Stavudine (trade name Zerit, also known as d4T) is an anti-HIV treatment in the class of drugs called Nucleoside Reverse Transcriptase Inhibitors (NRTIs). The body breaks down these drugs into chemicals that stop HIV from infecting uninfected cells in the body, but they do not help cells that have already been infected with the virus. As people with HIV lose CD4 cells cells - one of the immune systems main defenses - they become more likely to get infections and illnesses.
The standard dose is 40mg twice a day for people weighing more than 60kg and 30mg for those that weigh less. This can somtimes be lowered to 20 mg or 15mg if side effects are a problem. Zerit can be taken with or without food.
The most common side effect of Zerit is peripheral neuropathy. Peripheral neuropathy usually shows up as sharp burning pain sensations in the hands and/or legs. Early signs are a burning sensation or a numbness, like a deep pain that may come and go but always affects the same spot. Early symptoms of peripheral neuropathy are a tingling sensation in the fingertips, feet or legs. This side effect can sometimes be eliminated by using a lower dose.
Other rare side effects of Zerit are pancreatitis, elevated liver function tests and bone marrow suppression. Symptoms of pancreatitis can be pains in the stomach area that go through to your back, and you should notify your doctor immediately if these symptoms occur. Your bloodwork should also be routinely checked for any signs of pancreatitis. Liver function should be closely monitored if you are taking Zerit. Bone marrow suppression is monitored through your blood work. Bone marrow suppression does not occur as frequently with Zerit as with zidovudine (AZT, Retrovir).
One of the side effects linked to long term use of anti-HIV drugs has been given the name lipodystrophy. This side effect shows up as loss of tissue from the face, giving the cheekbones a "sunken" look. There can also be a build up of fat around the waist causing a pot belly. Fat levels in the blood (cholesterol and triglycerides) may also increase. At first, this side effect was thought to be caused by the class of anti-HIV drugs called protease inhibitors. However, recent research suggests that some symptoms of lipodystrophy may be related to other anti-HIV drugs. Although it is not yet certain, some researchers have found that long term use of Zerit may be a risk factor for some of the symptoms of lipodystrophy, such as loss of tissue from the face. One small study found some improvement in these symptoms when people taking Zerit as part of their combination switched to an alternative drug.
The combination of Zerit and zidovudine (AZT, Retrovir) is not recommended as these drugs do not work well together.
A set of rare but serious side effects of nucleoside analog anti-HIV drugs is called lactic acidosis and severe hepatomegaly with steatosis (an enlarged fatty liver). Women, especially those who are oveweight, are particularly at risk. This set of side effects is probably the result of mitochondrial toxicity. Mitochondria are cell's power organs that supply the energy needed for normal cell growth. Anti-HIV nucleoside analogs impair the function of mitochondria. This can lead to increased acid levels in the blood, and an enlarged fatty liver. The symptoms are severe nausea, shortness of breath and vomiting that does not get better. If you are taking anti-HIV drugs and experience these symptoms, tell your provider immediately.
Bristol-Myers Squibb, the maker of stavudine (Zerit), has a patient assistance program for people having problems getting the drug. The number to call is (800) 272-4878.
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