Comprehensive medication guide to Alinia including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$0–$30 copay for generic nitazoxanide (Tier 1–2 on most commercial plans); brand Alinia typically Tier 3–4 with higher copays, but commercially insured patients can use the Romark co-pay card to reduce cost to as little as $0 (max $300 savings).
Estimated Cash Pricing
$833–$1,605 retail for brand Alinia; generic nitazoxanide retails for $833–$1,113 but is available for as low as $223 with a GoodRx or SingleCare coupon for a 6-tablet (3-day) course.
Medfinder Findability Score
45/100
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Alinia is the brand name for nitazoxanide, a prescription antiprotozoal medication FDA-approved in 2004. It is manufactured by Romark Laboratories and is available in two forms: 500 mg film-coated tablets (for patients 12 years and older) and a 100 mg/5 mL strawberry-flavored oral suspension (for patients 1 year and older). A generic version of nitazoxanide was approved by the FDA in 2020.
Alinia is used to treat diarrhea caused by the intestinal parasites Giardia lamblia and Cryptosporidium parvum in immunocompetent patients. The standard adult course is 500 mg twice daily for 3 days, always taken with food. It is not a controlled substance and does not require alcohol abstinence during treatment.
Alinia belongs to the thiazolide class of antiprotozoal agents and works through a unique mechanism — blocking the PFOR enzyme essential to the energy metabolism of anaerobic parasites. This distinguishes it from nitroimidazole drugs like metronidazole and gives it a notably clean drug interaction and side effect profile.
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Alinia works by interfering with the energy production machinery of intestinal parasites. After oral administration, nitazoxanide is rapidly hydrolyzed to its active metabolite, tizoxanide (desacetyl-nitazoxanide). Tizoxanide then acts in the intestinal lumen where Giardia lamblia and Cryptosporidium parvum reside.
The primary mechanism is inhibition of the pyruvate:ferredoxin oxidoreductase (PFOR) enzyme — a critical enzyme in the anaerobic energy metabolism pathways of Giardia and Cryptosporidium. By blocking PFOR's electron transfer function, tizoxanide effectively cuts off the parasite's energy supply, preventing it from growing, reproducing, and surviving.
Human cells generate energy through aerobic processes (mitochondria) and do not rely on PFOR, which explains why Alinia can selectively target parasites without significant toxicity to human tissue. Tizoxanide is also notable for not inhibiting cytochrome P450 enzymes, resulting in fewer drug-drug interactions than many other antiparasitic agents. Food significantly enhances absorption — taking Alinia with a meal nearly doubles the plasma AUC of tizoxanide.
500 mg — tablet
For adults and adolescents 12 years and older. Take one tablet twice daily for 3 days with food.
100 mg/5 mL — oral suspension
For children ages 1–11. Children 1–3: 5 mL (100 mg) twice daily x 3 days with food. Children 4–11: 10 mL (200 mg) twice daily x 3 days with food.
Alinia (nitazoxanide) presents a genuine access challenge for patients. As of 2026, there is no active FDA-declared shortage — the drug is commercially available. However, its low prescription volume and high brand price mean that most community pharmacies do not maintain it in standing stock. Patients routinely report having to call multiple pharmacies before finding one that can fill the prescription immediately.
The best approach is to call ahead and ask specifically for 'nitazoxanide 500 mg tablets' by generic name. Hospital outpatient pharmacies, independent pharmacies, and pharmacies near infectious disease or travel medicine clinics are most likely to have it. Most chain pharmacies can order it within 24–48 hours if it's not on the shelf. The findability score of 45/100 reflects frequent localized availability gaps despite no national shortage.
Rather than calling pharmacies one by one, patients can use medfinder — a service that contacts pharmacies near you to find which ones can fill your Alinia prescription. You provide your medication, dosage, and location, and medfinder does the calling, texting you the results.
Because Alinia (nitazoxanide) is not a controlled substance, any licensed prescriber can write a prescription for it with no DEA registration requirements or scheduling restrictions. There are no federally mandated in-person evaluation requirements.
Primary care physicians (PCPs) — most common prescribers for straightforward giardiasis and cryptosporidiosis cases
Infectious disease specialists — most familiar with antiparasitic therapy; involved in complicated or refractory cases
Gastroenterologists — often involved when persistent diarrhea requires further workup
Travel medicine physicians — highly experienced with waterborne parasitic infections in returning travelers
Pediatricians — for children ages 1–11 using the oral suspension
Nurse practitioners (NPs) and physician assistants (PAs) — have full prescribing authority in most states
Telehealth providers can also prescribe Alinia without restriction — it is not a controlled substance, so virtual visits on platforms like Teladoc, MDLive, Sesame, or PlushCare are valid pathways to obtaining a prescription, especially for travelers returning with suspected giardiasis or known water exposure.
