Home Drug Guide Stavudine

Drug Guide

Generic Name

Stavudine

Brand Names Zerit, Zerit XR

Classification

Therapeutic: Antiretroviral agent

Pharmacological: Nucleoside reverse transcriptase inhibitor (NRTI)

FDA Approved Indications

Treatment of HIV-1 infection in combination with other antiretroviral agents

Mechanism of Action

Stavudine is a nucleoside analogue that inhibits the activity of reverse transcriptase, an enzyme critical for the replication of HIV, thereby preventing the replication of the virus.

Dosage and Administration

Adult: Typically 40 mg orally twice daily; dose adjustments may be required in renal impairment.

Pediatric: Dosage based on weight and age, usually 0.75 mg/kg twice daily.

Geriatric: Dose adjustments may be necessary due to renal function; monitor closely.

Renal Impairment: Reduce dosage based on creatinine clearance, and monitor renal function.

Hepatic Impairment: Use with caution; no specific dose adjustment recommended.

Pharmacokinetics

Absorption: Well absorbed orally.

Distribution: Widely distributed in body tissues.

Metabolism: Primarily metabolized via phosphorylation; minimal hepatic metabolism.

Excretion: Excreted mainly via the kidneys.

Half Life: Approximately 1.5 to 3 hours.

Contraindications

Hypersensitivity to Stavudine or any component of the formulation.

Precautions

Lactic acidosis and severe hepatomegaly with steatosis have been reported, especially in women. Monitor for mitochondrial toxicity, peripheral neuropathy, pancreatitis, and lipodystrophy. Use caution in patients with renal impairment.

Adverse Reactions - Common

Nausea (frequent)
Peripheral neuropathy (frequent)
Nausea and rash (frequent)

Adverse Reactions - Serious

Lactic acidosis (rare but serious)
Pancreatitis (rare)
Hepatomegaly with steatosis (rare)
Peripheral neuropathy leading to disability (rare)

Drug-Drug Interactions

Didanosine (increased risk of peripheral neuropathy and pancreatitis)
St. John’s wort (may decrease Stavudine levels)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for signs of peripheral neuropathy, pancreatitis, lactic acidosis, and hepatotoxicity. Regular renal function tests are necessary.

Diagnoses:

Impaired peripheral sensory perception
Risk for lactic acidosis

Implementation: Administer with food to reduce gastrointestinal upset. Educate patients about potential side effects and the importance of adhering to prescribed doses.

Evaluation: Evaluate for effectiveness of viral suppression through lab tests and monitor for adverse effects.

Patient/Family Teaching

Take medication exactly as prescribed.
Report symptoms like unusual numbness/tingling, abdominal pain, or signs of lactic acidosis.
Avoid alcohol and hepatotoxic substances.
Attend regular lab visits for monitoring.

Special Considerations

Black Box Warnings:

Lactic acidosis and severe hepatomegaly

Genetic Factors: None specified.

Lab Test Interference: May cause elevated serum amylase levels; monitor as clinically indicated.

Overdose Management

Signs/Symptoms: Nausea, vomiting, fatigue, lactic acidosis, and peripheral neuropathy.

Treatment: Supportive care, monitor acid-base status, and provide symptomatic treatment. Hemodialysis may be considered in overdose to remove Stavudine.

Storage and Handling

Storage: Store at room temperature between 20°C to 25°C (68°F to 77°F).

Stability: Stable under recommended storage conditions.