stavudine


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Related to stavudine: zidovudine, nevirapine, delavirdine, didanosine

stavudine

 [stav´u-dēn]
a nucleoside analogue of thymidine that inhibits replication of the human immunodeficiency virus (HIV); used in the treatment of HIV infection, administered orally.

stavudine (d4T)

Zerit

Pharmacologic class: Nucleoside reverse transcriptase inhibitor

Therapeutic class: Antiretroviral

Pregnancy risk category C

FDA Box 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

Precautions

Use cautiously in:

• advanced HIV infection, bone marrow depression, renal failure, peripheral neuropathy, hepatic dysfunction, hyperlactatemia, lactic acidosis

• concurrent use of hydroxyurea or didanosine (avoid use)

• elderly patients (with renal impairment)

• pregnant or breastfeeding patients.

Administration

• Give with or without food.

• Know that drug is usually given with other antiretrovirals.

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: body fat redistribution or accumulation, chills, fever, allergic reaction, immune reconstitution syndrome

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, hyperlactatemia, or pronounced hepatotoxicity (which may include hepatomegaly and steatosis even in the absence of marked transaminase elevations). Consult prescriber about suspending drug if these occur. Consider permanent discontinuation of drug for patients with confirmed lactic acidosis.

• Monitor patient for signs and symptoms of immune reconstitution syndrome.

• 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), hepatotoxicity, immune reconstitution syndrome, and pancreatitis.

• 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.

stavudine

(stăv′yo͝o-dēn′)
n.
An antiviral drug, C10H12N2O4, that is a nucleoside reverse transcriptase inhibitor and is used in the treatment of HIV infection. Also called d4T.

stavudine

d4T, Zerit® AIDS An antiretroviral nucleoside analogue used in multiagent management of AIDS Adverse effects Lactic acidosis, severe hepatomegaly with steatosis, severe peripheral neuropathy. See AIDS.

stavudine

A REVERSE TRANSCRIPTASE INHIBITOR drug used to treat HIV infections. The drug is on the WHO official list. A brand name is Zerit.
References in periodicals archive ?
In patients with AKI on CKD group 9/10 in (90%) of cases tenofovir regimen was changed to abacavir / stavudine based regimen.
Stavudine, lamivudine and nevirapine combination therapy for treatment of HIV infection and AIDS in adults.
In multivariate analysis, obesity (OR: 7.71, 95% CI: 1.36-43.7; p = 0.021), presence of lipohypertrophy (OR: 62.9, CI: 4.97-795.6; p = 0.001), and exposure to stavudine treatment for at least 6 months (OR: 8.18, 95% CI: 1.37-48.7; p = 0.021) were significantly associated with prediabetes/T2DM.
Prevalence of lipodystrophy was highest for participants receiving second-line PI based regimen (66.7%) followed by Stavudine based regimen (53.5%).
Concerning regimen change 2 (2.4%) of the patients changed their regimen and 6 (7.2%) changed the strength of stavudine from 30 to 40 mg during the 1 year.
Determination of stavudine in plasma by high performance liquid chromatography method has been described [2, 3]; analysis time was more than 12 minutes.
Of all patients receiving the combination stavudine, lamuvidine and efavirenz (n = 68), 72% were depressed.
The immunity-from-suit agreement signed with Matrix Laboratories Limited, a Mylan Company, enables the generic company to manufacture and sell atazanavir, as well as stavudine and didanosine, in sub-Saharan Africa and India.
However, resource constraints limit the national programme to use nucleoside reverse transcriptase inhibitors (NRTIs) like zidovudine (AZT) or stavudine (d4T) with lamivudine (3TC) and non nucleoside reverse transcriptase inhibitors (NNRTI) like nevirapine and efavirenz for highly active anti-retroviral therapy (HAART).
The MSF cohort showed a higher percentage of those AIC at 1 year (86%), but the data included several different second-line regimens, with most participants having been on a first-line regimen of stavudine, lamivudine and nevirapine.