal secretion of water and electrolytes without affecting gut motility or normal secretory functions. This mechanism helps alleviate diarrhoea symptoms by decreasing fluid loss, unlike motility inhibitors like loperamide, which can cause constipation or bacterial overgrowth. Clinical studies confirm its efficacy: in children, racecadotril reduced stool weights by 40-46% in the first 48 hours and shortened diarrhoea duration significantly. A meta-analysis of 24 studies showed it reduced time to cure by 28 hours on average (from 106.2 to 78.2 hours).
Unlike traditional antidiarrhoeals, racecadotril does not slow intestinal transit, minimizing risks like toxin retention. It is recommended as a complementary treatment alongside oral rehydration therapy (ORT) when ORT alone is insufficient. Guidelines from organizations like the Scottish Medicines Consortium support its use in infants over 3 months and children for symptomatic relief.
Before giving racecadotril to your child
Ensure racecadotril is suitable by discussing with a healthcare professional. It is indicated for acute diarrhoea in children over 3 months where rehydration alone fails to control symptoms, and no causal treatment (e.g., antibiotics for bacterial cause) is available.
Allergies
Do not use if your child is allergic to racecadotril or any ingredients. Sachets contain sucrose; avoid in children with fructose intolerance, glucose-galactose malabsorption, or sucrase-isomaltase deficiency.
Other medicines and conditions
- Inform your doctor of other medications, as interactions are minimal but possible with bulking agents.
- Not recommended if diarrhoea is bloody, severe (e.g., >8 stools/day), prolonged (>48 hours without improvement), or accompanied by fever >38.5°C or other symptoms like vomiting.
- Use cautiously in liver or kidney impairment; no dose adjustment typically needed.
- Safe with ORT, probiotics, or smectite; studies show additive benefits, e.g., improved cure rates when added to ORT + smectite.
Rehydration is essential
Acute diarrhoea can cause dangerous dehydration, especially in young children. Racecadotril treats symptoms but does not replace fluid/electrolyte replacement. Use oral rehydration salts (ORS) as directed: for children under 2 years, 50-100 ml/kg over 4 hours, then maintenance. Continue breastfeeding or normal feeding. Seek immediate help if signs of dehydration appear: dry mouth, no tears, sunken eyes/fontanelle, reduced urine, lethargy.
How to give racecadotril
Follow your doctor’s instructions precisely. Racecadotril is for short-term use (up to 7 days) alongside dietary measures and ORT.
Dosage
Dose depends on weight: 1.5 mg/kg three times daily (every 8 hours). Use the table below for sachets (10 mg or 30 mg racecadotril):
| Weight | Sachets per dose | Dosage (mg) |
|---|---|---|
| <9 kg | 1 × 10 mg | 10 mg |
| 9-27 kg | 1 × 30 mg or 3 × 10 mg | 30 mg |
| >27 kg | 2 × 30 mg | 60 mg |
Give first dose immediately. Continue until two consecutive normal stools or no stool for 12 hours, max 7 days. Clinical data supports efficacy: median diarrhoea duration reduced from 5.1 to 3.4 days vs. placebo.
Administration
Open sachet, mix granules with food, bottle feed, or water (e.g., apple juice). Stir well and give immediately. Can be given with/without food. Do not store mixed suspension.
Possible side effects
Racecadotril is well-tolerated, with a safety profile similar to placebo and better than loperamide. Common side effects (>1/100):
- Rash (toning down if severe, stop and seek advice)
- Headache, nausea, vomiting (usually mild)
Rare (<1/1000): constipation, dry mouth. No reports of serious adverse events in paediatric trials; meta-analyses confirm low risk. If symptoms worsen or new ones appear (e.g., blood in stool, high fever), stop and consult a doctor.
When not to give racecadotril
- Under 3 months or body weight <3 kg
- Bloody/mucoid stools, fever >38.5°C, severe dehydration
- Diarrhoea lasting >7 days or not improving in 3 days
- Known hypersensitivity
- Conditions like antibiotic-associated colitis.
Key facts
- Starts working within hours; full effect in 48 hours.
- Reduces stool output by up to 46% and hospital stay.
- Superior to placebo; comparable or better than smectite/probiotics.
- Not absorbed systemically; acts locally in gut.
Learn more
- ORS preparation: Dissolve in correct water volume, use promptly.
- Diet: Continue normal age-appropriate food; avoid high-sugar drinks.
- Prevention: Hand hygiene, safe water/food.
Frequently Asked Questions
Q: How quickly does racecadotril work?
A: It reduces stool output within 48 hours, with significant symptom relief often sooner. Meta-analysis shows 28-hour faster recovery.
Q: Can I use racecadotril with other treatments?
A: Yes, alongside ORT and smectite; studies show enhanced efficacy without increased side effects.
Q: What if diarrhoea doesn’t improve?
A: Stop after 3 days without improvement; seek medical advice for tests or alternative therapy.
Q: Is it safe for infants?
A: Yes, for over 3 months; well-tolerated in trials from 3 months to 18 years.
Q: Does it cause constipation?
A: Rarely; better tolerability than loperamide, no motility inhibition.
References
- Hidrasec: Dosages and Ingredients | Full Prescribing Info — MIMS Singapore. 2023. https://www.mims.com/singapore/drug/info/hidrasec?type=full
- Racecadotril in the treatment of acute diarrhea in children — PMC (NCBI). 2018-04-05. https://pmc.ncbi.nlm.nih.gov/articles/PMC5883268/
- Racecadotril (Hidrasec) Resubmission — Scottish Medicines Consortium (NHS Scotland). 2014-07. https://scottishmedicines.org.uk/media/2203/racecadotril__hidrasec__resubmission_final_july_2014_for_website.pdf
- Hidrasec Medication – Ingredients, Uses, Dosage — Vinmec International Hospital. 2023. https://www.vinmec.com/eng/blog/hidrasec-ingredients-uses-doses-and-notes-when-using-en
- Racecadotril for acute diarrhoea in children — Patient.info. 2023-01-13. https://patient.info/medicine/racecadotril-for-acute-diarrhoea-in-children-hidrasec
- Racecadotril for Acute Diarrhea in Infants, Children and Adolescents — JSciMed Central. 2022. https://www.jscimedcentral.com/public/assets/articles/pediatrics-8-1196.pdf
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