d4T

d4T,

symbol for dideoxythymidine.

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stavudine (d4T)

Zerit

Pharmacologic class: Nucleoside reverse transcriptase inhibitor

Therapeutic class: Antiretroviral

Pregnancy risk category C

FDA Boxed Warning

• Lactic acidosis and severe hepatomegaly with steatosis (including fatal cases) have occurred with use of drug alone or in combination with other nucleoside analogs. Fatal lactic acidosis has been reported in pregnant women who received stavudine-didanosine combination with other antiretrovirals. Use this combination cautiously in pregnant women and only if potential benefit clearly outweighs potential risk.
• Pancreatitis (fatal and nonfatal cases) has occurred when stavudine was used as part of combination regimen that included didanosine, in both treatment-naive and treatment-experienced patients.

Action

Inhibits replication of human immunodeficiency virus (HIV) by interfering with the enzyme reverse transcriptase, thereby terminating DNA chain

Availability

Capsules: 15 mg, 20 mg, 30 mg, 40 mg

Powder for oral solution: 1 mg/ml

⊘Indications and dosages

➣ HIV-1 infection

Adults weighing 60 kg (132 lb) or more: 40 mg P.O. q 12 hours

Adults and children weighing less than 60 kg (132 lb): 30 mg P.O. q 12 hours

Children weighing 30 kg (66 lb) or more: 30 mg P.O. q 12 hours

Children 14 days and older who weigh less than 30 kg (66 lb): 1 mg/kg P.O. q 12 hours

Newborns to infants 13 days old: 0.5 mg/kg P.O. q 12 hours

Dosage adjustment

• Renal impairment
• Elderly patients

Contraindications

• Hypersensitivity to drug or its components
• Lactic acidosis
• Hyperlactatemia
• Severe hepatotoxicity

Precautions

Use cautiously in:
• advanced HIV infection, bone marrow depression, renal failure, peripheral neuropathy
• pregnant or breastfeeding patients.

Administration

• Give with or without food.
• Know that drug is usually given with other antiretrovirals.

Route	Onset	Peak	Duration
P.O.	Variable	60-90 min	Unknown

Adverse reactions

CNS: headache, insomnia, peripheral neuropathy

GI: nausea, vomiting, diarrhea, abdominal pain, anorexia, pancreatitis

Hematologic: anemia, leukopenia, thrombocytopenia

Hepatic: hepatic steatosis, hepatitis, hepatic failure

Metabolic: increased glucose tolerance, lactic acidosis

Musculoskeletal: myalgia

Skin: rash

Other: chills, fever, allergic reaction

Interactions

Drug-drug. Chloramphenicol, dapsone, didanosine, ethambutol, hydralazine, hydroxyurea, lithium, phenytoin, vincristine, zalcitabine: increased risk of peripheral neuropathy

Doxorubicin, ribavarin, zidovudine: inhibition of stavudine's absorption and metabolism

Myelosuppressants: increased bone marrow depression

Drug-diagnostic tests. Alanine aminotransferase, amylase, aspartate aminotransferase, bilirubin, gamma-glutamyl transferase, lipase: increased levels

Neutrophils, platelets: decreased counts

Patient monitoring

☞ Monitor closely for signs and symptoms of lactic acidosis. Consult prescriber about drug discontinuation if these occur.
• Watch for and report onset and worsening of peripheral neuropathy.
☞ Monitor CBC. Report evidence of bone marrow depression.
• Monitor liver function tests and blood chemistry results.

Patient teaching

• Tell patient he may take with or without food.
☞ Teach patient to recognize and promptly report signs and symptoms of lactic acidosis (such as fatigue, GI distress, and difficult or rapid breathing).
• Instruct patient to report numbness or tingling in arms, legs, hands, or feet.
• Caution female patient not to breastfeed, because she may transmit drug effects and HIV to infant.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.

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d4T

Stavudine, Zerit AIDS An anti-HIV reverse transcriptase inhibitor/nucleoside analogue Adverse effects Neuropathies of hands and feet, stomach upset, pancreatitis, liver damage,. See AIDS. Cf AZT, DDC, ddC.