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Recent Developments in Therapies and Strategies Against COVID-19
Published in Hanadi Talal Ahmedah, Muhammad Riaz, Sagheer Ahmed, Marius Alexandru Moga, The Covid-19 Pandemic, 2023
Misbah Hameed, M. Zia-Ul-Haq, Marius Moga
Nitazoxanide is a broad-spectrum antiviral and antiparasitic agent. It is used for the treatment of different helminthic, protozoal, and viral infections. Nitazoxanide is the prototype agent of the thiazolides, which is a group having synthetic nitrothiazolyl-salicylamide derivatives with antiviral and antiparasitic activity. Tizoxanide, an active metabolite of nitazoxanide also antiparasitic drug of the thiazolide class. Clinical trials of nitazoxanide against influenza has been done and shown inhibitory effect on a broad range of influenza virus subtypes. The drug is also effective against influenza viruses which develop some resistance to neuraminidase inhibitors like oseltamivir Nitazoxanide is also being investigated as a potential treatment for chronic hepatitis B, chronic hepatitis C, norovirus gastroenteritis and rotavirus.
Antimicrobials during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Nitazoxanide is an antiprotozoal medication used to treat diarrhea. It has not been studied in human pregnancy. The manufacturer reported no increased frequency of congenital anomalies in pregnant animal models. It is an FDA pregnancy risk category B drug.
Drug Repurposing and Novel Antiviral Drugs for COVID-19 Management
Published in Debmalya Barh, Kenneth Lundstrom, COVID-19, 2022
Shailendra Dwivedi, Aakanksha Rawat, Amit Ranjan, Ruchika Agrawal, Radhieka Misra, Sunil Kumar Gupta, Surekha Kishore, Sanjeev Misra
Nitazoxanide, a small-molecule (nitrothiazolyl-salicylamide) antiprotozoal drug marketed as tablets (500 mg) and suspension (100 mg/5 ml), is mainly indicated in protozoa Cryptosporidium or Giardia diarrhea in adults and children. In in vitro studies, the molecule has demonstrated a broad spectrum of antiviral efficacy against respiratory syncytial virus (RSV), parainfluenza virus, coronavirus (CoV), rotavirus, norovirus, hepatitis B virus (HBV), hepatitis C virus (HCV), Dengue virus (DENV), yellow fever virus (YFV), Japanese encephalitis virus (JEV), and human immunodeficiency virus (HIV). Few clinical trials have proved its role in gastroenteritis, hepatitis and influenza. A special quality is its ability to promote balance between pro-inflammatory and anti-inflammatory mediators in acute conditions and this is potentially helpful in management of hyper inflammatory cytokine storm in patients with COVID-19. Repurposing nitazoxanide against COVID-19 has been reported in many studies. Two phase III trials for prevention of COVID-19 in high-risk, elderly populations, and healthcare workers are ongoing [33, 34] Another multi-center, randomized, double-blind phase III study was initiated in August 2020 for the treatment of COVID-19 patients aged 12 years and older [35].
Clinical outcomes, virological efficacy and safety of nitazoxanide in the treatment of patients with COVID-19: a systematic review and meta-analysis of randomized controlled trials
Published in Expert Review of Anti-infective Therapy, 2022
Tzu-Chieh Weng, Teng-Song Weng, Chih-Cheng Lai, Chien-Ming Chao, Jui-Hsiang Wang
Finally, we found that nitazoxanide is a tolerable agent in the treatment of patients with COVID-19, which was supported by the similar risk of AE between the study and the control group. Gastrointestinal AE was the most common AE, but no significant difference was found in the risks of diarrhea, nausea, vomiting, and abdominal pain between nitazoxanide and the placebo or standard care. Although discolored urine was another concern, the risk of nitazoxanide associated urine discoloration was 4.8% (19/396), which was similar to the control group. These findings are consistent with previous phase 1 study involving 14 healthy participants, in which high-dose nitazoxanide (1,500 mg nitazoxanide orally twice-daily for 7 days) was associated with moderate gastrointestinal disturbance in 8 participants (57.1%), and urine discoloration in 12 (85.7%) participants, respectively [33]. However, these AEs were self-limiting and resolved upon drug discontinuation [33]. All these findings suggest that nitazoxanide can be safely used for patients with COVID-19.
Host-directed therapies for malaria and tuberculosis: common infection strategies and repurposed drugs
Published in Expert Review of Anti-infective Therapy, 2022
Piyush Baindara, Sonali Agrawal, O. L. Franco
The most advanced example of drug repurposing is the case of the antiparasitic drug nitazoxanide, currently being repurposed for the treatment of influenza [189]. Nitazoxanide, a broad-spectrum antiparasitic and antiviral drug, is used in medicine for the treatment of various helminthic, protozoal, and viral infections [190–192]. Lam et al. 2012 reported that antiprotozoal drug nitazoxanide and its active metabolite tizoxanide strongly stimulate autophagy through inhibiting signaling by mTORC1. Nitazoxanide treatment was also found to inhibit both replicating and non-replicating forms of Mtb [193]. Furthermore, its low eukaryotic cytotoxicity, with no reports of resistance to Mtb mutant strains, makes this drug more promising. In malaria, co-administration of nitazoxanide with the intermittent preventive treatment of malaria in infants or children has been suggested [194].
Current pharmacotherapy of cryptosporidiosis: an update of the state-of-the-art
Published in Expert Opinion on Pharmacotherapy, 2021
Anne Schneider, Sebastian Wendt, Christoph Lübbert, Henning Trawinski
Currently, two nitazoxanide doses are available: 500 mg tablets and a 100 mg/5 mL oral suspension. However, the suspension’s oral bioavailability is 30% lower than the tablets’ [35,38]. Nitazoxanide’s area under the curve (AUC) can be increased by about 45–50% when administered with food [38]. For adults and children above 12 years old, the standard nitazoxanide dose is 500 mg twice daily (BID) for three days. Children from one to three years old should be treated with 100 mg/5 mL oral suspension BID, and children from four to 11 years old should be treated with 200 mg/10 mL oral suspension BID for three days [38]. Longer treatments for up to seven days may be considered in cases of persisting symptoms and the lack of a microbiological cure in stool samples. For SOT recipients, a 14-day treatment duration is recommended [39]. Several other therapeutics that have been tested for repurposing – such as HIV-protease inhibitors, paromomycin, rifamycin, rifaximin and azithromycin – have also shown insufficient clinical improvement in cryptosporidiosis treatment [31,32,40,41].