Zerit (stavudine) is a nucleoside reverse transcriptase inhibitor (NRTI) indicated for the treatment of human immunodeficiency virus (HIV-1) infection in combination with other antiretroviral agents. As a critical component of highly active antiretroviral therapy (HAART), Zerit works by inhibiting the reverse transcriptase enzyme, thereby impeding viral replication and reducing viral load. This medication is formulated to support immune reconstitution and delay disease progression in appropriate patient populations when used as part of a comprehensive treatment regimen under expert medical supervision.

Features

• Active pharmaceutical ingredient: Stavudine 15 mg, 20 mg, 30 mg, or 40 mg capsules
• Pharmaceutical class: Nucleoside reverse transcriptase inhibitor (NRTI)
• Bioavailability: Approximately 86% following oral administration
• Plasma half-life: 1.0-1.6 hours (intracellular half-life approximately 3.5 hours)
• Metabolism: Minimally hepatic, primarily eliminated renally
• Administration: Oral formulation with or without food
• Storage requirements: Room temperature (15-30°C) in tightly closed container

Benefits

• Effectively reduces HIV viral load when used in combination therapy
• Helps restore and preserve CD4+ T-cell counts
• Delays progression to AIDS-defining illnesses
• Contributes to improved long-term clinical outcomes
• Available in multiple strengths for individualized dosing
• Established safety profile with extensive clinical experience

Common use

Zerit is prescribed as part of combination antiretroviral therapy for the treatment of HIV-1 infection in adults and pediatric patients. It is typically used in regimens alongside other antiretroviral agents from different classes to create synergistic antiviral effects and minimize the development of resistance. The medication is particularly valuable in resource-limited settings due to its cost-effectiveness and stability at room temperature. Treatment decisions should be based on baseline viral load, CD4 count, resistance testing, and individual patient factors including comorbidities and potential drug interactions.

Dosage and direction

Adult dosing: The recommended dosage is based on body weight. For patients weighing 60 kg or more: 40 mg twice daily; for patients weighing less than 60 kg: 30 mg twice daily. Dosing should be adjusted in patients with renal impairment.

Pediatric dosing: For children weighing 30 kg or more: 30 mg twice daily if <60 kg, 40 mg twice daily if ≥60 kg. For children 14 days of age and older weighing less than 30 kg: 1 mg/kg twice daily.

Administration: Capsules should be swallowed whole with water. Zerit may be taken with or without food. Patients should maintain consistent dosing intervals approximately 12 hours apart to ensure stable drug levels. Dosage adjustments are required for patients with creatinine clearance less than 50 mL/min.

Precautions

Peripheral neuropathy, which may be severe and potentially irreversible, has been associated with Zerit use. Patients should be monitored for symptoms including numbness, tingling, or pain in hands or feet. Lactic acidosis and severe hepatomegaly with steatosis, including fatal cases, have been reported with nucleoside analogue use. Pancreatitis has occurred during therapy, particularly in patients with risk factors for pancreatitis. Lipoatrophy has been commonly observed in patients receiving stavudine-based regimens. Immune reconstitution syndrome may occur during initial treatment. Regular monitoring of liver function, amylase, lipase, and metabolic parameters is recommended.

Contraindications

Zerit is contraindicated in patients with known hypersensitivity to stavudine or any component of the formulation. Concomitant use with zidovudine is contraindicated due to antagonistic antiviral effects. The medication should not be administered to patients experiencing acute pancreatitis or a history of pancreatitis unless potential benefits outweigh risks. Severe hepatic impairment requires careful consideration before initiation. Concomitant use with doxorubicin or ribavirin is not recommended due to potential mitochondrial toxicity.

Possible side effects

Common (≥10%): Peripheral neuropathy, headache, nausea, diarrhea, rash Less common (1-10%): Pancreatitis, elevated liver enzymes, insomnia, dizziness, chills/fever Rare (<1%): Lactic acidosis, hepatic steatosis, severe hepatomegaly, lipodystrophy, myopathy Laboratory abnormalities: Elevated amylase, elevated lipase, elevated transaminases, hypertriglyceridemia

Patients should be advised to report any symptoms of neuropathy, abdominal pain, nausea, vomiting, or unexplained fatigue promptly. Most side effects are dose-related and may improve with dosage adjustment or discontinuation.

Drug interaction

Zerit exhibits interactions with several medication classes. Concomitant use with didanosine may increase risk of pancreatitis and peripheral neuropathy. Hydroxyurea may increase toxicity of stavudine. Drugs that cause peripheral neuropathy (isoniazid, vincristine) may additive neurotoxic effects. Zidovudine antagonizes stavudine’s antiviral activity. Medications that affect renal function may alter stavudine clearance. Methadone increases stavudine exposure; consideration should be given to monitoring for increased toxicity. Physicians should review all concomitant medications, including over-the-counter products and herbal supplements.

Missed dose

If a dose is missed, patients should take it as soon as remembered unless it is almost time for the next scheduled dose. In that case, the missed dose should be skipped and the regular dosing schedule resumed. Patients should not double the dose to make up for a missed dose. Consistent adherence to the prescribed regimen is critical for maintaining viral suppression and preventing resistance development. Healthcare providers should discuss strategies to improve adherence if multiple doses are missed.

Overdose

Experience with acute overdose is limited. There is no specific antidote for stavudine overdose. Management should consist of general supportive measures including monitoring of vital signs and observation of clinical status. Hemodialysis removes approximately 40% of the administered dose over 4 hours and may be considered in cases of significant overdose. Symptoms may include exacerbation of known adverse effects including peripheral neuropathy, pancreatitis, hepatic toxicity, and hematological abnormalities. Supportive care should be provided based on clinical manifestations.

Storage

Store at room temperature between 15°C and 30°C (59°F and 86°F). Keep container tightly closed and protect from moisture. Do not remove desiccant from bottle. Keep out of reach of children and pets. Do not use beyond the expiration date printed on the packaging. Avoid storing in bathroom cabinets where humidity levels may fluctuate. Proper storage ensures stability and potency throughout the shelf life.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Treatment decisions should be made by qualified healthcare professionals based on individual patient circumstances. The prescribing physician should be consulted for complete information regarding indications, dosing, warnings, and precautions. Patients should not alter or discontinue medication without medical supervision. Full prescribing information is available upon request.

Reviews

Clinical studies demonstrate that Zerit-containing regimens achieve significant viral load reduction and CD4 count improvements in treatment-naïve and experienced patients. The medication has shown particular utility in resource-limited settings where cost considerations are paramount. However, many clinicians now prefer alternative NRTIs with improved side effect profiles, particularly regarding lipoatrophy and peripheral neuropathy. Patient experiences vary, with some reporting excellent tolerance and virological response, while others describe challenging side effects that necessitated regimen changes. Contemporary guidelines generally recommend Zerit as an alternative rather than first-line option due to its toxicity profile, though it remains an important component of the antiretroviral arsenal.