zinc sulfate

Therapeutic Classification: mineral and electrolyte replacements/supplements

Pharmacologic Classification: trace metals

Indications ⬆ ⬇

REMS

Replacement and supplementation therapy in patients who are at risk for zinc deficiency, including patients on long-term parenteral nutrition.

Unlabeled Use:

Management of impaired wound healing due to zinc deficiency.

Action ⬆ ⬇

Serves as a cofactor for many enzymatic reactions.
Required for normal growth and tissue repair, wound healing, and senses of taste and smell.

Therapeutic effects:

Replacement in deficiency states.

Pharmacokinetics ⬆ ⬇

Absorption: Poorly absorbed from the GI tract (20–30%).

Distribution: Widely distributed. Concentrates in muscle, bone, skin, kidney, liver, pancreas, retina, prostate, RBCs, and WBCs.

Metabolism/Excretion: 90% excreted in feces, remainder lost in urine and sweat.

Half-Life: Unknown.

Time/Action Profile ⬆ ⬇

(blood levels)

ROUTE	ONSET	PEAK	DURATION
PO	unknown	2 hr	unknown
IV	unknown	unknown	unknown

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity or allergy to any components in formulation.

Use Cautiously in:

Renal failure;
OB: Use only if potential maternal benefit justifies potential fetal risk;
Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant;
Pedi: May lead to aluminum toxicity in preterm infants with prolonged parenteral use.

Adv. Reactions/Side Effects ⬆ ⬇

GI: gastric irritation (oral use only), nausea, vomiting

Interactions ⬆ ⬇

Drug-drug:

Oral zinc may ↓ absorption of tetracyclines or fluoroquinolones.

Drug-Food:

Caffeine, dairy products, and bran may ↓ absorption of orally administered zinc.

Route/Dosage ⬆ ⬇

RDA = 15 mg. Doses expressed in mg of elemental zinc unless otherwise noted. Zinc sulfate contains 23% zinc

Deficiency

PO (Adults ): Prevention of deficiency: 15–19 mg/day; treatment of deficiency: must be individualized; based on degree of deficiency.

IV Nutritional Supplementation—Metabolically Stable Patients

IV (Adults ): 3 mg/day; up to 12 mg/day in patients with excessive losses.
IV (Children ≥10 kg): 50 mcg/kg/day (up to 3 mg/day).
IV (Children 5–<10 kg): 100 mcg/kg/day.
IV (Neonates 3–<5 kg): 250 mcg/kg/day.
IV (Neonates <3 kg): Preterm neonates: 400 mcg/kg/day.

Availability ⬆ ⬇

(Generic available)

Tablets: 66 mg^OTC; 110 mg^OTC; 220 mg^OTC
Capsules: 220 mg^OTC
Injection: 1 mg/mL; 3 mg/mL; 5 mg/mL

Assessment ⬆ ⬇

Monitor progression of zinc deficiency symptoms (impaired wound healing, growth retardation, decreased sense of taste, decreased sense of smell) during therapy.

Lab Test Considerations:

Serum zinc levels may not accurately reflect zinc deficiency.
- Long-term high-dose zinc therapy may cause ↓ serum copper concentrations.
- Monitor serum alkaline phosphatase concentrations monthly; may ↑ with zinc therapy.
- Monitor HDL concentrations monthly in patients on long-term high-dose zinc therapy. Serum concentrations may be ↓.

Implementation ⬆ ⬇

PO: Administer oral doses with food to decrease gastric irritation. Administration with caffeine, dairy products, or bran may impair absorption.
IV: Zinc is often included as a trace mineral in total parenteral nutrition solution prepared by pharmacist. Avoid use as a direct IV infusion.

Patient/Family Teaching ⬆ ⬇

Encourage patient to comply with diet recommendations of health care professional. Explain that the best source of vitamins is a well-balanced diet with foods from the four basic food groups. Foods high in zinc include seafood, organ meats, and wheat germ.
Patients self-medicating with vitamin supplements should be cautioned not to exceed RDA. The effectiveness of megadoses for treatment of various medical conditions is unproved and may cause side effects.
Instruct patients receiving oral zinc to notify health care professional if severe nausea or vomiting, abdominal pain, or tarry stools occur.
Advise patient to notify health care professional if pregnancy is planned or suspected and to avoid breastfeeding during therapy.
Emphasize the importance of follow-up exams to evaluate progress.

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Pronunciation ⬇

Classifications ⬆ ⬇