Nitazoxanide is a thiazolide anti-infective used to treat infections by protozoa, helminths, anaerobic bacteria, microaerophilic bacteria, and viruses.

Brand Names
Alinia, Busulfex
Generic Name
DrugBank Accession Number

Nitazoxanide belongs to the class of drugs known as thiazolides. Nitazoxanide (NTZ) is a broad-spectrum anti-infective drug that markedly modulates the survival, growth, and proliferation of a range of extracellular and intracellular protozoa, helminths, anaerobic and microaerophilic bacteria, in addition to viruses. This drug is effective in the treatment of gastrointestinal infections including Cryptosporidium parvum or Giardia lamblia in healthy subjects. It is generally well tolerated. Nitazoxanide is a first-line, standard treatment for illness caused by C. parvum or G. lamblia infection in healthy (not immunosuppressed) adults and children and may also be considered in the treatment of illnesses caused by other protozoa or helminths 2. Recently, this drug has been studied as a broad-spectrum antiviral agent due to its ability to inhibit the replication of several RNA and DNA viruses 3.

Small Molecule
Approved, Investigational, Vet approved
Average: 307.282
Monoisotopic: 307.026291103
Chemical Formula
  • Nitaxozanid
  • Nitaxozanide
  • Nitazoxanida
  • Nitazoxanide
  • Nitazoxanidum
External IDs
  • PH 5776
  • PH-5776



For the treatment of diarrhea in adults and children caused by the protozoa Giardia lamblia, and for the treatment of diarrhea in children caused by the protozoan, Cryptosporidium parvum Label.

Nitazoxanide has not been shown to be superior to placebo medication for the management of diarrhea caused by Cryptosporidium parvum in patients with HIV/immunodeficiency Label,1,2.

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Associated Conditions
Contraindications & Blackbox Warnings
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The general effect of this medication is the prevention of microbe activity through disruption of important energy pathways for survival and proliferation Label,2. 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 10. Interference with the PFOR enzyme-dependent electron transfer reaction may only be one of the many pathways by which nitazoxanide exhibits antiprotozoal activity Label,1,10.

Mechanism of action

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 5. 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 2. 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 2.

APyruvate-flavodoxin oxidoreductase
Desulfovibrio africanus

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 Label.

Volume of distribution

Not Available

Protein binding

Very High (greater than 99%), bound to proteins in the plasma Label,5.


The active metabolite of this drug is tizoxanide (desacetyl-nitazoxanide). The initial reaction in the metabolic pathway of Nitazoxanide is hydrolysis to tizoxanide, followed by conjugation, primarily by glucuronidation to tizoxanide glucuronide.

The oral suspension bioavailability of this drug is not equivalent to that of the oral tablets. Compared to the to the tablet, the bioavailability of the suspension was 70% Label.

When administered with food, the AUCt of tizoxanide and tizoxanide glucuronide in plasma is increased to almost two-fold and the maximum concentration is increased by almost 50% compared to when ingested without food Label.

When the oral suspension was ingested with food, the AUC of tizoxanide and tizoxanide glucuronide increased by approximately 50% and the Cmax increased by less than 10% Label.

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Route of elimination

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 Label,5.


7.3h 8


Nitazoxanide is cleared in the urine and feces. The metabolite, tizoxanide, is also found in the urine, plasma, and breastmilk 9. The drug is not found unchanged in the urine 9.

Adverse Effects
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Data on nitazoxanide overdosage is not available Label. 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 Label.

According to previous studies Label, 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.

Not Available
Pharmacogenomic Effects/ADRs
Not Available


Drug Interactions
This information should not be interpreted without the help of a healthcare provider. If you believe you are experiencing an interaction, contact a healthcare provider immediately. The absence of an interaction does not necessarily mean no interactions exist.
No interactions found.
Food Interactions
  • Take with food. Food improves oral bioavailability.


