Retrovir (zidovudine) is an HIV nucleoside analog reverse transcriptase inhibitor (NRTI) drug. It is used as part of a treatment and prophylaxis regimen for HIV infection together with other antiretroviral drugs, and has a special indication for preventing vertical transmission during pregnancy and parturition. Retrovir is a potent inhibitor of HIV replication, and works by preventing the completion of the viral nucleic acid chains during reverse transcription. Retrovir has been shown to improve clinical parameters associated with HIV infection, including immunological function and neurological dysfunction.
Dosage and administration
Retrovir may be used in all ages, including premature neonates, for treatment of HIV infection, and for HIV post-exposure prophylaxis following occupational or non-occupational exposure, including sexual assault. As well, treatment with zidovudine for post-partum prophylaxis is recommended by guidelines for all HIV-exposed neonates to reduce perinatal vertical transmission. Dosages and drug regimens are detailed in the product monograph. Retrovir is available as an oral tablet, oral suspension, and intravenous solution preparation. It can be taken with or without meals. Retrovir requires dose adjustment for renal impairment for patients with a creatinine clearance below 15 mL/min in adults and 10 mL/min in children. Dose adjustments and considerations for use of Retrovir in dialysis are outlined in the product monograph.
Retrovir is tagged with a boxed warning for its potential to cause hematologic toxicity. This adverse effect appears to be dose-related, treatment duration-related, and influenced by pre-treatment bone marrow reserve. Neonates, patients with advanced HIV disease, and patients undergoing cytotoxic chemotherapy or radiation therapy seem to be especially at risk. Risk assessment and haematological monitoring recommendations are detailed in the product monograph.
Retrovir is mainly eliminated by the liver, so serum concentrations and risk for toxicity may increase in the presence of liver disease. As such, Retrovir should be used with caution in patients with known liver disease or risk factors for liver dysfunction. Toxicity may include hepatotoxicity and lactic acidosis. Females and obese patients seem to be especially at risk. Recommendations for monitoring of serum markers of liver function are detailed in the product monograph.
This medication may cause side effects. These effects include, but are not limited to:
- nausea, vomiting
- loss of appetite
- joint pain
- changes in the distribution of body fat
If patients experiences any of the following, they should contact a medication professional:
- unexplained weight loss
- muscle aches or weakness, joint pain
- numbness or tingling of the hands, feet, arms, and/or legs
- vision changes
- signs of infection (such as fever, chills, trouble breathing, cough, non-healing skin sores)
- signs of an overactive thyroid (such as irritability, nervousness, heat intolerance, fast/pounding/irregular heartbeat, bulging eyes, unusual growth in the neck/thyroid known as a goiter)
- signs of a certain nerve problem known as Guillain-Barre Syndrome (such as difficulty breathing/swallowing/moving your eyes, drooping face, paralysis, slurred speech)
For more adverse effects, consult the product monograph.
In accordance with current guidelines, and patients infected with HIV should be screened for comorbid hepatitis B virus (HBV) and hepatitis C virus (HCV) infection. The presence of co-infection requires special attention and guidelines should be followed closely.
Pregnancy and lactation
Highly active Retroviral combination treatment should be used in all pregnant women, regardless of viral load and CD4 count. Retrovir has a special indication for preventing vertical transmission, with guidelines outlining its use during pregnancy, labor and delivery, and in the neonatal period. Retrovir is known to be excreted in the breast milk. The CDC recommends that all HIV-positive women, treated or untreated, avoid breastfeeding to prevent vertical transmission of the virus.
A detailed list of potential drug interactions is available in the product monograph and should be reviewed by all prescribers.
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