Nizonide DT (Nitazoxanide Tablet) 200mg

Nitazoxanide is used to treat diarrhoea and gastrointestinal infection caused by protozoal parasites, and shows broader antiparasitic activity.

• Giardiasis: treats diarrhoea caused by Giardia lamblia, and works in some cases resistant to metronidazole.
• Cryptosporidiosis: treats diarrhoea caused by Cryptosporidium parvum in patients with a healthy immune system, where efficacy is greatest.
• Intestinal amoebiasis: shows documented activity against Entamoeba histolytica and is used for amoebic infection in some regions.
• Other intestinal protozoa: active against organisms such as Cyclospora and Cystoisospora that cause persistent diarrhoea.
• Some helminth infections: has recorded activity against certain roundworms and tapeworms, though it is not established first-line therapy for these.

• Nitazoxanide is a prodrug that the body converts to its active form, tizoxanide. This metabolite interferes with the pyruvate:ferredoxin oxidoreductase enzyme reaction, a step that many protozoa and anaerobic bacteria rely on to release energy from nutrients. Blocking this pathway starves the parasite of usable energy, halting its growth and leading to its death. Human cells use different energy pathways, so the drug is relatively selective for the organism.

Nitazoxanide is generally well tolerated, with effects that are usually mild and short-lived; report anything persistent to a clinician.

Common Side Effects

• Abdominal pain: mild stomach cramps during the short treatment course.
• Diarrhoea: loose stools that may occur as the infection clears.
• Nausea and vomiting: mild digestive upset, often reduced by taking the dose with food.
• Headache: a common but usually minor effect.

Serious or Rare Side Effects

• Yellow or greenish discolouration of the eyes or urine: usually harmless and reversible when the drug is stopped, but have it checked if it persists.
• Marked or bloody diarrhoea: seek medical review if diarrhoea is severe, prolonged, or contains blood.
• Allergic reaction: rare; stop the tablet and seek care for rash, swelling, or breathing difficulty.

Nitazoxanide is well tolerated, but a few precautions support safe, effective treatment.

• Confirm the diagnosis: treat based on a stool test for Giardia or Cryptosporidium, not symptoms alone.
• Take with food: give each dose with a meal to improve absorption and reduce stomach upset.
• Use caution in liver or kidney impairment: monitor patients with significant organ disease.
• Expect reduced benefit in weakened immunity: cryptosporidiosis responds less well in immunocompromised patients.
• Review use in pregnancy and breastfeeding: treat only after weighing benefit and risk with a clinician.
• Store at room temperature: keep tablets dry in a sealed pack, away from heat, sunlight, and children.

Review nitazoxanide alongside the patient’s other medicines, especially those that bind strongly to blood proteins.

Major Interactions (Avoid)

• Warfarin: nitazoxanide’s active metabolite competes for the same protein-binding sites and can increase warfarin’s blood-thinning effect; monitor clotting closely.
• Other highly protein-bound drugs with a narrow margin: competition for binding can raise free levels of medicines such as anticonvulsants, so monitor for toxicity.

Moderate Interactions (Monitor Closely)

• Antiplatelet agents: watch for an additive effect on bleeding risk when combined.
• Digoxin: monitor levels and for signs of toxicity, as protein-binding competition may raise free drug.
• Highly bound antidiabetic or other chronic medicines: review the combination and monitor the relevant clinical effect.