stavudine

STAVUDINE

Complete information including dosage, side effects, interactions and pregnancy & breast feeding warnings for patient and professional use

Overview and uses

Stavudine is a medicine used for HIV treatment. It is available only as a prescription medicine. Stavudine is prescribed by a doctor in combination with other medicines for HIV treatment. This is done to increase the therapeutic efficacy of the medicines used in the treatment of HIV. Also, combination therapy reduces the risk of virus getting resistant to any one particular medicine.

Stavudine does not cure HIV, but it slows down the progression of HIV within the body. HIV destroys CD4+ T Lymphocytes – a type of white blood cells (WBC) that gives immunity to the body. In other words, these cells protect the body against the infections or illness caused by various organisms like bacteria, viruses and other germs. Thus, one may conclude that HIV infection, if left untreated, may make the body susceptible to this infections/illness.

Brand names of Stavudine: Zerit, Stag, Stavir, Virostav.

Pharmacological classification: Nucleoside reverse transcriptase inhibitor anti-retroviral drug

Indication (used for):

  • For the treatment of HIV-1 infections.

Dosage

  • Interval between two consecutive doses of Stavudine should be 12 hours. It can be taken with or without food.
  • Adult dose:
    • 40 mg twice a day if body weight is 60 kg or more than 60 kg for adults.
    • 30 mg twice a day if bodyweight is less than 60 kg for adults.
  • Pediatric dose:
    • 5 mg/kg orally twice a day for children from birth to up to 13 days.
    • For children aging 14 days or older than 14 days and weighing 30 kg or more: adult dosage is recommended.
    • For children aging 14 days or older than 14 days and weighing less than 30 kg: 1mg/kg orally every 12 hours.
  • RENAL DOSE ADJUSTMENTS:
    • Creatinine clearance more than 50ml/min:
      • 40 mg every 12 hours if body weight is 60 kg or more.
      • 30 mg every 12 hours if body weight is less than 60 kg.
    • Creatinine clearance 26 ml/min to 50 ml/min:
      • 20 mg every 12 hours if body weight is 60 kg or more.
      • 15 mg every 12 hours if body weight is less than 60 kg.
    • Creatinine clearance 10 ml/min to 25 ml/min:
      • 20 mg every 24 hours if body weight is 60 kg or more.
      • 15 mg every 24 hours if body weight is less than 60 kg.
    • If patient is on hemodialysis:
      • 20 mg every 24 hours if body weight is 60 kg or more.
      • 15 mg every 24 hours if body weight is less than 60 kg.

Dose should be administered after hemodialysis on the days of dialysis at the same time when dose is administered on non-dialysis days.

Dosage form: Stavudine is available as capsules for adults and as oral reconstitution solution for children.

Over dosage:

  • Chronic overdose of Stavudine may cause hepatic toxicity and peripheral neuropathy.

Pregnancy

Category C, which means that Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.

Mechanism of action: Stavudine – a thymidine analogue gets intracellularly converted into active form by the enzyme thymidine kinase, which terminates the elongation of proviral DNA. It gets incorporated into nascent DNA by reverse transcriptase but it lacks 3’-OH (hydroxyl) group.

Unwanted or side effects:

  • The most common and serious side effect of Stavudine is peripheral neuropathy. This is more common in patients receiving higher doses of Stavudine or in those patients with underlying HIV related neuropathy or in those patients who are taking Stavudine along with other neurotoxic medicines.
    • Tingling or numbness in hands or feet, sharp pain, regularly dropping things from your hands, thinning of the skin, constipation, diarrhea, excessive sweating and low blood pressure are some of the symptoms. Consult your doctor as soon as possible.
  • Lactic acidosis and severe hepatomegaly with steatosis.
    • feeling or being sick, abdominal pain (tummy) pain, loss of appetite, loss of weight, feeling dizzy and fast or gasping breathing, diarrhea, sleepiness, tiredness or weakness, nausea and vomiting, pain in upper right portion of the abdomen, rash, weight loss, yellowing of the skin and whites of the eye are some of the symptoms of the above mentioned condition. Consult your doctor as soon as possible.
    • Commonly observed in patients receiving combination therapy of Stavudine and Didanosine
  • Hepatic toxicity is commonly observed in patients receiving combination therapy of Stavudine with interferons and Ribavirin.
  • Pancreatitis
    • Nausea, vomiting, upper abdominal (tummy) pain that radiates to your back, upper abdominal (tummy) pain that worsens after eating, fever, rapid pulse, weight loss, oily and smelly stool are some of the symptoms. Consult your doctor as soon as possible.
  • Fat redistribution or accumulation of body fat including central obesity, dorsocervical fat enlargement (buffalo hump), peripheral wasting, facial wasting, breast enlargement and “cushingoid appearance” have been observed in patients receiving anti HIV therapy.
  • Immune reconstitution syndrome: during the initial phase of the treatment, patients whose immune systems respond may develop an inflammatory response to opportunistic infections, which may necessitate further evaluation and treatment. Auto immune disorders have also been reported to occur in some people at any time after the initiation of the treatment.

