Question
Compare and contrast: loperamide and racecadotril.
Q10 4 marks Short Answers ★ ✓
Answer
Compare and contrast: Loperamide and Racecadotril
Feature Loperamide Racecadotril Class Opioid-receptor agonist (peripherally restricted) Enkephalinase inhibitor Mechanism Activates mu-opioid receptors in the gut wall, reducing peristalsis and increasing transit time Inhibits enkephalinase, prolonging the action of endogenous enkephalins, which reduces intestinal hypersecretion without slowing motility Effect on motility Reduces motility (antimotility) Antisecretory, motility largely unaffected CNS penetration Minimal (P-glycoprotein substrate, excluded from CNS at normal doses) Minimal Risk in invasive/infective diarrhea Can worsen outcomes by delaying pathogen clearance and increasing toxin dwell time (risk of toxic megacolon in some infections) Considered safer in infective diarrhea, since motility (and hence clearance) is not slowed Typical use Acute non-infective/traveler’s diarrhea, chronic diarrhea Acute diarrhea, including in children, as an adjunct to oral rehydration
Shared feature : both provide symptomatic relief in acute diarrhea without being antimicrobial agents themselves, and neither substitutes for oral rehydration, which remains the priority.
1 Drugs for Constipation and Diarrhoea
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