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Transcript
NITAZOXANIDE: Alinia Class: Antiprotozoal Dosage Forms. Tablet: 500 mg; Suspension: 100 mg/5 mL N Romark 500 mg pictured Common FDA Label Indication, Dosing, and Titration. 1. Diarrhea caused by Cryptosporidium parvum or Giardia lamblia: Adults: 500 mg po bid × 3 d; Children 1-3 y: 100 mg bid × 3 d; Children 4-11 y: 200 mg bid × 3 d Off-Label Uses. 1. Clostridium difficile-associated diarrhea: 500 mg po bid MOA. Interference with the pyruvate ferredoxin oxidoreductase (PFOR) enzyme-dependent electron transfer reaction, which is essential to anaerobic metabolism or protozoans. Drug Characteristics: Nitazoxanide Dose Adjustment Hepatic Use with caution Absorption F <5%, food enhances absorption by 50% Dose Adjustment Renal Use with caution Distribution 98-99% protein bound Dialyzable Not dialyzable Metabolism Metabolized to one active metabolite by plasma esterases Pregnancy Category B Elimination 33% renal, 67% fecal 202 Lactation Weigh risks and benefits Pharmacogenetics None known Contraindications Hypersensitivity to nitazoxanide Black Box Warnings None Medication Safety Issues: Nitazoxanide Suffixes Tall Man Letters Do Not Crush High Alert Confused Names No No No No No Drug Interactions: Nitazoxanide. None Adverse Reactions: Nitazoxanide Common (>10%) Less Common (1-10%) Rare but Serious (<1%) Nausea, vomiting, diarrhea, headaches Elevated liver function tests Efficacy Monitoring Parameters. Resolution of signs and symptoms of infection. Toxicity Monitoring Parameters. Consider LFTs and CBC prior to therapy. Key Patient Counseling Points. Complete full course of therapy; take with food. Clinical Pearls. Suspension bioavailability is 70% of tablet, not interchangeable. Preferred agent for treating Cryptosporidium diarrhea in immunocompetent adults, has not been proven to be superior to placebo in HIV-infected individuals. Equivalent efficacy to metronidazole for C difficile and Giardia, however, based on cost metronidazole remains the treatment of choice. 202