nitazoxanide

Therapeutic Classification: antiprotozoals

Pharmacologic Classification: benzamides

Indications ⬆ ⬇

REMS

Treatment of diarrhea due to Cryptosporidium parvum and Giardia lamblia.
Not effective for C. parvum diarrhea in patients infected with HIV.

Action ⬆ ⬇

Interferes with electron transfer reaction necessary for anaerobic energy metabolism of offending organisms.

Therapeutic effects:

Antiprotozoal action resulting in decreased diarrhea.

Pharmacokinetics ⬆ ⬇

Absorption: Following oral administration, nitazoxanide is rapidly converted to tizoxanide which is the active metabolite; tizoxanide is further metabolized.

Distribution: Unknown.

Protein Binding: >99%.

Metabolism/Excretion: Tizoxanide: excreted in urine, bile and feces; inactive metabolites excreted in urine, bile and feces.

Half-Life: Unknown.

Time/Action Profile ⬆ ⬇

(blood levels)

ROUTE	ONSET	PEAK	DURATION
PO	unknown‡	1–4 hr	12 hr

‡Onset of antidiarrheal activity is 24–48 hr.

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity.

Use Cautiously in:

Hepatic or renal impairment;
Diabetes (contains 1.48 g sucrose/5 mL);
OB: Safety not established in pregnancy;
Lactation: Safety not established in breastfeeding;
Pedi: Children <1 yr (safety and effectiveness not established).

Adv. Reactions/Side Effects ⬆ ⬇

Derm: pruritus, sweating

EENT: yellow eye discoloration

GI: abdominal pain, diarrhea, vomiting

GU: discolored urine

Neuro: dizziness

Misc: fever

Interactions ⬆ ⬇

Drug-drug:

May interact with other highly protein-bound drugs by competing for binding sites.

Route/Dosage ⬆ ⬇

PO (Adults and Children ≥12 yr): 500 mg every 12 hr for 3 days (as tablets or oral suspension).
PO (Children 4–11 yr): 200 mg every 12 hr for 3 days (as oral suspension).
PO (Children 1–4 yr): 100 mg every 12 hr for 3 days (as oral suspension).

Availability ⬆ ⬇

(Generic available)

Tablets: 500 mg
Oral suspensionstrawberry: 100 mg/5 mL

Assessment ⬆ ⬇

Assess frequency and consistency of stools and bowel sounds before and during therapy.
Assess fluid and electrolyte balance and skin turgor for dehydration.

Implementation ⬆ ⬇

PO: Administer with food. Keep container tightly closed and shake well before each administration. Suspension may be stored at room temperature for 7 days; discard unused portion.
- Pedi: Tablets contain more than pediatric dose; use solution for patients ≤12 years.

Patient/Family Teaching ⬆ ⬇

Explain to parents administration of medication and monitoring of condition.
Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

Evaluation/Desired Outcomes ⬆ ⬇

Resolution of symptoms: no watery stools, no more than 2 soft stools within the past 24 hr and no unformed stools within the past 48 hr.

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Pronunciation ⬇

Classifications ⬆ ⬇