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stavudine

Detailed Prescribing Information

October 2005

 

Zerit  and Zerit-XR*  = stavudine = d4T
*XR formulation not available as of May 2005
Forms Available immediate release form 15, 20, 30, 40 mg caps
*extended-release form
37.5 mg, 50 mg, 75 mg, and 100 mg [not available June 2004]

Powder for oral solution (1 mg/ml after reconstitution)

Dosing

Immediate-release form:

Wt. > 60 kg: 40 mg twice a day

Wt. < 60 kg, OR if restarting after mild peripheral neuropathy resolves: 30 mg twice a day


Extended-release form:

Wt>60 kg: 100 mg daily

Wt<60 kg: 75 mg daily

Renal dosing1 Creatinine
Clearance
(cc/min)
Weight
(kg)
< 60 > 60
> 50 30 mg twice a day 40 mg twice a day
26-50 15 mg twice a day 20 mg twice a day
10-25 15 mg daily 20 mg daily
hemodialysis 15 mg daily 20 mg daily
Hepatic dosing: limited data - stavudine pharmacokinetics were not altered in 5 non-HIV-infected volunteers with cirrhosis - however, see Warnings below
Food dependence This medication may be taken with or without food.
Adverse Effects Fairly well tolerated in most patients

Peripheral neuropathy (10-20%) [consider baseline neuropathy exam]

Rare pancreatitis, lactic acidosis and hepatic steatosis

Increasingly associated with fat redistribution, hyperlipidemia, metabolic syndrome

Interactions LIkely increased neurotoxicity of other neuropathic drugs including stavudine, didanosine, zalcitabine
Suggested lab follow-up Lipase testing as desired or indicated for symptomatology compatible with pancreatitis
Warning Avoid use with zalcitabine due to increased neurotoxicity and zidovudine (in vitro/in vivo antagonism).
Concomitant use with ddI/didanosine and hydroxyurea may increase the risk of fat redistribution, peripheral neuropathy, pancreatitis, and/or lactic acidosis.
Use with extreme caution in the setting of liver disease especially hepatitis C
Usage suggestions The extended release form of stavudine has not been widely available at the time of this writing (July 2005), but it certainly may be the preferred form in many cases.

In general (in the author's opinion) stavudine should not be used especially in older, more ill or more immunodeficient patients without compelling reasons due to the issues of lipoatrophy, dyslipidemia, and peripheral neuropathy that are associated increasingly with this drug.
Do not use with other mitochondrial toxins (ddC, ddI)
Do not use with zidovudine, Combivir, or Trizivir due to antagonism (with zidovudine.)

Complete prescribing information

http://www.zerit.com/

 

 

 

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Quick Menu / Table of Contents
Introduction Principles Management NRTI Key NRTI Info
NNRTI Key NNRTI Info PI Key PI Info Fusion Inhibitors
Drug Summary Investigational Adherence Lab Evaluation Resistance Tests
PEP Antiretroviral Tables OI Prevention Vaccinations TB Therapy
Hepatitis Therapy OI Diagnosis OI Therapy Bibliography Links

 

Updated 10.25.2005

 


 

1. Renal dosing information from: Ian R. McNicholl & Rudolph A. Rodriguez, MD, Dosing of Antiretroviral Drugs in Renal Insufficiency and Hemodialysis, May 2004
http://hivinsite.ucsf.edu/InSite?page=md-rr-18