Description
Nitazoxanide (NT Z) has been approved as an orphan drug for the treatment of diarrhea in children
(age, 1–11 years) and is associated with giardiasis, but it also is approved for diarrhea caused by
crytosporidiosis in patients with AIDS. Crytosporidiosis is a protozoal infection caused by
Cryptosporidi um parvum. The condition is uncommon in healthy individuals but can be
life-threatening in immunosuppressed patients and those with HIV infections.
Chemical Properties
Crystalline Solid
Originator
Alinia,Romark Laboratories, L.C.
Uses
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.
Uses
An anthelmintic (cestodes), antiprotozoal (cryptosporidium). Kills Mycobacterium tuberculosis.
Uses
Nitazoxanide has been used:
- to test its anti-viral activity against chikungunya virus
- as an antiprotozoal agent to test its effect on cell viability in various cancer cell lines
- to test its effect on human cytomegalovirus (HCMV) infected human fibroblast HFF cells
Definition
ChEBI: Acetic acid [2-[[(5-nitro-2-thiazolyl)amino]-oxomethyl]phenyl] ester is a carboxylic ester and a member of benzamides. It is functionally related to a salicylamide.
Manufacturing Process
To a solution containing one mole p-metoxy-benzoyl chloride and one mole of
carefully purified 2-amino-5-nitro-triazole in 200 ml of anhydrous
tetrahydrofuran, one mole of triethylamine has been slowly added (about 10
minutes) while stirring. The reaction mixture, which became slightly warm,
was stirred during 45 minutes and then poured under agitation, into 2 liters of
distilled water. The stirring was continued until the precipitation of
salicylamide, N-(5-nitro-2-thiazolyl)-, acetate (ester) was complete. The
obtained precipitate was dried, washed with water, dried again and
recrystallized from methanol. The yield about 60%; melting point 202°C.
brand name
Alinia (Romark).
Therapeutic Function
Anthelmintic
Antimicrobial activity
In vitro Cryptosporidium parvum sporocytes and oocysts are
inhibited by <33 μm, and Giardia lamblia (intestinalis) trophozoites
by <10 μm. The metabolite tizoxanide is more active than
the parent compound against some isolates. E. histolytica is inhibited
by 6–23 μm (parent compound) and 5.6–
28 μm (metabolite),
and T. vaginalis by 0.5–15.5 μm (parent compound)
and 0.3–12.2 μm (metabolite). Activity against other micro-
organisms,
including some helminths, bacteria (Clostridium difficile)
and viruses (hepatitis C) has also been demonstrated.
Acquired resistance
Resistance caused by altered expression of genes involved in
stress response has been demonstrated in experimental studies
with G. lamblia.
General Description
Nitazoxanide (NTZ), a thiazolide compound is a antiparasitic drug with structure similar to niclosamide.
Pharmaceutical Applications
A synthetic broad-spectrum antiparasitic nitroheterocycle (2-acetyloxy-
N-(5-nitro-2-thiazolyl) benzamide), formulated for oral use.
Biochem/physiol Actions
Nitazoxanide is an inhibitor of pyruvate-ferredoxin oxidoreductase (PFOR); Antimicrobial recently found to kill both non-replicating and replicating mycobacteria. FDA approved anti-parasitic drug (2002). Recent work (C & EN Sept. 14, 2009, p. 28) highlights that NTZ kills non-replicating and replicating TB bacteria and no apparent resistance is detected.
Mechanism of action
Nitazoxanide is a pro-drug that is metabolically converted into the deactylated drug tizoxanide
(TIZ). The TIZ then undergoes a four-electron reduction of the 5-nitro group giving
various short-lived intermediates, which may include the hydroxylamine derivative. It is these
reduced products that represent the active form of NTZ. Whereas these intermediates would
suggest that NTZ has the same mechanism of action as metronidazole, this does not appear to be
the case. Nitazoxanide is thought to inhibit the enzyme pyruvate:ferredoxin oxidoreductase in
Trichomonas vaginali s, Entamoeba histolytica, and Cl ostridium perfingens. The results of this
inhibition is disruption of the bioenergetics of these organisms. Unlike metronidazole and
tinidazole, which fragment DNA and are suspected mutagenic agents, NTZ and TIZ do not cause
DNA fragmentation and are not considered to be mutagenic. This might be associated with the
higher redox potential found for NTZ, a nitrothiazole, in comparison with very low redox potential
found for the nitroimidazoles, such as metronidazole and tinidazole. Additional metabolites of TIZ
also includes the glucuronide, which shows some biological activity, and small amounts of an
aromatic hydroxylation product.
