Nitazoxanide

INTRODUCTION

Indications

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

Action

Interferes with electron transfer reaction necessary for anaerobic energy metabolism of offending organisms. Therapeutic Effects: Antiprotozoal action resulting in decreased diarrhea.

Adverse Reactions/Side Effects

CNS: dizziness. EENT: yellow eye discoloration. GI: abdominal pain, diarrhea, vomiting. GU: discolored urine. Derm: pruritus, sweating. Misc: fever.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

Interventions

• Make sure patient remains adequately hydrated to offset fluid loss from diarrhea.

Patient/Client-Related Instruction

• Instruct patient and family/caregivers to report other troublesome side effects such as severe or prolonged fever, skin reactions (itching, increased swearing), or GI problems (diarrhea, vomiting, abdominal pain).

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

Half-life: Unknown.

Contraindications/Precautions

Contraindicated in: Hypersensitivity.

Use Cautiously in: Hepatic and/or renal impairment; Diabetics (contains 1.48 g sucrose/5 mL); Pedi, OB: Children <1 pregnancy or lactation (safety not established).

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.

PO (Children 4–11 yr): 200 mg (10 mL) every 12 hr for 3 days.

PO (Children 1–4 yr): 100 mg (5 mL) every 12 hr for 3 days.

Availability

Tablets: 500 mg. Oral suspension (strawberry): 100 mg/5 mL in 60-mL bottle.