Nitazoxanide Uses, Dosage, Side Effects, Food Interaction and all others data.

Nitazoxanide, a synthetic antiprotozoal agent. Nitazoxanide is well absorbed from GIT. It interferes with the Pyruvate Ferredoxin Oxidoreductase (PFOR) enzyme dependent electron transfer reaction which is essential to anaerobic glucose energy metabolism. This results in cell swelling, membrane damage resulting in dysfunction of the parasite.

The general effect of this medication is the prevention of microbe activity through disruption of important energy pathways for survival and proliferation . Nitazoxanide exhibits antiprotozoal activity by interfering with the pyruvate ferredoxin/flavodoxin oxidoreductase dependent electron transfer reaction, an essential reaction need for anaerobic energy metabolism of various microorganisms. Sporozoites of Cryptosporidium parvum and trophozoites of Giardia lamblia are therefore inhibited, relieving symptoms of diahrrea . Interference with the PFOR enzyme-dependent electron transfer reaction may only be one of the many pathways by which nitazoxanide exhibits antiprotozoal activity .

Trade Name Nitazoxanide
Availability Prescription only
Generic Nitazoxanide
Nitazoxanide Other Names Nitaxozanid, Nitaxozanide, Nitazoxanida, Nitazoxanide, Nitazoxanidum
Related Drugs doxycycline, metronidazole, Flagyl, albendazole, mebendazole, Vibramycin, tinidazole, chloroquine, praziquantel, paromomycin
Weight 100mg/5ml, 500mg
Type Oral powder for reconstitution, oral tablet
Formula C12H9N3O5S
Weight Average: 307.282
Monoisotopic: 307.026291103
Protein binding

Very High (greater than 99%), bound to proteins in the plasma .

Groups Approved, Investigational, Vet approved
Therapeutic Class Anti-diarrhoeal Antiprotozoal
Available Country United States
Last Updated: September 19, 2023 at 7:00 am


Nitazoxanide is used for diarrhoea caused by Cryptosporidium parvum and Giardia lamblia, Amebiasis and helminth infections.

Nitazoxanide is also used to associated treatment for these conditions: Ascariasis, Cestode infections, Clostridium difficile infection recurrence, Cryptosporidiosis infection, Diarrhea caused by Cryptosporidium parvum, Diarrhea caused by Giardia lamblia, Giardiasis, Trichuriasis

How Nitazoxanide works

The most widely accepted mechanism of NTZ is believed to be the disruption of the energy metabolism in anaerobic microbes by inhibition of the pyruvate: ferredoxin/flavodoxin oxidoreductase (PFOR) cycle . In parasitic-protozoa, Nitazoxanide also induces lesions in the cell membranes and depolarizes the mitochondrial membrane while inhibiting quinone oxidoreductase NQO1, nitroreductase-1 and protein disulphide isomerase enzymes. In addition, this drug also inhibits the glutathione-S-transferase (a major detoxifying enzyme) and modulates the Avr-14 gene, encoding for the alpha-type subunit of glutamate-gated chloride ion channel present in nematodes. Aside from its well understood non-competitive inhibition of the PFOR in anaerobic bacteria, NTZ also demonstrates various other antibacterial mechanisms. It inhibits pyruvate dehydrogenase in E Coli, disrupts the membrane potential and pH homeostasis in the Mycobacterium tuberculosis, suppresses the chaperone/usher (CU) pathway of the gram-negative bacteria, and stimulates host macrophage autophagy in tuberculosis patients . NTZ also suppresses viral replication by inhibiting the maturation of the viral hemagglutinin and the viral transcription factor immediate early 2 (IE2) as well as by activating the eukaryotic translation initiation factor 2α (an antiviral intracellular protein). Lastly, NTZ exhibits an inhibitory effect on tumor cell progression by altering drug detoxification (glutathione-S-transferase P1), unfolded protein response, autophagy, anti-cytokines activity, and c-Myc inhibition .


Nitazoxanide dosage

Age 1-3 years: 5 ml (100 mg) twice daily for 3 days

Age 4-11 years: 10 ml (200 mg) twice daily for 3 days

Age >12 years: 25 ml or 1 tablet (500 mg) twice daily for 3 days

The suspension or tablet should be taken with food.

