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Nitazoxanide for COVID-19
14 studies with >3,000 patients
Serious outcome risk
Nitazoxanide
Control
Significantly lower risk for ventilation and hospitalization.
8 studies from 7 independent teams in 4 countries show significant benefit.
COVID-19 Nitazoxanide studies · October 2026
Recent:
Abd Elsalam.
Covid Analysis Nitazoxanide for COVID-19: real-time meta-analysis of 14 studies (Version 28)
Significantly lower risk is seen for ventilation and hospitalization. 8 studies from 7 independent teams in 4 countries show significant benefit. Meta-analysis using the most serious outcome reported shows 36% [-4‑61%] lower ri..
Apr 9
 Abd Elsalam et al., AMB Express, doi:10.1186/s13568-026-02030-8 Anti-COVID-19 activity and simple HPLC method for concurrent detection of repurposed drugs in novel binary mixtures
In vitro study showing enhanced anti-SARS-CoV-2 activity of remdesivir-nitazoxanide and daclatasvir-piroxicam mixtures in Vero-E6 cells.
Nov 26
2024
 García-Méndez et al., Cureus, doi:10.7759/cureus.74513 Clinical Experience With Ivermectin and Nitazoxanide in the Management of COVID-19 Among Mexican Out- and Inpatients
Prospective study of 228 outpatients and 179 inpatients in Mexico showing potential benefits with ivermectin and nitazoxanide treatment for COVID-19. Ivermectin improved viral clearance compared to nitazoxanide, and the combination of bot..
Jun 26
2024
 Romark, NCT04359680 Trial to Evaluate the Efficacy and Safety of Nitazoxanide (NTZ) for Pre- and Post Exposure Prophylaxis of COVID-19 and Other Viral Respiratory Illnesses (VRI) in Healthcare Workers and Others at Increased Risk of SARS-CoV-2 Infection
43% lower progression (p=0.02), 50% faster recovery (p=0.1), and 3% fewer cases (p=1). RCT 1,407 healthcare workers and others at high risk of SARS-CoV-2 exposure, showing no difference in COVID-19 cases (13 in each group). There was lower symptom severity for nitazoxanide and a trend towards shorter illness duration. There..
Apr 30
2024
 Brechot et al., Medical Research Archives, doi:10.18103/mra.v12i4.5252 Nitazoxanide in the Treatment of COVID-19: A paradigm for Antiviral Drugs Targeting Host-Infected Cells
Review of nitazoxanide as a potential treatment for COVID-19. Authors highlight nitazoxanide's unique mechanism of action, which involves inhibiting mitochondrial oxidative phosphorylation in host cells, thereby lowering cellular ATP cont..
Apr 12
2024
 Corral et al., Global Journal of Aging & Geriatric Research, doi:10.33552/GJAGR.2024.03.000557 Early Treatment Outcomes of SARS-Cov-2 with Ivermectin, Nitazoxanide and Acetylsalicylic Acid in 2 Nursing Homes During The COVID-19 Pandemic in Cali, Colombia
Retrospective 475 nursing home residents showing low mortality with early treatment using ivermectin, nitazoxanide, and acetylsalicylic acid. All residents were treated when the first positive cases were identified. 87 residents tested po..
Apr 3
2024
 Xu et al., Antimicrobial Agents and Chemotherapy, doi:10.1128/aac.01015-23 Two-way pharmacodynamic modeling of drug combinations and its application to pairs of repurposed Ebola and SARS-CoV-2 agents
In silico study supporting the synergistic combination of nitazoxanide and remdesivir for SARS-CoV-2. Authors developed a two-way pharmacodynamic modeling approach to capture the concentration-dependent drug-drug interactions and combined..
Mar 21
2023
 Smith et al., NCT04918927 Favipiravir and/or Nitazoxanide: a Randomized, Double-blind, Placebo-controlled Trial of Early Antiviral Therapy in COVID-19 (FANTAZE)
120 patient nitazoxanide early treatment RCT with results not reported over 3 years after completion. The protocol has been published [trialsjournal.biomedcentral.com].