No. Alinia (nitazoxanide) is not a controlled substance and is not scheduled by the DEA (Drug Enforcement Administration). It has no abuse potential or risk for dependence, which is why it carries no scheduling classification.
Because Alinia is non-controlled, any licensed prescriber can write it without DEA registration requirements, and it can be prescribed via telehealth without restrictions. Patients can receive multiple refills if needed (though the standard treatment is just 3 days and refills are rarely needed). No special ID verification or prescription pickup procedures apply at the pharmacy.
Alinia has a generally mild side effect profile. In FDA clinical trials, common adverse reactions (≥2% of patients) included:
Abdominal pain — most common; minimize by always taking with food
Headache — mild; typically resolves without treatment
Chromaturia (yellow/orange urine) — harmless, expected; resolves after completing treatment
Nausea — mild; reduced by taking with food
Alinia carries no boxed warning. Serious side effects are rare but include:
Hypersensitivity (allergic) reactions — rash, hives, throat or facial swelling, difficulty breathing. Seek emergency care immediately if these occur. Alinia is contraindicated in patients with prior hypersensitivity to nitazoxanide.
Sucrose content in suspension — the oral suspension contains 1.48 g sucrose per 5 mL; relevant for diabetic patients monitoring glucose
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Metronidazole (Flagyl)
WHO first-line treatment for giardiasis. More affordable and universally stocked. Requires alcohol abstinence. 5–7 day course. Not as effective for Cryptosporidium.
Tinidazole (Tindamax)
Single-dose treatment for giardiasis with highest clinical cure rate per meta-analysis. Also requires alcohol abstinence for 72 hours. Well tolerated with fewer GI side effects than metronidazole.
Albendazole (Albenza)
Broad-spectrum antiparasitic effective for giardiasis. 5-day course, no alcohol restriction, fewer GI side effects. Also treats other parasites.
Paromomycin
Oral aminoglycoside preferred for use during pregnancy due to low systemic absorption. Less effective than other first-line agents but minimal fetal risk.
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Warfarin (Coumadin)
moderateProtein binding competition — both tizoxanide (>99.9% protein-bound) and warfarin compete for plasma protein binding sites. Oral suspension label advises to avoid concurrent use. Monitor INR if concurrent use is unavoidable.
Phenytoin (Dilantin)
moderateProtein binding competition may alter phenytoin blood levels. Monitor drug levels and clinical response during concurrent use.
Valproic acid (Depakote)
moderateProtein binding competition may affect valproic acid levels. Inform prescriber before starting Alinia if taking this medication.
Baricitinib (Olumiant)
majorNitazoxanide inhibits OAT3 transporter, reducing baricitinib elimination and potentially increasing toxicity. Coadministration not recommended.
CAR-T cell therapies
majorMutual immunosuppressive effects increase infection risk. Use with extreme caution; consult managing oncology team.
Sulfonylureas
minorProtein binding competition may alter sulfonylurea levels. Monitor blood glucose during the short 3-day Alinia course.
Alinia (nitazoxanide) is an effective, well-tolerated antiprotozoal medication with a proven track record against Giardia lamblia and Cryptosporidium parvum. Its short 3-day treatment course, lack of alcohol restriction, and clean drug interaction profile make it a patient-friendly option compared to older antiparasitic drugs. The 2020 approval of the generic has made it more financially accessible for many patients.
The primary challenge with Alinia in 2026 is access — not shortage. Low prescription volume means many pharmacies don't keep it routinely stocked. Patients should be prepared to call ahead or use a pharmacy-finding service. Providers should write for the generic by name with 'substitution permitted' and inform commercially insured patients about the Romark co-pay program. For cash-pay patients, GoodRx coupons for generic nitazoxanide can bring the cost to around $223.
If you're struggling to find Alinia at a pharmacy near you, medfinder can contact pharmacies on your behalf — you enter your medication, dosage, and location, and receive a text with which pharmacies near you can fill your prescription.
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Our medication guides are researched and written to help patients make informed decisions. All content is reviewed for accuracy and updated regularly. Learn more about our standards
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