Interactions

Drug – drug interactions of Stavudine:

  • Zidovudine inhibits intracellular phosphorylation of Stavudine. Hence, both should not be used together.
  • Doxorubicin inhibits intracellular phosphorylation of Stavudine. Hence, both should not be used together.
  • Concomitant use of Ribavirin and Stavudine should be done with caution and under strict monitoring.
  • Didanosine and Stavudine should not be used concomitantly as it increases the risk and severity of peripheral neuropathy and potentially fatal pancreatitis.
  • Mipomersen, leflunomide, teriflunomide, bexarotene, lomitapide and teriflunomide should be avoided with Stavudine.

Drug – food interactions of Stavudine:

  • Can be taken regardless of food intake.

Important information on anti HIV and anti AIDS medicines

Benefits of taking your anti HIV medicines regularly

  • Sustained viral suppression.
  • Reduced risk of resistance.
  • Reduced risk of treatment failure.
  • Improved quality of life and overall health.
  • Reduced risk of HIV transmission.

Getting the most from your treatment

  • Precisely follow every advice given to you by your doctor and pharmacist regarding your medications. Take your dose regularly without missing out a single one.
  • Make all the necessary changes in your lifestyle and eating/food habits as advised by your doctor and pharmacist. This may include quitting smoking, alcohol, other substances of abuse, taking up exercise and some/many others that your doctor finds it best in your interest.
  • Do not make any changes in your dose unless suggested/recommended by your doctor.
  • Keep your regular appointments with your doctor so that the progress can be monitored. This may involve blood tests and other test that a doctor finds necessary.
  • Consult your doctor if you develop an infection or an allergy after you start the treatment.
  • Consult your doctor if you feel low or even depressed. This is common especially after diagnosis and during the early stages of treatment.
  • Some people who have taken anti HIV medicines for a long period of time may develop Osteonecrosis – a condition where bone tissue dies due to reduced blood supply. This causes joint pain, stiffness and difficulty in movement. Consult your doctor if you if you notice any of this symptoms.
  • If you are going to take any operation/surgery or a dental treatment, tell doctor who is going to carry out operation/surgery or dental procedure about all the medicines that you are taking. If possible, carry your containers with you to the doctor even if it is empty.
  • If you buy any medicines, supplements including your vitamin supplements, herbal medicines or even the medicines that do not require a prescription, check with your pharmacist whether they can be taken along with your anti HIV medicines or not.
  • Treatment of HIV is life-long. Continue taking your anti HIV medicines even if you feel well. This should be done to keep your immune system healthy.

Forgot to take your medicine?

  • Forgetting a dose/frequent missed out doses may lead to viral resistance or treatment failure.
  • If you forget to take a dose, take it immediately as soon as you remember unless it’s almost the time for your next dose.
  • Do not take two doses at the same time to make up for the missed out dose.
  • If you are forgetting/missing your dose frequently or very often, try using pill boxes that are available as weekly or monthly dose boxes. Alternatively, you can also try posting reminder notes on places like doors of refrigerator, wardrobe, bathroom, side tables of your bed, above or below switch boards etc. You can also set a reminder on your cell phone.
  • If possible, ask your family members and friends to remind you of your dose.

Click here to go to Stavudine forums

Note: The sole purpose of every information shared on this article is to bring awareness. Do not use this information as a medical advice or prescription advice or as a tool for the treatment, diagnosis or prevention of the disease.

By |2017-12-20T13:34:58+00:00May 2nd, 2017|medicines|19 Comments

About the Author:

B. Pharm (K.L.E. society's S.V.V. Patil College of Pharmacy, Bengaluru) M. Pharm (Maharishi Arvind Institute of Pharmacy, Jaipur)

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