Nov 3
2022
 Weng et al., Expert Review of Anti-infective Therapy, doi:10.1080/14787210.2022.2142117 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
Meta analysis of 5 RCTs showing improved viral clearance with nitazoxanide. Mortality was lower, but without statistical significance.
Nov 1
2022
 Chandiwana et al., eBioMedicine, doi:10.1016/j.ebiom.2022.104322 Safety and efficacy of four drug regimens versus standard-of-care for the treatment of symptomatic outpatients with COVID-19: A randomised, open-label, multi-arm, phase 2 clinical trial
13% higher progression (p=0.89), 23% slower recovery (p=0.42), and 67% worse viral clearance (p=0.13). High COI low-risk patient RCT in South Africa, showing no significant differences with favipiravir plus nitazoxanide. There were no deaths and no COVID-19 hospitalizations for favipiravir plus nitazoxanide. More patients were seropositive..
Oct 31
2022
 Abuelazm et al., Clinical Drug Investigation, doi:10.1007/s40261-022-01213-y The Effect of Nitazoxanide on the Clinical Outcomes in Patients with COVID-19: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Systematic review and meta analysis of 6 RCTs, showing significantly improved viral clearance and lower oxygen requirements with nitazoxanide, but no significant differences for mortality, ICU admission, and recovery.
Aug 12
2022
 Sokhela et al., Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkac266 Randomized clinical trial of nitazoxanide or sofosbuvir/daclatasvir for the prevention of SARS-CoV-2 infection
66% lower mortality (p=1), 79% lower hospitalization (p=0.5), 17% fewer symptomatic cases (p=0.49), and 21% more cases (p=0.67). Prophylaxis RCT 828 high-risk participants in South Africa, showing no significant difference with nitazoxanide and sofosbuvir/daclatasvir treatment. FLU-PRO results were available for 74% of the nitazoxanide arm compared to 54% of the co..
May 6
2022
 Medhat et al., Arab Journal of Gastroenterology, doi:10.1016/j.ajg.2022.04.005 Sofosbuvir/Ledipasvir in Combination or Nitazoxanide Alone are Safe and Efficient Treatments for COVID-19 Infection: A Randomized Controlled Trial for Repurposing antivirals
56% improved viral clearance (p=0.02). RCT with 77 nitazoxanide, 70 sofosbuvir/ledipasvir, and 73 SOC patients in Egypt, showing faster viral clearance with nitazoxanide and with sofosbuvir/ledipasvir. There was no mortality or progression to severe COVID-19 or ICU admission. ..
Apr 13
2022
 Rocco et al., Frontiers in Medicine, doi:10.3389/fmed.2022.844728 Nitazoxanide in Patients Hospitalized With COVID-19 Pneumonia: A Multicentre, Randomized, Double-Blind, Placebo-Controlled Trial
5% higher mortality (p=0.95), 31% lower ICU admission (p=0.18), 40% lower need for oxygen therapy (p=0.06), and 64% faster improvement (p<0.0001). RCT late stage patients with COVID-19 pneumonia, 202 treated with nitazoxanide and 203 placebo patients, showing improved recovery, but no significant difference in mortality.
Apr 7
2022
 Riccio et al., Cellular and Molecular Life Sciences, doi:10.1007/s00018-022-04246-w Impairment of SARS-CoV-2 spike glycoprotein maturation and fusion activity by nitazoxanide: an effect independent of spike variants emergence
In vitro study showing that the host-directed broad-spectrum antiviral drug nitazoxanide may be effective for COVID-19 by hampering spike protein maturation and fusion activity. Authors note efficacy across alpha, beta, gamma and delta va..
Feb 28
2022
 ANTICOV, News ANTICOV Trial Finds Nitazoxanide/Ciclesonide Drug Combination Does Not Reduce Hospitalisation Risk in Patients With Mild COVID-19
104% higher progression (p=0.09). RCT with 591 nitazoxanide/ciclesonide and 557 control patients, up to 7 days from onset, showing higher progression, without statistical significance. Control patients were assigned to paracetamol as needed for fever or pain, however trea..