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International/Other Brands
Alpex Nizox (Alpex Pharmaceutical) / ANNITA (Alpex Pharmaceutical) / Azoxanid (G&R) / Celectan (Farma) / Colufase (Roemmers) / Coluquim (Quilab) / Daxon (Siegfried) / Dianide (General Pharma) / Diar (ACI) / Famidox (Lafrancol) / Kaside (Lafrancol) / Kazide (Lafrancol) / Larvisol (Armofar) / Lumbris (Farmedic) / Mixel (California) / Niazid (Apex) / Nitax (Delta) / Nitaxide (Beximco) / Nitazet (Glenmark) / Nitazofin (Bussié) / Nodik / Omniparax
Brand Name Prescription Products
NameDosageStrengthRouteLabellerMarketing StartMarketing EndRegionImage
AliniaTablet500 mg/1OralRomark Laboratories, L.C.2004-07-21Not applicableUS flag
AliniaTablet500 mg/1OralAvera McKennan Hospital2015-05-262017-05-24US flag
AliniaPowder, for suspension100 mg/5mLOralLupin Pharma2013-10-092018-07-31US flag
AliniaPowder, for suspension100 mg/5mLOralRomark Laboratories, L.C.2002-11-22Not applicableUS flag
Generic Prescription Products
NameDosageStrengthRouteLabellerMarketing StartMarketing EndRegionImage
N/aTablet500 mg/1OralLupin Pharmaceuticals, Inc.2021-02-17Not applicableUS flag
NitazoxanideTablet, film coated500 mg/1OralRising Pharmaceuticals, Inc.2020-11-27Not applicableUS flag


ATC Codes
P01AX11 — Nitazoxanide
Drug Categories
Chemical TaxonomyProvided by Classyfire
This compound belongs to the class of organic compounds known as acylsalicylamides. These are o-acylated derivatives of salicylamide.
Organic compounds
Super Class
Benzene and substituted derivatives
Sub Class
Benzoic acids and derivatives
Direct Parent
Alternative Parents
Phenol esters / Benzamides / Phenoxy compounds / Benzoyl derivatives / Nitroaromatic compounds / Nitrothiazoles / 2,5-disubstituted thiazoles / Heteroaromatic compounds / Secondary carboxylic acid amides / Carboxylic acid esters
show 10 more
2,5-disubstituted 1,3-thiazole / Acylsalicylamide / Allyl-type 1,3-dipolar organic compound / Aromatic heteromonocyclic compound / Azacycle / Azole / Benzamide / Benzoyl / C-nitro compound / Carbonyl group
show 24 more
Molecular Framework
Aromatic heteromonocyclic compounds
External Descriptors
Not Available
Affected organisms
  • Mycobacterium tuberculosis
  • Helminthic Microorganisms
  • Bacteria and protozoa
  • Escherichia coli

Chemical Identifiers

CAS number
InChI Key
2-[(5-nitro-1,3-thiazol-2-yl)carbamoyl]phenyl acetate


Synthesis Reference
General References
  1. Anderson VR, Curran MP: Nitazoxanide: a review of its use in the treatment of gastrointestinal infections. Drugs. 2007;67(13):1947-67. [Article]
  2. Shakya A, Bhat HR, Ghosh SK: Update on Nitazoxanide: A Multifunctional Chemotherapeutic Agent. Curr Drug Discov Technol. 2017 Jul 27. pii: CDDT-EPUB-85034. doi: 10.2174/1570163814666170727130003. [Article]
  3. Rossignol JF: Nitazoxanide: a first-in-class broad-spectrum antiviral agent. Antiviral Res. 2014 Oct;110:94-103. doi: 10.1016/j.antiviral.2014.07.014. Epub 2014 Aug 7. [Article]
  4. Balamurugan K, Said HM: Role of reduced folate carrier in intestinal folate uptake. Am J Physiol Cell Physiol. 2006 Jul;291(1):C189-93. doi: 10.1152/ajpcell.00594.2005. Epub 2006 Feb 22. [Article]
  5. Broekhuysen J, Stockis A, Lins RL, De Graeve J, Rossignol JF: Nitazoxanide: pharmacokinetics and metabolism in man. Int J Clin Pharmacol Ther. 2000 Aug;38(8):387-94. [Article]
  6. Nitazoxanide, Pub Chemistry [Link]
  7. EPA Chemistry Dashboard: Nitazoxanide [Link]
  8. Nitazoxanide: A New Thiazolide Antiparasitic Agent [Link]
  9. Validated and optimized high-performance liquid chromatographic determination of tizoxanide, the main active metabolite of nitazoxanide in human urine, plasma and breast milk. [Link]
  10. Pharmacology review, Nitazoxanide [Link]
  11. FDA Approved Drug Products: ALINIA (nitazoxanide) oral [Link]
Human Metabolome Database
PubChem Compound
PubChem Substance
Therapeutic Targets Database
PDBe Ligand
RxList Drug Page Drug Page
PDRhealth Drug Page
PDB Entries
FDA label
Download (150 KB)
Download (57.4 KB)

