Nitazoxanide is a clinically relevant antiparasitic agent.1It has since been repurposed as a broad-spectrum antiviral agent that is active against many RNA and DNA viruses including influenza, Hepatitis B and C, RSV, coronavirus, dengue and others.2 Its antiparasitic activity is believed to be due to inhibition of pyruvate:ferredoxin/flavodoxin oxidoreductases.3 Antiviral activity involves activation of protein kinase activated by double-stranded RNA (PKR) leading to phosphorylation of eukaryotic initiation factor 2 alpha (eIF2alpha).4 Nitazoxanide has also been found to inhibit Wnt signaling independent of adenomatous polyposis coli (APC) - it targets peptidyl arginine deiminase 2 (PAD2) resulting in increased citrullination of beta-catenin.5
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