Feb 9
2022
 Miorin et al., bioRxiv, doi:10.1101/2022.02.08.479634 The oral drug nitazoxanide restricts SARS-CoV-2 infection and attenuates disease pathogenesis in Syrian hamsters
Syrian hamster study showing improvements in SARS-CoV-2 related weight loss, inflammation, viral load, and lung synctia formation with nitazoxanide, and an in vitro study showing that nitazoxanide inhibits SARS-CoV-2 in H9, iAT2, Vero E6,..
Feb 4
2022
 Fowotade et al., medRxiv, doi:10.1101/2022.02.03.22270152 Efficacy and safety of nitazoxanide combined with ritonavir-boosted atazanavir for the treatment of mild to moderate COVID-19
11% worse recovery (p=0.73) and 5% improved viral clearance (p=0.92). Small RCT in Nigeria with 31 nitazoxanide and atazanavir/ritonavir patients, and 26 control patients, showing no significant differences with treatment. 4 treatment group patients discontinued treatment due to the size of the tablets. Tim..
Nov 23
2021
 Calderón et al., PAMJ - Clinical Medicine, doi:10.11604/pamj-cm.2021.7.15.30981 Treatment with hydroxychloroquine vs nitazoxanide in patients with COVID-19: brief report
68% lower mortality (p=0.38), 87% lower ventilation (p=0.15), 59% lower ICU admission (p<0.0001), and 52% shorter hospitalization (p=0.007). Planned RCT of HCQ vs. HCQ+nitazoxanide which was aborted due to the retracted Surgisphere paper. Authors retrospectively analyze a small set of HCQ vs. nitazoxanide patients (which were protocol deviations in the planned RCT), showing re..
Sep 11
2021
 Walker et al., Clinical Pharmacology & Therapeutics, doi:10.1002/cpt.2463 (date from preprint) An open label, adaptive, phase 1 trial of high-dose oral nitazoxanide in healthy volunteers: an antiviral candidate for SARS-CoV-2
Phase I trial of high dose nitazoxanide, 1500mg twice daily, with 14 participants. Treatment was safe and well tolerated. PBPK predictions were confirmed on day 1 but with underprediction at day 5. Median Cmin was above the in vitro targe..
Aug 10
2021
 Calderón et al., News Report Mantiene Hospital Mónica Pretelini bajo índice de muertes Covid de mujeres embarazadas
News report on the use of nitazoxanide for pregnant COVID-19 patients in a clinic in Mexico, reporting significant improvements in hospitalization and mortality compared to locations without treatment.
May 13
2021
 Enríquez López et al., Cureus, doi:10.7759/cureus.15002 Evolution of COVID-19 Pregnancies Treated With Nitazoxanide in a Third-Level Hospital
Case study of 51 COVID-19 positive pregnant women in Mexico treated with nitazoxanide, showing much better survival compared to hospitals not using nitazoxanide.
Apr 20
2021
 Rossignol et al., eClinicalMedicine, doi:10.1016/j.eclinm.2022.101310 (date from preprint) A randomized double-blind placebo-controlled clinical trial of nitazoxanide for treatment of mild or moderate COVID-19
79% lower hospitalization (p=0.22), 85% lower severe cases (p=0.07), and 7% slower recovery (p=0.88). RCT with 184 outpatients treated with an extended release formulation of nitazoxanide, and 195 controls, showing lower hospitalization and progression to severe disease with treatment. There was one COVID-19 related death in the treatment..
Mar 5
2021
 Silva et al., Medical Research Archives, doi:10.18103/mra.v11i2.3364 (date from preprint) Efficacy of Nitazoxanide in reducing the viral load in COVID-19 patients. Randomized, placebo-controlled, single-blinded, parallel group, pilot study
26% improved viral clearance (p=0.36). Small RCT with 23 nitazoxanide and 13 control patients showing significantly more patients achieved over 35% reduction in viral load from baseline.
Feb 28
2021
 Bobrowski et al., Molecular Therapy, doi:10.1016/j.ymthe.2020.12.016 Synergistic and Antagonistic Drug Combinations against SARS-CoV-2
In silico and in vitro study showing both synergistic and antagonistic drug combinations against SARS-CoV-2 in Vero E6 cells. Authors screened 73 combinations of 32 drugs and identified 16 synergistic and 8 antagonistic combinations. Nita..
