ZIDOVUDINE (AZT)

Indications & Dose:

Treatment of HIV infection when antiretroviral therapy is indicated (should not be used as monotherapy); prevention of maternal-fetal HIV transmission 

• BY MOUTH

Adult

• PO 500-600 mg/d in divided doses in combination with other antiretroviral agents; IV 1 mg/kg/close infused over 1 hr q4h while awake (5 mg/kg/day)

Children

under 3 month not recommended (except for maternal foetal transmission.

• Maternal fetal HIV transmission: Maternal dose (> 14 wk of pregnancy) PO 100 mg 5 times/day until start of labor; during labor and delivery, IV zidovudine should be administered at 2 mg/kg (total body weight) over 1 hr followed by continuous IV INF of 1 mg/kg/hr (total body weight) until clamping of the umbilical cord; infant dose PO 2 mg/kg q6h starting within 12 hr after birth and continuing through 6 wk of age; IV 1.5 mg/kg, infused over 30 min q6h

Child 3 mo-12 yr: • PO 180 mg/m2 taken q6h, max 200 mg q6h; IV INF 0.5-1.8 mg/ kg/hr; IV 100 mg/ m2/dose q6h

Adults: By mouth symptomatic  200mg every 4 hours (total 1.2g daily) for 70kg patients, for advaced disease with poor tolerance dose may be reduced to maintanance of 100mg every 4 hours (total 600mg daily) daily dosage can be given in 4-5 divided doses. Asymptomatic disease initially 500mg daily increased if diseases progressess to 1.5g daily.

Children : Over 3 months initially 180mg/m2 every 6 hours Under 3 months: Not recommended.  By intravenous infusion patients temporarily unable to take oral zidovudine 2.5mg/kg every 4 hours, not be given more than 2 weeks. 

Contraindications:

Side Effects:

Cautions:

Precautions:

Interaction:

Drugs

Food: Taking zidovudine with meals lowers plasma concentrations

Gonciclovir: Increased hematologic toxicity

Interferon: Increased plasma concentrations of zidovudine

Probenecid: Increased plasma concentration of zidovudine

Rifampin: Reduced plasma concentrations of zidovudine 

Warnings:

Adverse Effects:

Lactations:

 Indicated for pregnant women > 14 wk gestation for prevention of maternal-fetus HIV transmission 

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

CNS: Anxiety, chills, confusion, depression, dizziness, emotional lability, fever, headache, insomnia, loss of mental acuity, paresthesia, somnolence, tremor, twitching

EENT: Hearing loss, photophobia, vertigo

GI: Anorexia, cholestatic hepatitis, constipation, cramps, diarrhea, dyspepsia, dysphagia, flatulence, mouth ulcer, nausea, taste change, vomiting

GU: Dysuria, polyuria, urinary frequency or hesitancy

HEME: Anemia, granulocytopenia, leukopenia, thrombocytopenia

MS: Arthralgia, muscle spasm, myalgia

RESP: Dyspnea

SKIN: Acne, diaphoresis, pigmentation of nails (blue), pruritus, rash, urticaria

MISC: Malaise 

Patient And Carer Advice: