Names and pronunciation
(sta′vyoo-deen)
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Drug reference
(sta′vyoo-deen)
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Func. class.: Antiretroviral
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Chem. class.: Nucleoside reverse transcriptase inhibitor (NRTI)
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Do not confuse: Zerit/ZyrTEC
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ACTION: Prevents replication of HIV by the inhibition of the enzyme reverse tran- scriptase; causes DNA chain termination
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USES: Treatment of HIV-1 in combina- tion with other antiretrovirals
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CONTRAINDICATIONS: Hyper- sensitivity to this product or zidovudine; didanosine, zalcitabine; severe periph- eral neuropathy Precautions: Breastfeeding, advanced HIV infection, bone marrow suppression, renal disease, peripheral neuropathy, osteoporo- sis, obesity
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Black Box Warning: Pregnancy, hepatic disease, pancreatitis, lactic acidosis Black Box Warning: Lactic acidosis and severe hepatomegaly with steato- sis: death may result; monitor LFTs Black Box Warning: Pancreatitis: se- vere upper abdominal pain, radiating to back, nausea, vomiting usually when used in combination with didanosine • Blood studies: WBC, differential, RBC, Hct, HB, platelets, serum amylase, lipase, blood glucose, plasma hepatitis C RNA, pregnancy test, serum cholesterol, serum lipids, hepatitis serology, baseline and periodically • Renal tests: urinalysis, protein, blood, serum creatinine • Lipoatrophy/lipodystrophy during treatment • Bowel pattern before, during treatment • Weakness, tremors, confusion, dizzi- ness; product may have to be decreased, discontinued • Viral load, CD4 counts, plasma HIV RNA at baseline and throughout treatment • Peripheral neuropathy: tingling, pain in extremities; discontinue product, may not resolve after treatment is discontin- ued • Pregnancy/breastfeeding: use only if benefits outweigh fetal risk; register patient in the Antiretroviral Pregnancy Registry, 1-800-258-4263; do not breast- feed S
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SIDE EFFECTS CNS: Peripheral neuropathy, insomnia, anxiety, depression, dizziness, confusion, headache, chills/fever, malaise, neuropathy CV: Chest pain, vasodilation, hyperten sion EENT: Conjunctivitis, abnormal vision GI: Hepatotoxicity, diarrhea, nausea, vomiting, anorexia, dyspepsia, constipa- tion, stomatitis, pancreatitis HEMA: Bone marrow suppression, leu- kopenia, macrocytosis INTEG: Rash, sweating, pruritus, benign neoplasms MISC: Lactic acidosis, asthenia, lipodys trophy MS: Myalgia, arthralgia RESP: Dyspnea, pneumonia, asthma
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INTERACTIONS Increase: myelosuppression—other myelosuppressants Increase: peripheral neuropathy—lithium, dapsone, chloramphenicol didanosine, eth- ambutol, hydrALAZINE, phenytoin, vinCRIS- tine, zalcitabine Increase: stavudine levels—probenecid Decrease: stavudine effect—methadone, zidovudine
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DOSAGE AND ROUTES • Adult >60 kg: PO 40 mg q12hr • Adult <60 kg: PO 30 mg q12hr • Child <30 kg: PO 1 mg/kg q12hr • Child ≥30 kg, ≤60 kg: PO 30 mg q12hr • Child >60 kg: PO 40 mg q12hr Renal dose • Adult: PO CCr 26-50 mL/min, reduce by 50%, give q12hr; CCr 10-25 mL/min, reduce by 50%, give q24hr
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Available forms: Caps 15, 20, 30, 40 mg; powder for oral sol 1 mg/mL
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Administer: • With/without meals; absorption does not appear to be lowered when taken with food • Use after hemodialysis • Every 12 hr around the clock • Shake suspension well before using
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Assess:
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Evaluate: • Therapeutic response: decreased symptoms of HIV
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • About the signs of peripheral neurop- athy: burning, weakness, pain, prickling feeling in extremities • That product should not be given with antineoplastics • That product is not a cure for AIDS but will control symptoms • To notify prescriber if sore throat, swollen lymph nodes, malaise, fever oc- cur; that other products may be needed to prevent other infections • That, even with use of product, patient may pass AIDS virus to others • That follow-up visits are necessary; that serious toxicity may occur; that blood counts must be done q2wk • That serious product interactions may occur if other medications are ingested; to discuss with prescriber before taking chloramphenicol, dapsone, CISplatin, di- danosine, ethambutol, lithium, antifungals, antineoplastics • To notify prescriber if pregnancy is planned or suspected; that fatal lactic aci- dosis may occur; to avoid breastfeeding • That product may cause fainting or dizziness
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PHARMACOKINETICS Excreted in urine, breast milk; peak 1 hr; half-life: elimination 1-1.6 hr
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• Child <30 kg: PO 1 mg/kg q12hr
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• Child ≥30 kg, ≤60 kg: PO 30 mg q12hr
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• Child >60 kg: PO 40 mg q12hr Renal dose
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