30 ml suspension: Shake the bottle well before adding water. Then add 20 ml of boiled and cooled water (with the help of provided cup) into the bottle and shake well to make 30 ml suspension.

60 ml suspension: Shake the bottle well before adding water. Then add 40 ml of boiled and cooled water (with the help of provided cup) into the bottle and shake well to make 60 ml suspension.

Side Effects

Nitazoxanide is generally well tolerated. However abdominal pain, diarrhoea vomiting and headache have been reported rarely


Data on nitazoxanide overdosage is not available . In studies in rodents and dogs, the oral LD50 was higher than 10,000 mg/kg. One-time oral doses of up to 4000 mg nitazoxanide have been given to healthy adult volunteers without severe adverse effects. Gastric lavage may be appropriate soon after oral administration if overdose occurs. Supportive and symptomatic treatment should also be administered .

According to previous studies , less than 1% of the patients age 12 years and older participating in clinical trials with NTZ suffered from the following adverse effects: Systemic: asthenia, fever, pain, allergic reaction, pelvic pain, back pain, chills, fever, flu-like syndrome. Central Nervous System: dizziness, somnolence, insomnia, tremor, hypesthesia. Gastrointestinal System: vomiting, dyspepsia, anorexia, flatulence, constipation, dry mouth, thirst. Urogenital System: discolored urine, dysuria, amenorrhea, metrorrhagia, kidney pain, edema labia. Metabolic & Nutrition: increased SGPT. Hemic & Lymphatic Systems: anemia, leukocytosis. Skin: rash, pruritus. Special Senses: eye discoloration, ear ache. Respiratory System: epistaxis, lung disease, pharyngitis. Cardiovascular System: tachycardia, syncope, hypertension. Muscular System: myalgia, leg cramps, spontaneous bone fracture.


Nitazoxanide should be administrated with caution to patients with hepatic, renal and biliary disease.


Nitazoxanide is highly bound to plasma protein (>99.9%). Therefore, caution should be used when administering Nitazoxanide concurrently with other highly plasma-protein bound drugs.

Food Interaction

  • Take with food. Food improves oral bioavailability.

[Moderate] ADJUST DOSING INTERVAL: Food enhances the bioavailability of the pharmacologically active metabolite tizoxanide (desacetyl-nitazoxamide) from nitazoxanide administration.

According to the product labeling, administration of nitazoxanide tablets with food increases the area under the plasma concentration-time curve (AUC) of tizoxanide and tizoxanide glucuronide in plasma by almost 2-fold and the peak plasma concentration (Cmax) by almost 50%.

Administration of nitazoxanide oral suspension with food increases the AUC of tizoxanide and tizoxandie glucuronide by about 45% to 50% and the Cmax by less than 10%.

MANAGEMENT: Nitazoxanide tablets and oral suspension were administered with food in clinical trials and are recommended to be administered with food to ensure maximal drug levels in plasma.

Nitazoxanide Disease Interaction

Moderate: diabetes, renal/liver disease

Elimination Route

The relative bioavailability of the suspension compared to the tablet was 70%. When administered with food the AUC and Cmax increased by two-fold and 50%, respectively, for the tablet and 45 to 50% and ≤ 10%, respectively, for the oral suspension .

Half Life



Nitazoxanide is cleared in the urine and feces. The metabolite, tizoxanide, is also found in the urine, plasma, and breastmilk . The drug is not found unchanged in the urine .

Elimination Route

Tizoxanide is excreted in the urine, bile and feces, and tizoxanide glucuronide is excreted in urine and bile. Approximately 2/3 of the oral dose of nitazoxanide is excreted in the faeces and 1/3 in the urine .

Pregnancy & Breastfeeding use

Pregnancy category B. This drug should be used during pregnancy only if clearly needed.

Nursing mother: It is not known whether Nitazoxanide is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Nitazoxanide is administrated to a nursing woman.


Known hypersensitivity to Nitazoxanide or any other ingredient in the formulations

Special Warning

Paediatric Use: Safety and effectiveness of Nitazoxanide for Oral Suspension in paediatric patients less than one year of age have not been studied.

