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Therapeutic Classification: antiretrovirals
Pharmacologic Classification: nucleoside reverse transcriptase inhibitors
REMS
Absorption: Well absorbed following oral administration.
Distribution: Widely distributed; enters the CNS.
Half-Life: 1 hr.
Contraindicated in:
Use Cautiously in:
Derm: nail pigmentation
Endo: gynecomastia
F and E: LACTIC ACIDOSIS
GI: abdominal pain, diarrhea, nausea, anorexia, dyspepsia, HEPATOMEGALY (WITH STEATOSIS), oral mucosa pigmentation, PANCREATITIS, vomiting
Hemat: anemia, neutropenia, pure red-cell aplasia, thrombocytosis
Neuro: headache, weakness, ↓mental acuity, anxiety, confusion, depression, dizziness, insomnia, restlessness, SEIZURES, syncope, tremor
Misc: immune reconstitution syndrome
Drug-drug:
HIV
Prevention of Maternal/Fetal Transmission of HIV Infection
Lab Test Considerations:
Monitor CBC every 2 wk during the first 8 wk of therapy, then every 4 wk after the 1st 2 mo if well tolerated, or monthly during the 1st 3 mo and every 3 mo thereafter unless indicated in patients who are asymptomatic or have early symptoms. Commonly causes granulocytopenia and anemia. Anemia may occur 2–4 wk after initiation of therapy and may respond to epoetin therapy. Granulocytopenia usually occurs after 6–8 wk of therapy. If hemoglobin <7.5 g/dL or ↓ of >25% from baseline and/or granulocyte count <750 cells/mm3 or ↓ of >50% from baseline occurs, consider ↓ dose, discontinuing zidovudine, or transfusing blood. May gradually resume when bone marrow recovered.
May ↑ AST, ALT, and alkaline phosphatase. If lactic acidosis or severe hepatotoxicity occurs, hold zidovudine; may be fatal, especially in women.
IV Administration:
Instruct patient to notify health care provider promptly if signs of lactic acidosis (feel very weak or tired; feel cold, especially in arms and legs; unusual muscle pain; feel dizzy or light-headed; trouble breathing; fast or irregular heartbeat; stomach pain with nausea and vomiting) or liver problems (yellowing of skin or white part of eyes; loss of appetite; nausea; dark or tea-colored urine; pain, aching, or tenderness on right side of abdomen; light-colored stools) occur.
Instruct patient to notify health care provider promptly if fever, sore throat, signs of infection, muscle weakness, or shortness of breath occurs. Caution patient to avoid crowds and persons with known infections. Instruct patient to use soft toothbrush, to use caution when using toothpicks or dental floss, and to have dental work done prior to therapy or deferred until blood counts return to normal.