What are the uses of Alinia (nitazoxanide)?

Uses of Alinia (Nitazoxanide)

Alinia is FDA-approved for treating diarrhea caused by Giardia lamblia and Cryptosporidium parvum in immunocompetent patients, but it is NOT effective for cryptosporidiosis in HIV-infected or immunodeficient patients. 1

FDA-Approved Indications

Cryptosporidiosis

• Primary indication: Treatment of diarrhea caused by Cryptosporidium parvum in immunocompetent children and adults 2, 1
• Dosing for children:
  • Ages 1-3 years: 100 mg orally twice daily 2
  • Ages 4-11 years: 200 mg orally twice daily 2
• Dosing for adults: 500-1000 mg orally twice daily 2
• Treatment duration: 3 days for immunocompetent patients; up to 14 days may be needed for HIV-infected adults 2
• Clinical response rates: 88% in immunocompetent children versus 38% with placebo 2, 3

Critical limitation: Nitazoxanide has limited to no efficacy in HIV-infected patients with CD4 counts <50 cells/µL 2, 3, 1. In HIV-infected children, the drug was no more effective than placebo in one Zambian study 2.

Giardiasis

• Primary or alternative treatment for Giardia lamblia infection 2, 1
• Dosing: Same as for cryptosporidiosis (age-based) 2, 4
• Efficacy: Comparable to metronidazole with fewer side effects 5
• Position in treatment algorithm: The IDSA guidelines list tinidazole as first-line, with nitazoxanide as an approved alternative 2, 6

Off-Label/Investigational Uses

Cyclospora cayetanensis

• Alternative treatment when TMP-SMX cannot be used (limited data) 2
• TMP-SMX remains first-line therapy 2

Cystoisospora belli

• Potential second-line alternative when TMP-SMX or pyrimethamine are not suitable 2

Enterocytozoon bieneusi (Microsporidiosis)

• Used in HIV-infected adults for this specific microsporidia species 2
• Note: Albendazole is ineffective against E. bieneusi but works for other microsporidia species 2

Key Clinical Considerations

When to Use Nitazoxanide

• Immunocompetent patients with confirmed Cryptosporidium or Giardia infection 2, 1
• HIV-infected patients with cryptosporidiosis ONLY in combination with effective antiretroviral therapy (cART) and CD4 >50 cells/µL 2, 3
• Alternative to metronidazole for giardiasis when better tolerability is needed 5

When NOT to Use Nitazoxanide

• Severely immunocompromised patients (CD4 <50 cells/µL) with cryptosporidiosis—immune reconstitution with cART is the priority 2, 3, 1
• As monotherapy in advanced AIDS—always combine with effective cART 2

Essential Supportive Care

Regardless of nitazoxanide use, always provide 2, 3:

• Aggressive hydration and electrolyte correction
• Nutritional supplementation
• Use antimotility agents with extreme caution in young children 2

Common Pitfall to Avoid

Do not prescribe nitazoxanide for cryptosporidiosis in HIV/AIDS patients without first optimizing their antiretroviral therapy—immune reconstitution is the most effective treatment 2, 3. The drug's efficacy is directly tied to immune function 2, 3.