Impaired renal or hepatic function: The pharmacokinetics of Nitazoxanide in patients with impaired renal or hepatic function have not been studied. Therefore, Nitazoxanide must be administered with caution to patients with hepatic and biliary disease, to patients with renal disease and to patients with combined renal and hepatic disease.

Acute Overdose

Information on Nitazoxanide overdosage is not available. Single oral doses of up to 4000 mg Nitazoxanide have been administered to healthy adult volunteers without significant adverse effects.

Storage Condition

Store in a cool and dry place, away from light and moisture. Once reconstituted suspension should be used within 7 days.

Innovators Monograph

You find simplified version here Nitazoxanide

Nitazoxanide contains Nitazoxanide see full prescribing information from innovator Nitazoxanide Monograph, Nitazoxanide MSDS, Nitazoxanide FDA label


What is Nitazoxanide used for?

Nitazoxanide is a broad-spectrum antiparasitic and broad-spectrum antiviral medication that is used in medicine for the treatment of various helminthic, protozoal, and viral infection. Nitazoxanide is used to treat diarrhea caused by Giardia or Cryptosporidium. These conditions are sometimes called "Traveler's diarrhea." 

How safe is Nitazoxanide?

Nitazoxanide demonstrates a good safety profile at approved doses. However, further evidence is required regarding hepatorenal and cardiovascular effects, as well as teratogenicity.

How does Nitazoxanide work?

Nitazoxanide works by interfering with the conversion of chemicals to energy in protozoal cells.

What are the common side effects of Nitazoxanide?

Common side effects of Nitazoxanide are include:

  • abdominal pain,
  • nausea,
  • diarrhea,
  • vomiting, or.
  • headache.

Is Nitazoxanide safe during pregnancy?

This Nitazoxanide should be used during pregnancy only if the benefit outweighs the risk. No data available on use of this drug in pregnant women to inform a drug-related risk.

Is Nitazoxanide safe during breastfeeding?

The effects in the nursing infant are unknown; potential side effects in the breastfed child due to this drug or the mother's underlying condition should be considered. Until more data are available, an alternative agent may be preferred, particularly while breastfeeding newborn or preterm infants; caution is recommended.

Can I drink alcohol with Nitazoxanide?

No interactions were found between Alcohol (contained in alcoholic beverages) and Nitazoxanide. This does not necessarily mean no interactions exist. Always consult your healthcare provider.

How long does Nitazoxanide take to work ?

It may take up to 5 days for diarrhea to resolve in approximately 80% of patients 4.

How long does Nitazoxanide stay in my system?

Elimination half-life of Nitazoxanide 3.5 hours.

Can I take Nitazoxanide in empty stomach?

Nitazoxanide should be taken just after eating food. Do not take it on an empty stomach. This will make it easier for your body to absorb the medication.

When should be taken of Nitazoxanide?

Nitazoxanide is usually taken with food every 12 hours for 3 days. Take Nitazoxanide at around the same times every day.

Can I take Nitazoxanide for a long time?

Do not take more of this Nitazoxanide and do not take it more often than your doctor ordered. This Nitazoxanide works best if there is a constant amount in the blood.

How much Nitazoxanide can I take daily?

Adults and children 12 years or older 25 milliliters (mL) every 12 hours, taken with food, for 3 days. Children 4 to 11 years of age 10 mL every 12 hours, taken with food, for 3 days.

How long should I take Nitazoxanide?

Nitazoxanide is usually taken once every 12 hours for 3 days.

Who should not take Nitazoxanide?

You should not use Nitazoxanide if you are allergic to it. To make sure Nitazoxanide is safe for you, tell your doctor if you have: liver or kidney disease; HIV or AIDS; or a weak immune system.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I take too much medication?

The more medications you are taking, the higher the risk of those drugs interacting dangerously with each other. Multiple medications can cause confusion, lightheadedness and even internal bleeding — all dangerous and injurious conditions.

Can Nitazoxanide affects my liver?

Nitazoxanide has some adverse effects on liver and kidney of rats. Therefore, Nitazoxanide should be used with caution by people with liver.

Can Nitazoxanide affect my kidneys?

Nitazoxanide should be used with caution by people with kidney problems.

*** Taking medicines without doctor's advice can cause long-term problems.