Racecadotril: An Effective Anti-Diarrheal Drug

Marco Manfredi, MD, PhD (Editor)
Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy

Series: Pharmacology – Research, Safety Testing and Regulation
BISAC: MED071000

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Volume 10

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Volume 2

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Special issue: Resilience in breaking the cycle of children’s environmental health disparities
Edited by I Leslie Rubin, Robert J Geller, Abby Mutic, Benjamin A Gitterman, Nathan Mutic, Wayne Garfinkel, Claire D Coles, Kurt Martinuzzi, and Joav Merrick

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Acute diarrhea, although tends to be a self-limiting disease in otherwise healthy people, continues to cause millions of deaths every year, particularly in infants and the elderly. Therefore it represents a very frequent medical problem with a significant societal impact such as health-care utilization and lost working days by caregivers. Dehydration, the most frequent and severe complication occurs in the first 48 hours from the onset of the disease. For this reason, the WHO considers this time frame the more critical period where we should mostly act. Oral rehydration solution is the most important component of treatment to avoid dehydration, but despite its proven effectiveness it is still rarely used because of low compliance mainly due to the subjective perception of poor effectiveness, as it does not reduce stools frequency, nor loss of intestinal liquids, neither the length of diarrhea.

Racecadotril represents, so far, the unique drug acting on one of the main pathophysiological mechanisms underlying acute diarrhea.

In this book some experts discussed the main international diarrheal guidelines in children and adults even analyzing the health costs of the disease.

Other authors have thoroughly addressed the etiopathological mechanisms underlying acute diarrhea and some others have fully analyzed the clinical studies on Racecadotril present in the literature both in children and adults.

In addition, the world’s leading experts on Racecadotril have thoroughly clarified the drug’s pharmacological mechanisms and have wonderfully summarized its safety profile.

Finally we analyzed the cost-effectiveness of the drug based on the studies published so far, which confirm that Racecadotril can be a cost-saving drug in treating acute diarrhea because it can facilitate the home-management of the disease.

All things considered, we can say that Racecadotril is an effective and safe anti-diarrheal drug that can reduce the associated health care costs by increasing the likelihood of resolving the disease in outpatient setting.
(Imprint: Nova Medicine and Health)

Preface

Chapter 1. Acute Gastroenteritis in Children: Epidemiology, Guidelines, and Health Costs
(Paolo Quitadamo, Giusy Romano, Federica Anselmi and Licia Pensabene, Department of Pediatrics, A.O.R.N. Santobono-Pausilipon, Naples, Italy, and others)

Chapter 2. Acute Gastroenteritis in Adults: Epidemiology, Guidelines, and Health Costs
(Stefano Kayali, Federica Gaiani and Gian Luigi de’Angelis, Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy)

Chapter 3. Etiology and Pathophysiology of Infectious Diarrhea
(Maria Chiara Marisi, Maria Beatrice Ruozi, Icilio Dodi, Margherita Varini and Valentina Maffini, Emergency and General Pediatrics, “Pietro Barilla” Children's Hospital, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy)

Chapter 4. Therapeutic Choices in Acute Gastroenteritis in Children: The Role of Oral Rehydration Solutions
(Valeria Dipasquale and Claudio Romano, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy)

Chapter 5. Therapeutic Choices in Acute Gastroenteritis in Children: Beyond the ORS. The Role of Adjuvants
(Silvia Iuliano, Giancarlo Gargano, Pierpacifico Gismondi, Fabiola Fornaroli and Marco Manfredi, Department of Pediatrics, “Pietro Barilla” Children's Hospital, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy, and others)

Chapter 6. Therapeutic Choices in Acute Gastroenteritis in Adults
(Federica Gaiani, Stefano Kayali and Gian Luigi de’Angelis, Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy)

Chapter 7. Racecadotril: Pharmacological Aspects
(Jeanne-Marie Lecomte, PhD, Jean-Charles Schwartz, PhD, and Philippe Baumer, MD, Bioprojet Pharma, Paris, France, and others)

Chapter 8. Clinical Studies on Racecadotril in Children
(Bartłomiej M. Zalewski and Hania Szajewska, Department of Paediatrics, Medical University of Warsaw, Poland)

Chapter 9. Clinical Studies on Racecadotril in Adults
(Luigi Iannone and Luca Gallelli, Department of Health Science, University of Catanzaro, Catanzaro, Italy)

Chapter 10. Racecadotril: Side Effects and Tolerability
(Philippe Baumer, MD, Department of Gastroenterology, Saint-Antoine Hospital, Paris, France, and others)

Chapter 11. Pharmacoeconomical Aspects of Racecadotril
(Marco Manfredi, Silvia Iuliano, Pierpacifico Gismondi, Gino Camellini and Giancarlo Gargano, Maternal and Child Department, Azienda USL – IRCCS di Reggio Emilia, Pediatric Unit, Sant’Anna Hospital, Castelnovo ne’ Monti, Italy, and others)

Chapter 12. Conclusions
(Marco Manfredi, Pierpacifico Gismondi, Silvia Iuliano, Alessandro De Fanti and Giancarlo Gargano, Maternal and Child Department, Azienda USL – IRCCS di Reggio Emilia, Pediatric Unit, Sant’Anna Hospital, Castelnovo ne’ Monti, Italy, and others)

Index

“Diarrhea, whose morbidity is still a non-solved problem, still creates a great deal of anxiety among parents who look for something to stop the disease as quickly as possible. Racecadotril fulfills all the characteristics that an ideal antidiarrheal drug should have, as described by Dr. Robert Edelman in 1985, when adequate antidiarrheal drugs were not yet available. Taken by mouth, racecadotril is rapidly absorbed in the intestine and found subsequently in large quantities in the submucosal structures of the intestinal wall. It inhibits the enkephalinase activity, protects enkephalins from inactivation, reduces cytosolic cyclic AMP level, and rapidly controls hypersecretion of water and electrolytes without affecting the intestinal motility. Furthermore, it does not cross the blood-brain barrier and thus has no sedative effects. This book, edited by Dr. Marco Manfredi, is a comprehensive review of racecadotril. A group of experts in the field reviews its history, pharmacologic properties, mode of action, and results of clinical trials conducted to prove its efficacy and safety. It is particularly remarkable to have among the authors, Dr. Schwartz and Dr. Lecomte, who were the developers of this drug. Time will prove that this book is an excellent addition to the bookshelf of those who have an interest in the field of diarrheal diseases and its treatment.” - Eduardo Salazar-Lindo, MD, Professor of Pediatrics, Universidad Peruana Cayetano Heredia, Peru

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