Home Drug Guide Zalcitabine

Drug Guide

Generic Name

Zalcitabine

Brand Names Hivid

Classification

Therapeutic: Antiviral

Pharmacological: Nucleoside Reverse Transcriptase Inhibitor (NRTI)

FDA Approved Indications

  • Treatment of HIV-1 infection in combination with other antiretroviral agents

Mechanism of Action

Zalcitabine is a nucleoside analog reverse transcriptase inhibitor that incorporates into viral DNA during replication, leading to chain termination and inhibition of HIV replication.

Dosage and Administration

Adult: Typically 0.75 mg orally every 8 hours, in combination with other antiretrovirals; dosage adjustments may be necessary based on renal function.

Pediatric: Dosing varies; consult specific pediatric guidelines.

Geriatric: Use with caution due to potential renal impairment.

Renal Impairment: Adjust dose based on degree of renal dysfunction, as the drug is primarily renally excreted.

Hepatic Impairment: No specific adjustment; use with caution.

Pharmacokinetics

Absorption: Well absorbed orally.

Distribution: Distributed widely; crosses blood-brain barrier.

Metabolism: Minimal hepatic metabolism.

Excretion: Primarily renal excretion of unchanged drug.

Half Life: Approximately 8 hours.

Contraindications

  • Hypersensitivity to zalcitabine or any component of the formulation.

Precautions

  • Use with caution in renal impairment, as accumulation may occur.
  • Monitor for signs of peripheral neuropathy, pancreatitis, and lipoatrophy.
  • Not recommended during pregnancy unless potential benefit outweighs risk; use effective contraception.

Adverse Reactions - Common

  • Peripheral neuropathy (Common)
  • Headache (Common)
  • Lipoatrophy (Less common)

Adverse Reactions - Serious

  • Pancreatitis (Serious (rare))
  • Peripheral neuropathy leading to disability (Serious (rare))
  • Myelosuppression, including anemia and granulocytopenia (Serious (rare))

Drug-Drug Interactions

  • Other nephrotoxic or neurotoxic drugs
  • Didanosine (increased risk of peripheral neuropathy)

Drug-Food Interactions

  • None specifically known

Drug-Herb Interactions

  • Limited data; avoid combining with St. John's Wort due to potential pharmacokinetic interactions

Nursing Implications

Assessment: Monitor renal function (BUN, creatinine), neurologic status, signs of pancreatitis.

Diagnoses:

  • Risk of peripheral neuropathy
  • Risk of pancreatitis
  • Impaired comfort related to adverse effects

Implementation: Administer as prescribed; monitor labs and clinical status; counsel on adherence.

Evaluation: Evaluate for adverse effects; monitor virologic response.

Patient/Family Teaching

  • Take medication exactly as prescribed.
  • Report symptoms of neuropathy, pancreatitis, unexplained weakness, or neurological changes.
  • Maintain regular follow-up appointments.
  • Avoid alcohol and toxic substances.

Special Considerations

Black Box Warnings:

  • Lactic acidosis and severe hepatomegaly with steatosis—rare but serious risk associated with NRTIs including zalcitabine.

Genetic Factors: Limited data.

Lab Test Interference: May cause elevated amylase or lipase if pancreatitis develops.

Overdose Management

Signs/Symptoms: Severe peripheral neuropathy, pancreatitis, lactic acidosis, la hepatitis.

Treatment: Provide supportive care; hemodialysis may be considered to enhance drug elimination in overdose.

Storage and Handling

Storage: Store at room temperature 20-25°C (68-77°F).

Stability: Stable under recommended conditions; protect from excessive heat and moisture.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.