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Hepatitis Researcher Anxiety about Alinia and Ribavirin competition
I am entering my second week of Infergen(2x's), Riba and Alinia.  I told you in previous posts about how I have had trouble eating 4x's daily in order to seperate the the Riba and Alinia and have now resorted to taking the Riba and Alinia together at two meals(AM and PM).  I know you said I could take the Alinia on an empty stomach but the more I read about it the more it seems that it needs food to perform correctly.  Am I making a big mistake taking it with the Riba and should I just take it alone on an empty stomach?  
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NTZ and riba both do not affect P450 enzymes, so no interaction is expected here. Tizoxanide, the major NTZ metabolite, is 99% bound to protein and could interfere with other protein bound drugs in plasma.  Ribavirin is readily soluble in water, so it is likely not dependent on plasma protein transport, but respective data in the official files in this regard are not available.

Food affects the bioavailibility of NTZ by about a factor of two.
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135456_tn?1301441224
Thank You.  When you say NTZ  bioavailibilty is affected by food by a factor of two can you explain that to me a little more?  So , are you saying that I could still get enough NTZ in my blood stream if I took it on an empty stomach spaced away from the Riba?
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I believe he is saying the Alinia works better with food and you can take it along with the Riba.
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Are you in a study for Alinia?
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I think HR is saying that it is better to take Alinia with food but it doesnt matter that much if you dont,
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Basically you have higher plasma levels of Tizoxanide for a longer time if NTZ is taken with food.

Specifically the max concentration Cmax was 10% higher and the Tmax ( time when Cmax occurs) was dalayed from 1.5 to 2.5 hours.
Comparing the concentration curves over time, the AUC ( Area Under the Curve) reflecting total bioavailibility, was 44% higher when NTZ was taken with food.
It is not possible to predict the exact effects this difference in bioavailibility will have on anti HCV activity overall.
Since higher plasma levels for longer times probably will translate into higher therapeutic efficacy, it seems advisable to take NTZ with food if possible.
This is different if a patient receives NTZ to treat intestinal parasites, the approved indication. In this situation the more rapid absorption/removal into the bloodstream by the food effect actually diminishes the local concentration inside the intestinal lumen, the site of action in this indication.
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