Zidovudine is an HIV Nucleoside Analog Reverse Transcriptase Inhibitor (NRTI) drug, used as part of a treatment and prophylaxis regimen for HIV infection. Zidovudine works by preventing the completion of viral nucleic acid chains during reverse transcription.
Dosing & Administration
Zidovudine 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. Zidovudine is also used for postpartum prophylaxis to reduce perinatal vertical transmission. Dosages and drug regimens are detailed in the product monograph. Zidovudine can be taken with or without meals.
Zidovudine does not require dose reduction in patients with mild liver dysfunction, but requires dose adjustment for renal impairment for patients with a creatinine clearance below 15 mL/min in adults and 10 mL/min in children, or who require dialysis. Dose adjustments and considerations are outlined in the product monograph.
Zidovudine is contraindicated in patients known to be hypersensitive to the drug, patients with low neutrophil or hemoglobin levels, and some neonates with hyperbilirubinemia of elevated transaminase levels. Details are given in the product monograph.
The most serious potential side effects of zidovudine include anemia, leukopenia, and neutropenia. Details of these and other adverse effects are provided in the product monograph.
Zidovudine has a boxed warning for its potential to cause hematologic toxicity. This appears to be related to dose, treatment duration, and pre-treatment bone marrow reserve. Neonates, patients with advanced HIV disease, and patients undergoing cytotoxic chemotherapy or radiation therapy are especially at risk. Risk assessment and haematological monitoring recommendations are detailed in the product monograph.
Zidovudine 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 are detailed in the product monograph.
All patients who test positive for HIV infection should be screened for comorbid Hepatitis B virus (HBV) and Hepatitis C virus (HCV) infection. Co-infected patients should be started on an antiretroviral regimen targeting co-infected viruses, regardless of CD4 counts or viral loads. Current HIV treatment guidelines outline drug regimens and prescribing considerations.
Zidovudine is associated with a large number of drug-drug interactions. Prescribers should familiarize themselves with the complete list of drug interactions provided in the product monograph.
Pregnancy & Lactation
Highly active retroviral combination treatment should be used in all pregnant women, regardless of viral load and CD4 count. Zidovudine has a special indication for preventing vertical transmission during pregnancy, labor and delivery, and in the neonatal period. Zidovudine is excreted in breast milk. The CDC recommends that all HIV positive women, treated or untreated, avoid breastfeeding to prevent vertical transmission of the virus.
Zidovudine overdose should be treated with standard supportive treatment and monitoring. Zidovudine has limited response to hemodialysis.
Alternative Brand Names
Zidovudine is also known by the trade name Retrovir and is a component of Combivir and Trizivir.
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