Drug/Small Molecule:
nitazoxanide

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PharmGKB contains no Clinical Variants that meet the highest level of criteria.

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This is a non-comprehensive list of genetic tests with pharmacogenetics relevance, typically submitted by the manufacturer and manually curated by PharmGKB. The information listed is provided for educational purposes only and does not constitute an endorsement of any listed test or manufacturer.

A more complete listing of genetic tests is found at the Genetic Testing Registry (GTR).

PGx Test Variants Assayed Gene?
2D structure from PubChem
provided by PubChem

Overview

Generic Names
  • 2-(Acetolyloxy)-N-(5-nitro-2-thiazolyl)benzamide
  • 2-Acetyloxy-N-[(5-nitro-2-thiazolyl)]benzamide
  • NTZ
  • Nitazoxanid
  • Nitazoxanida [INN-Spanish]
  • Nitazoxanidum [INN-Latin]
  • Tizoxanide Glucuronide
  • nitazoxanide
Trade Names
  • Alinia
  • Fental
  • Phavic-1
Brand Mixture Names

PharmGKB Accession Id:
PA164754874

Description

Nitazoxanide, also known by the brand name Alinia, is a synthetic nitrothiazolyl-salicylamide derivative and an anti-protozoal agent. It is approved for treatment of infectious diarrhea caused by Cryptosporidium parvum and Giardia lamblia in patients 1 year of age and older. Following oral administration it is rapidly hydrolyzed to its active metabolite, tizoxanide, which is 99% protein bound. Peak concentrations are observed 1-4 hours after administration. It is excreted in the urine, bile and feces. Untoward effects include abdominal pain, vomiting and diarrhea. Wikipedia

Source: Drug Bank

Indication

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 protozoa Cryptosporidium parvum.

Source: Drug Bank

Other Vocabularies

Information pulled from DrugBank has not been reviewed by PharmGKB.

Pharmacology, Interactions, and Contraindications

Mechanism of Action

The antiprotozoal activity of nitazoxanide is believed to be due to interference with the pyruvate:ferredoxin oxidoreductase (PFOR) enzyme-dependent electron transfer reaction which is essential to anaerobic energy metabolism. Studies have shown that the PFOR enzyme from Giardia lamblia directly reduces nitazoxanide by transfer of electrons in the absence of ferredoxin. The DNA-derived PFOR protein sequence of Cryptosporidium parvum appears to be similar to that of Giardia lamblia. Interference with the PFOR enzyme-dependent electron transfer reaction may not be the only pathway by which nitazoxanide exhibits antiprotozoal activity.

Source: Drug Bank

Pharmacology

Nitazoxanide is an antifolate containing the pyrrolopyrimidine-based nucleus that exerts its antineoplastic activity by disrupting folate-dependent metabolic processes essential for cell replication. In vitro studies have shown that nitazoxanide inhibits thymidylate synthase (TS), dihydrofolate reductase (DHFR), and glycinamide ribonucleotide formyltransferase (GARFT), all folate-dependent enzymes involved in the de novo biosynthesis of thymidine and purine nucleotides. Nitazoxanide is transported into cells by both the reduced folate carrier and membrane folate binding protein transport systems. Once in the cell, nitazoxanide is converted to polyglutamate forms by the enzyme folylpolyglutamate synthetase. The polyglutamate forms are retained in cells and are inhibitors of TS and GARFT. Polyglutamation is a time- and concentration-dependent process that occurs in tumor cells and, to a lesser extent, in normal tissues. Polyglutamated metabolites have an increased intracellular half-life resulting in prolonged drug action in malignant cells.

Source: Drug Bank

Absorption, Distribution, Metabolism, Elimination & Toxicity

Biotransformation

Rapidly hydrolyzed to an active metabolite, tizoxanide (desacetyl-nitazoxanide), followed by conjugation, primarily by glucuronidation to tizoxanide glucuronide.

Source: Drug Bank

Protein Binding

Very High (greater than 99%), bound to proteins. Binding is not affected by degree of renal impairment.

Source: Drug Bank

Absorption

The relative bioavailability of the suspension compared to the tablet was 70%. When administered with food the AUC and C max increased by two-fold and 50%, respectively, for the tablet and 45 to 50% and <= 10%, respectively, for the oral suspension.

Source: Drug Bank

Half-Life

3.5 hours in patients with normal renal function

Source: Drug Bank

Toxicity

In acute studies in rodents and dogs, the oral LD 50 was higher than 10,000 mg/kg. Single oral doses of up to 4000 mg nitazoxanide have been administered to healthy adult volunteers without significant adverse effects.

Source: Drug Bank

Route of Elimination

Tizoxanide is excreted in the urine, bile and feces, and tizoxanide glucuronide is excreted in urine and bile. Approximately two-thirds of the oral dose of nitazoxanide is excreted in the feces and one-third in the urine.

Source: Drug Bank

Chemical Properties

Chemical Formula

C12H9N3O5S

Source: Drug Bank

Isomeric SMILES

CC(=O)Oc1ccccc1C(=O)Nc2ncc(s2)N(=O)=O

Source: OpenEye

Canonical SMILES

CC(=O)OC1=CC=CC=C1C(=O)NC1=NC=C(S1)[N+]([O-]

Source: Drug Bank

Average Molecular Weight

307.282

Source: Drug Bank

Monoisotopic Molecular Weight

307.026291103

Source: Drug Bank

LinkOuts

Web Resource:
Wikipedia
National Drug Code Directory:
67546-111-12
DrugBank:
DB00507
KEGG Drug:
D02486
PubChem Compound:
41684
PubChem Substance:
182380
46507813
BindingDB:
50182652
ChemSpider:
38037
Therapeutic Targets Database:
DAP001293
FDA Drug Label at DailyMed:
56b1575a-dff4-4c5a-a159-2f858e7a0cb8

Clinical Trials

These are trials that mention nitazoxanide and are related to either pharmacogenetics or pharmacogenomics.

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Sources for PharmGKB drug information: DrugBank, Open Eye Scientific Software.