Feb 16
2021
 Elalfy et al., Journal of Medical Virology, doi:10.1002/jmv.26880 Effect of a combination of Nitazoxanide, Ribavirin and Ivermectin plus zinc supplement (MANS.NRIZ study) on the clearance of mild COVID-19
87% improved viral clearance (p<0.0001). Non-randomized controlled trial with 62 mild and early moderate patients with home treatment with ivermectin + nitazoxanide + ribavirin + zinc, showing significantly faster viral clearance.
Jan 22
2021
 Blum et al., eClinicalMedicine, doi:10.1016/j.eclinm.2021.100981 (date from preprint) Nitazoxanide superiority to placebo to treat moderate COVID-19 – A Pilot prove of concept randomized double-blind clinical trial
67% lower mortality (p=0.25), 62% lower ventilation (p=0.17), 20% lower severe cases, and 56% shorter hospitalization (p=0.02). RCT with 25 nitazoxanide patients and 25 control patients, showing improved virological and clinical outcomes with treatment. Authors also perform an in vitro study in Vero E6 cells showing 90% inhibition with 0.5µM, with no cytotoxicity...
Dec 31
2020
 Rajoli et al., British Journal of Clinical Pharmacology, doi:10.1111/bcp.14619 Dose prediction for repurposing nitazoxanide in SARS‐CoV‐2 treatment or chemoprophylaxis
In silico physiologically based pharmacokinetic (PBPK) modeling study predicting optimal doses of nitazoxanide to maintain plasma and lung concentrations of the active metabolite tizoxanide above the SARS-CoV-2 EC90 in >90% of patients. A..
Nov 4
2020
 Cadegiani et al., New Microbes and New Infections, doi:10.1016/j.nmni.2021.100915 (date from preprint) Early COVID-19 Therapy with azithromycin plus nitazoxanide, ivermectin or hydroxychloroquine in Outpatient Settings Significantly Improved COVID-19 outcomes compared to Known outcomes in untreated patients
88% lower mortality (p=0.08), 97% lower ventilation (p<0.0001), and 99% lower hospitalization (p<0.0001). Comparison of HCQ, nitazoxanide, and ivermectin showing similar effectiveness for overall clinical outcomes in COVID-19 when used before seven days of symptoms, and overwhelmingly superior compared to the untreated COVID-19 population, ev..
Oct 23
2020
 Rocco et al., European Respiratory Journal, doi:10.1183/13993003.03725-2020 (date from preprint) Early use of nitazoxanide in mild Covid-19 disease: randomized, placebo-controlled trial (preprint 10/23)
404% higher ICU admission (p=0.24), 2% higher hospitalization (p=1), 16% worse recovery (p=0.37), and 12% improved viral clearance (p=0.006). RCT 392 patients, median treatment delay 5 days, showing improved viral recovery at 5 days. Symptom recovery was no different at 5 days, and the treatment arm had two ICU admissions compared to zero for control. There were no serious adve..
May 20
2020
 Arshad et al., Clinical Pharmacology & Therapeutics, doi:10.1002/cpt.1909 Prioritization of Anti-SARS-Cov-2 Drug Repurposing Opportunities Based on Plasma and Target Site Concentrations Derived from their Established Human Pharmacokinetics
Pharmacokinetic analysis predicting that ivermectin, HCQ, CQ, and azithromycin will achieve lung concentrations well over 10 times higher than the reported EC50. Nitazoxanide had a lung tissue Cmax/EC50 of 7.8.
Apr 30
2020
 Pepperrell et al., Journal of Virus Eradication, doi:10.1016/S2055-6640(20)30017-0 Review of safety and minimum pricing of nitazoxanide for potential treatment of COVID-19
Review of safety and minimum pricing of nitazoxanide for potential treatment of COVID-19. Nine RCTs comparing nitazoxanide with placebo or active control for 5-14 days in participants experiencing acute infections were included, accountin..