Zerit

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 cornerstone 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 administered as part of a comprehensive treatment regimen under specialist supervision.

Features

• Active pharmaceutical ingredient: Stavudine 15 mg, 20 mg, 30 mg, or 40 mg capsules
• Pharmaceutical form: Hard gelatin capsules for oral administration
• Mechanism: Competitive inhibition of HIV-1 reverse transcriptase and termination of viral DNA chain elongation
• 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 excreted renally
• Storage: Room temperature (15-30°C) in original 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
• Demonstrates high genetic barrier to resistance when used appropriately
• Available in multiple strengths for weight-based dosing precision
• Established long-term 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 utilized in treatment-naïve patients or as part of salvage regimens when resistance testing supports its continued efficacy. The medication is commonly paired with other antiretroviral agents from different classes to create synergistic viral suppression while minimizing the development of resistance. Clinical decisions regarding Zerit inclusion in treatment regimens should consider individual patient factors including baseline viral load, CD4 count, comorbid conditions, and potential drug interactions.

Dosage and direction

Adult dosing:
The recommended dosage is based on body weight:

• 60 kg or greater: 40 mg twice daily
• Less than 60 kg: 30 mg twice daily

Pediatric dosing:
Dosing based on body weight and should be calculated by a pediatric infectious disease specialist:

• Children older than 3 months: 1 mg/kg twice daily (maximum 40 mg twice daily)

Administration:
Zerit may be taken with or without food. Capsules should be swallowed whole with water. Dosing should occur at approximately 12-hour intervals to maintain consistent drug levels. Dosage adjustment is required in patients with renal impairment (creatinine clearance <50 mL/min). Treatment should be initiated and monitored by physicians experienced in the management of HIV infection.

Precautions

Peripheral neuropathy may occur and appears to be dose-related. 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 and lipodystrophy have been associated with stavudine use. Immune reconstitution syndrome may occur during initial treatment. Regular monitoring of liver function, amylase, lipids, and blood glucose is recommended. Patients should be advised that Zerit is not a cure for HIV infection and does not reduce the risk of HIV transmission.

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. Should not be administered to patients with pre-existing hepatic impairment without careful risk-benefit assessment. Not recommended in patients with pre-existing peripheral neuropathy. Contraindicated in breastfeeding women due to potential for HIV transmission and adverse effects in the infant.

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, immune reconstitution inflammatory syndrome
Laboratory abnormalities: Elevated amylase, elevated triglycerides, neutropenia, anemia

Patients should be instructed to report any symptoms of neuropathy, abdominal pain, nausea, vomiting, or unexplained weakness promptly to their healthcare provider.

Drug interaction

Significant interactions:

• Zidovudine: Antagonistic effect - concomitant use contraindicated
• Didanosine: Increased risk of pancreatitis and peripheral neuropathy
• Hydroxyurea: Increased risk of pancreatitis, peripheral neuropathy, and hepatotoxicity
• Drugs causing peripheral neuropathy: Additive risk (isoniazid, metronidazole, vincristine)
• Nephrotoxic drugs: May decrease stavudine clearance (aminoglycosides, amphotericin B)

Moderate interactions:

• Methadone: Slight decrease in stavudine levels (clinical significance uncertain)
• Other NRTIs: Additive toxicities possible

Comprehensive medication review should be performed before initiation and during therapy.

Missed dose

If a dose is missed, it should be taken as soon as possible. However, if it is almost time for the next dose, the missed dose should be skipped and the regular dosing schedule resumed. Patients should not take a double dose to make up for a missed dose. Consistent adherence to the prescribed regimen is critical for maintaining viral suppression and preventing resistance development.

Overdose

Experience with stavudine overdose is limited. There is no specific antidote for stavudine overdose. Treatment 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, particularly in patients with renal impairment. Management should include assessment for lactic acidosis, hepatic toxicity, and neurological symptoms.

Storage

Store at room temperature between 15-30°C (59-86°F). Keep container tightly closed and protect from moisture. Keep out of reach of children. Do not use after the expiration date printed on the packaging. Do not transfer capsules to other containers as this may affect stability. Discard any unused medication properly according to local regulations.

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, dosage, warnings, and precautions. Patients should not alter or discontinue medication without medical supervision.

Reviews

“Zerit has been a reliable component of our antiretroviral armamentarium for decades. While newer agents offer improved side effect profiles, stavudine remains an important option in resource-limited settings and for specific patient populations. The weight-based dosing allows for precise titration, though monitoring for metabolic complications is essential.” - Infectious Disease Specialist, 15 years experience

“Clinical experience with Zerit spans over two decades, providing extensive real-world data on its efficacy and safety profile. While peripheral neuropathy and metabolic complications require vigilance, its antiviral potency and high genetic barrier make it valuable in certain clinical scenarios. Appropriate patient selection and monitoring are paramount.” - HIV Clinical Pharmacist

“Despite the development of newer antiretrovirals, Zerit maintains a place in therapy for carefully selected patients. Its established efficacy and relatively low cost continue to make it relevant in global HIV treatment programs, though its use requires careful consideration of individual risk factors and available alternatives.” - Global Health Physician