Clinical Trials

Clinical Trials
4CompletedTreatmentChronic Hepatitis C Virus (HCV) Infection / Type 2 Diabetes Mellitus1
4CompletedTreatmentCoronavirus Disease 2019 (COVID‑19) / COVID1
4CompletedTreatmentCoronavirus Disease 2019 (COVID‑19) / Infections, Coronavirus1
4CompletedTreatmentIrritable Bowel Syndrome (IBS)1
4RecruitingPreventionCoronavirus Disease 2019 (COVID‑19) / Households Contacts1
4TerminatedTreatmentCoronavirus Disease 2019 (COVID‑19) / Infections, Coronavirus1
4Unknown StatusTreatmentChronic Hepatitis C Virus (HCV) Infection1
3Active Not RecruitingPreventionCoronavirus Disease 2019 (COVID‑19) / Viral Respiratory Illnesses1
3CompletedTreatmentClostridium Difficle Colitis / Clostridium Enterocolitis1


  • Romark laboratories
  • Industriale Chimica S.R.L.
  • Laboratoria Qualiphar NV SA
  • Murfreesboro Pharmaceutical Nursing Supply
  • Romark Pharmaceuticals
Dosage Forms
Powder, for suspensionOral100 mg/5mL
TabletOral500 mg/1
Powder, for suspensionOral2000 mg
Powder, for suspensionOral6 g
TabletOral500 mg
Tablet, solubleOral100 mg
Tablet, solubleOral250 mg
SuspensionOral1.2000 g
TabletOral200.00 mg
TabletOral500.000 mg
SuspensionOral2 g
Powder, for solutionOral2 g
Tablet, coatedOral500 mg
Tablet, coatedOral200 mg
Tablet, solubleOral200 mg
SuspensionOral600.000 mg
SuspensionOral600.00 mg
Powder, for suspensionOral1.9999 g
TabletOral200 mg
GranuleOral2 g
Capsule, liquid filledOral500 mg
Tablet, film coatedOral500 mg/1
Powder, for suspensionOral1.2 g
SuspensionOral0.600 g
TabletOral100.00 mg
Powder, for suspensionOral2 g
Tablet, film coatedOral500 mg
SuspensionOral400 mg
TabletOral500.00 mg
Unit descriptionCostUnit
Alinia 500 mg tablet23.22USD tablet
DrugBank does not sell nor buy drugs. Pricing information is supplied for informational purposes only.
Patent NumberPediatric ExtensionApprovedExpires (estimated)Region
US5387598No1995-02-072012-02-07US flag
US5968961No1999-10-192017-05-07US flag
US5965590No1999-10-122017-07-03US flag
US6117894No2000-09-122017-05-07US flag


