MEDICATION FACT SHEET/FEUILLET DE RENSEIGNEMENTS

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Other NAMES: Zerit®, Zerit XR®

WHY is this drug prescribed?

Stavudine is an antiretroviral (anti-HIV) drug that is part of the nucleoside reverse transcriptase inhibitor (NRTIs or Nukes) family. It is used together with other antiretrovirals to delay the progression of HIV infection. By doing this, your immune system should improve (increase in CD4⁺ count) and you will be better protected against infections.

Stavudine does not cure AIDS or completely kill the HIV virus, but helps to prevent further damage by slowing down the production of new viruses.  Treatment with stavudine does not reduce the risk of passing infection on to others.  You will still be able to pass HIV by sexual contact, by blood transfer or by sharing needles.  You should always use appropriate precautions to prevent passing HIV on to others. 

HOW should this drug be taken?

Generally, the dose is 40 mg twice daily.  However, the dose may need to be decreased if you have kidney problems or if you weigh less than 60 kg.

If you have been prescribed the stavudine extended-release capsule (Zerit XR®), the usual dose is 100 mg once daily. This dose may also need to be decreased.

Your dosage is:

 15 mg capsule

 20 mg capsule

30 mg capsule

40 mg capsule

 37.5 mg Zerit XR®

 50 mg  Zerit XR®

 75 mg Zerit XR®

 100 mg Zerit XR®

____ capsule (____mg) ____ times a day

What should you do if you FORGET a dose?

If you miss a dose of stavudine, take it as soon as possible.  However, if it is time for your next dose, do not double the dose, just carry on with your regular schedule.

Why should you not forget to take this drug? 

If you miss doses of stavudine, the amount of HIV virus in your blood (known as the viral load) will start increasing again and your immune system will be further damaged.  A few missed doses can be enough for stavudine to stop being active.  A phenomenon known as resistance.  When this happens, other antiretrovirals that work in a similar way to stavudine may also become inactive.  Therefore, missing doses of stavudine can decrease treatment options for the future.  Even if you do not feel well, you should always take your doses of stavudine. Please do not stop stavudine without talking to your doctor first.

What ADVERSE EFFECTS can this drug cause?  What should you do about them?

Stavudine may cause tingling, burning or numbness in the hands and feet (peripheral neuropathy).  These symptoms can disappear if recognized quickly and if the dose of the drug is decreased or if the drug is stopped.  If you develop any of these symptoms, please inform your doctor or pharmacist. Rarely, stavudine can cause inflammation of the pancreas (pancreatitis).  Symptoms include severe abdominal pain with or without nausea and vomiting.  Consult a doctor immediately if this occurs.

Other adverse events include nausea, vomiting, abdominal pain, diarrhea and difficulties sleeping. 

Very rarely, stavudine can cause leucopenia (a decrease in the number of white blood cells so that you have a higher risk of bacterial infection) and an abnormal liver function. These adverse effects usually occur after you have been on the drug for a long period of time.  Blood tests will be done regularly to check for any changes in your white blood cell count and in your liver and pancreas function. Inform your doctor if you notice any symptoms of fever, chills, shortness of breath, fatigue, abdominal pain and muscle pain.

It is important that you keep your doctor appointments and come for your laboratory tests so that your progress can be followed.

What other PRECAUTIONS should you follow while using this drug?

You must make sure that you are taking the right dose. If you take higher doses of stavudine than what is prescribed, you may increase the chance of having adverse effects. If you take lower doses of stavudine than what is prescribed, the HIV virus may become resistant to stavudine.

It is recommended that you do not drink alcohol while taking stavudine, as alcohol may worsen the adverse events.

Certain drugs can increase or decrease the effect of stavudine. Also, stavudine might influence the effect of other drugs you are taking. Inform your doctor and pharmacist of all prescribed and non-prescribed drugs you are taking.  As well, you should inform them of natural products you are taking. If you wish to start a new drug or natural product, please consult with your pharmacist before doing so.

For example, stavudine should never be taken with zidovudine (Retrovir®) as the efficacy of each drug may be decreased.  Also, taking other drugs that cause tingling, burning and numbness in the hands and feet (peripheral neuropathy) may increase the risk of developing this adverse effect.

Please inform your doctor if you are pregnant.  Your doctor can recommend the appropriate treatment to help to reduce the risk of passing the HIV virus on to your baby.  Breastfeeding is NOT recommended if you have HIV as you might transmit the virus to your baby through your breast milk.

How should this drug be STORED?

Stavudine capsules should be stored in a cool (15-30°C) dry place, protected from light and well out of the reach of children. Ensure that the drug has not expired by checking the expiry date (“EXP”) shown on the outside of the package.

Do not store in your bathroom or kitchen, as heat and moisture may cause the drug to be less active. 

If you have any questions or concerns about this drug or if you are experiencing adverse effects, please discuss them with your pharmacist, doctor or nurse.Write questions or concerns down to ensure they are addressed.

The following pharmacist is available to answer questions:

Pharmacist:  __________________

Telephone:   __________________

Reference:  Product Monograph. Zerit® (stavudine).  Montréal, Qc, Canada: Bristol-Myers Squibb, 1999. 

Prepared by the Ontario HIV Pharmacy Professional Specialty Group, 2003.

Additional medication fact sheets and updates may be found at: www.tthhivclinic.com