Pharmacokinetics
After oral administration the major circulating metabolites
are tizoxanide (desacetyl nitazoxanide) and its glucuronide.
Minor metabolites include salicyluric acid and tizoxanide sulfate.
Maximum concentrations of the active metabolites tizoxanide
and tizoxanide glucuronide are observed within 1–4 h.
Following a single oral dose of 500 mg given with food, the C
max
of both metabolites was around 10 mg/L. Tizoxanide has a halflife
of around 1–2 h and is >99.9% bound to plasma proteins.
Clinical Use
It is indicated for the treatment of diarrhea caused by G. lamblia
or C. parvum.
Side effects
Nitazoxanide appears well tolerated. Side effects may include
abdominal pain diarrhea, headache and nausea.
Veterinary Drugs and Treatments
Nitazoxanide oral paste is indicated for the treatment of horses with
equine protozoal myeloencephalitis (EPM) caused by Sarcocystis
neurona.
In humans, nitazoxanide is approved (in the USA) for use in
treating diarrhea caused by Cryptosporidium parvum and Giardia
lamblia in pediatric patients from ages 1 to 11 years old.
Because of the drug’s spectrum of activity and apparent safety,
there is considerable interest in using it in a variety of companion
animal species, but data is lacking for specific indications and
dosages.
Metabolism
Nitazoxanide is available as powder that is reconstituted and dispensed as an oral suspension.
The drug is well absorbed from the GI tract and rapidly metabolized, with elimination products
appearing in the urine and feces. The only identified products in the plasma are TIZ and its
glucuronide. The product can be taken with food.
Background
Nitazoxanide, also known as NTZ, is a broad-spectrum thiazolide antiparasitic agent that is a noncompetitive inhibitor of pyruvate:ferredoxin/flavodoxin oxidoreductases. This small molecule is an effective antiviral agent by activating protein kinase activated by double-stranded RNA, resulting in the phosphorylation of eukaryotic initiation factor 2 alpha. This method of influencing the host’s antiviral pathways increases the barrier to develop antiviral resistance. Nitazoxanide has shown anticancer activity in vivo by inhibiting oxidative phosphorylation and mitochondrial respiration. Treatment with Nitazoxanide leads to AMPK activation, inhibition of mTOR, and downregulation of c-Myc and Wnt signaling. Nitazoxanide has been found to be a particularly potent c-Myc inhibitor with IC50 values ranging between 10 nM to 500 nM in different cancer cell lines. Studies have shown that Nitazoxanide may be an effective treatment against Middle East respiratory syndrome coronavirus and other coronaviruses.
References
References/Citations:
1.Qu et al. (2018), Small molecule promotes b-catenin citrullination and inhibits Wnt signaling in cancer; Nat.Chem.Biol. 14 94
2.White (2004) Nitazoxanide: a new broad spectrum antiparasitic agent; Expert Rev.Anti.Infect.Ther. 2 43
3.Rossignol (2014) Nitazoxanide: a first-in-class broad-spectrum antiviral agent; Antiviral Res. 110 94
4.Hoffman et al. (2007) Antiparasitic Drug Nitazoxanide Inhibits the Pyruvate Oxidoreductases of Helicobacter pylori, Selected anaerobic Bacteria and Parasites, and Campylobacter jejuni; Agents Chemother. 51 868
5.Elazar et al. (2009), The anti-hepatitis C agent nitazoxanide induces phosphorylation of eukaryotic initiation factor 2alpha via protein kinase activated by double-stranded RNA activation; Gastroenterology 137 1827
