Racecadotril is licensed for the symptomatic treatment of acute diarrhoea in adults when causal treatment is not possible. If causal treatment is possible, racecadotril can be administered as a complementary treatment (see the Hidrasec summary of product characteristics).
Although racecadotril appears to have similar efficacy to loperamide in reducing the duration of diarrhoea and frequency of stool output, and causes fewer adverse effects, it is unclear where it fits within current UK practice. According to the Health Protection Agency most infectious diarrhoea in the UK is self-limiting: nearly half of episodes last less than 1 day. Specialists have suggested that racecadotril might have a place in the treatment of travel-associated diarrhoea or chronic diarrhoea of unknown cause. However, evidence from clinical studies is needed before this can be recommended.
Assuming symptomatic treatment of diarrhoea is necessary, racecadotril is more expensive than antimotility agents, which are the current first-line option. The manufacturers of racecadotril suggest that the adults most likely to benefit are those with acute diarrhoea in which inhibition of peristalsis, abdominal distension or constipation should be avoided (Abbott Healthcare Products Limited: personal communication December 2012). However, further research is necessary to examine the possible clinical and health economic benefits that might be associated with use of racecadotril in the UK.
Local decision makers will need to consider the available evidence when making decisions about using racecadotril.
It is not possible to provide estimated usage based on the available data.
Between November 2011 and October 2012, more than 1.6 million items of loperamide capsules, tablets and orodispersible tablets were prescribed in primary care in England, at a cost of over £4.6 million. Over the same period, almost 548,000 items of ORS solution were prescribed at a cost of almost £2.7 million (NHS Business Services Authority: personal communication January 2013).