Experimental Properties
melting point (°C)202 °C [L1417]
boiling point (°C)394[L1417]
water solubility1.89e-04[L1417]
logP1.63 [L1417]
Predicted Properties
Water Solubility0.00755 mg/mLALOGPS
pKa (Strongest Acidic)10.62Chemaxon
pKa (Strongest Basic)-4.2Chemaxon
Physiological Charge0Chemaxon
Hydrogen Acceptor Count5Chemaxon
Hydrogen Donor Count1Chemaxon
Polar Surface Area111.43 Å2Chemaxon
Rotatable Bond Count5Chemaxon
Refractivity72.89 m3·mol-1Chemaxon
Polarizability27.61 Å3Chemaxon
Number of Rings2Chemaxon
Rule of FiveYesChemaxon
Ghose FilterYesChemaxon
Veber's RuleNoChemaxon
MDDR-like RuleNoChemaxon
Predicted ADMET Features
Human Intestinal Absorption+0.9045
Blood Brain Barrier+0.7175
Caco-2 permeable-0.5571
P-glycoprotein substrateNon-substrate0.7978
P-glycoprotein inhibitor INon-inhibitor0.8874
P-glycoprotein inhibitor IINon-inhibitor0.9836
Renal organic cation transporterNon-inhibitor0.9228
CYP450 2C9 substrateNon-substrate0.7438
CYP450 2D6 substrateNon-substrate0.8431
CYP450 3A4 substrateNon-substrate0.5596
CYP450 1A2 substrateNon-inhibitor0.6339
CYP450 2C9 inhibitorInhibitor0.6655
CYP450 2D6 inhibitorNon-inhibitor0.9027
CYP450 2C19 inhibitorNon-inhibitor0.6341
CYP450 3A4 inhibitorInhibitor0.6669
CYP450 inhibitory promiscuityHigh CYP Inhibitory Promiscuity0.5635
Ames testAMES toxic0.8322
BiodegradationReady biodegradable0.5458
Rat acute toxicity1.7902 LD50, mol/kg Not applicable
hERG inhibition (predictor I)Weak inhibitor0.9283
hERG inhibition (predictor II)Non-inhibitor0.9295
ADMET data is predicted using admetSAR, a free tool for evaluating chemical ADMET properties. (23092397)


Mass Spec (NIST)
Not Available
SpectrumSpectrum TypeSplash Key
Predicted GC-MS Spectrum - GC-MSPredicted GC-MSNot Available
Predicted MS/MS Spectrum - 10V, Positive (Annotated)Predicted LC-MS/MSNot Available
Predicted MS/MS Spectrum - 20V, Positive (Annotated)Predicted LC-MS/MSNot Available
Predicted MS/MS Spectrum - 40V, Positive (Annotated)Predicted LC-MS/MSNot Available
Predicted MS/MS Spectrum - 10V, Negative (Annotated)Predicted LC-MS/MSNot Available
Predicted MS/MS Spectrum - 20V, Negative (Annotated)Predicted LC-MS/MSNot Available
Predicted MS/MS Spectrum - 40V, Negative (Annotated)Predicted LC-MS/MSNot Available
LC-MS/MS Spectrum - LC-ESI-qTof , PositiveLC-MS/MSNot Available
MS/MS Spectrum - , positiveLC-MS/MSsplash10-01b9-1950000000-3d1aca26d9cbdaaab410


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insights and accelerate drug research.
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Desulfovibrio africanus
Pharmacological action
General Function
Thiamine pyrophosphate binding
Specific Function
Catalyzes the ferredoxin-dependent oxidative decarboxylation of pyruvate. Required for the transfer of electrons from pyruvate to ferredoxin (PubMed:9294422, PubMed:7612653). Ferredoxin I and ferre...
Gene Name
Uniprot ID
Uniprot Name
Pyruvate synthase
Molecular Weight
133679.405 Da
  1. Hoffman PS, Sisson G, Croxen MA, Welch K, Harman WD, Cremades N, Morash MG: Antiparasitic drug nitazoxanide inhibits the pyruvate oxidoreductases of Helicobacter pylori, selected anaerobic bacteria and parasites, and Campylobacter jejuni. Antimicrob Agents Chemother. 2007 Mar;51(3):868-76. Epub 2006 Dec 11. [Article]
  2. Ballard TE, Wang X, Olekhnovich I, Koerner T, Seymour C, Hoffman PS, Macdonald TL: Biological activity of modified and exchanged 2-amino-5-nitrothiazole amide analogues of nitazoxanide. Bioorg Med Chem Lett. 2010 Jun 15;20(12):3537-9. doi: 10.1016/j.bmcl.2010.04.126. Epub 2010 May 18. [Article]

Drug created at June 13, 2005 13:24 / Updated at November 03, 2023 23:43