Antiretroviral Agents: Nucleoside Reverse Transcriptase Inhibitors

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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/

Links to Antiretroviral Sections (click on anything)

Nucleoside & Nucleotide Reverse Transcriptase Inhibitors (NRTI)

AZT | ddC | ddI | d4T | 3TC | ABC | FTC | TDF | Combivir | Trizivir | Epzicom | Truvada

Nonnucleoside Reverse Transcriptase Inhibitors (NNRTI)

efavirenz | nevirapine | delavirdine

Protease Inhibitors (PI) | Boosted Protease Inhibitors

Fusion Inhibitors

enfuvirtide

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