Nitazox (Nitazoxanide)
Also sold as: Nitazox, Alinia, Nitarid, Nitamide, Cryptonit
Pregnancy
Cat B
Lactation
Unknown
Schedule
H
Forms
Tablet 200mg, 500mg +2
Indications
- Cryptosporidiosis (Cryptosporidium parvum/hominis — especially in HIV-negative patients)
- Giardiasis (Giardia lamblia) — effective alternative to metronidazole
- Amoebiasis (Entamoeba histolytica) — adjunct or alternative
- Rotavirus diarrhoea (reduces duration — emerging evidence)
- Clostridium difficile colitis (alternative)
- Broad antiprotozoal and some antiviral properties (influenza — ongoing research)
Adult Dosing
Giardiasis / Cryptosporidiosis
500 mg PO BD for 3 days
Take with food — better absorption. HIV-negative immunocompetent patients: 3-day course. HIV-positive: longer courses needed under specialist guidance.
Amoebiasis (intestinal)
500 mg PO BD for 3 days (acute) or up to 10 days if needed
C. difficile diarrhoea
500 mg PO BD for 10 days
Emerging evidence; metronidazole or vancomycin is established first-line
Pediatric Dosing
Oral suspension (100mg/5mL) preferred for children
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| Any CrCl | Use with caution in significant CKD — limited data; dose reduction not established but exercise caution |
Hepatic Adjustment
Use with caution in significant hepatic impairment — primarily hepatically metabolised
Pregnancy & Lactation
Pregnancy: Category B
Limited human data — no teratogenicity in animal studies. May be used if benefit outweighs risk (giardiasis/cryptosporidiosis in pregnancy can be severe). Generally preferred over metronidazole in 1st trimester.
Lactation: Unknown
No data on breast milk excretion — manufacturer recommends caution. Short 3-day course: consider temporary suspension of breastfeeding or discuss risk-benefit.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| Warfarin | Nitazoxanide is highly protein-bound — may displace warfarin; monitor INR | Moderate |
| Other highly protein-bound drugs | Competition for protein binding — monitor clinical effect | Minor |
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Side Effects
Common
- Urine discolouration (bright yellow — harmless metabolite)
- Nausea
- Abdominal pain
- Diarrhoea
- Headache
- Flatulence
Serious / Discontinue If
- Hepatic injury (rare — case reports)
- Allergic reactions (rash, urticaria)
Contraindications
- Hypersensitivity to nitazoxanide
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Nitazox 500mg | Macleods | 6 tab ₹185 |
| Nitarid 500mg | Cipla | 6 tab ₹175 |
| Nitamide 500mg | Sun Pharma | 6 tab ₹165 |
| Cryptonit 500mg | Torrent | 6 tab ₹178 |
Monitoring Required
- Stool microscopy post-treatment (3–4 weeks — to confirm parasitological clearance)
- Symptom resolution (diarrhoea, cramps)
- LFTs if prolonged use or hepatic concern
Patient Counseling Points
- Take with food — significantly improves absorption and reduces stomach upset
- Your urine may turn bright yellow during treatment — this is harmless, from the drug metabolite
- Complete the full 3-day course — do not stop early
- For giardiasis: also treat household contacts if symptomatic; practice good hand hygiene
- Do not drink untreated water — reinfection is common without attention to water safety
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Clinically reviewed by: Dr. Rajesh Kulkarni, MD (Infectious Diseases), Consultant Infectious Disease Specialist
Last reviewed: 2026-04-01
References
- CDC Giardia Treatment Guidelines
- IDSA Cryptosporidiosis Guidelines
- Cochrane — Nitazoxanide for Diarrhoea
- BNF — Nitazoxanide
- Indian Journal of Gastroenterology — Protozoal Infections