Stavudine

(stav' yoo deen)

Brand Name(s): Zerit^®; also available generically

Other Name(s): d4T

IMPORTANT WARNING:

Stavudine may cause serious or life-threatening lactic acidosis (build-up of acid in the blood) that will probably need to be treated in the hospital. The risk that you will develop lactic acidosis is higher if you are a woman, if you are overweight, and if you have been treated with medications for human immunodeficiency virus (HIV) for a long time. The risk may also be higher if you are pregnant and you are taking stavudine along with didanosine (Videx). Tell your doctor if you have or have ever had liver disease, including hepatitis C virus infection. If you experience any of the following symptoms, call your doctor immediately: nausea; vomiting; loss of appetite; excessive tiredness; weakness; dizziness; lightheadedness; fast or irregular heartbeat; trouble breathing; dark yellow or brown urine; unusual bleeding or bruising; flu-like symptoms; light-colored bowel movements; yellowing of the skin or eyes; pain in the upper right part of your stomach; feeling cold, especially in the arms or legs; or muscle pain that is different than any muscle pain you usually experience.

Stavudine may cause serious or life-threatening pancreatitis (swelling of the pancreas). Tell your doctor if you drink or have ever drunk large amounts of alcoholic beverages and if you have or have ever had pancreatitis. Do not drink alcohol while you are taking stavudine. Also tell your doctor if you are taking didanosine (Videx). If you experience any of the following symptoms, call your doctor immediately: stomach pain or swelling, nausea, vomiting, or fever.

Keep all appointments with your doctor and the laboratory. Your doctor will order certain tests to check your body's response to stavudine.

Talk to your doctor about the risks of taking stavudine.

WHY is this medicine prescribed?

Stavudine is used along with other medications to treat human immunodeficiency virus (HIV) infection. Stavudine is in a class of medications called nucleoside reverse transcriptase inhibitors (NRTIs). It works by decreasing the amount of HIV in the blood. Although stavudine does not cure HIV, it may decrease your chance of developing acquired immunodeficiency syndrome (AIDS) and HIV-related illnesses such as serious infections or cancer. Taking these medications along with practicing safer sex and making other life-style changes may decrease the risk of transmitting (spreading) the HIV virus to other people.

Are there OTHER USES for this medicine?

Stavudine is also sometimes used in combination with other medications to prevent HIV infection in healthcare workers or other people who were accidentally exposed to HIV. Talk to your doctor about the possible risks of using this medication for your condition.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

HOW should this medicine be used?

Stavudine comes as a capsule and as an oral solution (liquid) to take by mouth. It is usually taken twice a day (every 12 hours), with or without food and with plenty of water. To help you remember to take stavudine, take it at around the same times each day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take stavudine exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

If you are giving the oral solution to a child, shake the bottle well before each use to mix the medication evenly. Use the measuring cup provided to measure the child's dose.

Stavudine controls HIV infection but does not cure it. Continue to take stavudine even if you feel well. Do not stop taking stavudine without talking to your doctor. When your supply of stavudine starts to run low, get more from your doctor or pharmacist. If you miss doses or suddenly stop taking stavudine, your condition may become more difficult to treat.

What SPECIAL PRECAUTIONS should I follow?

Before taking stavudine,

• tell your doctor and pharmacist if you are allergic to stavudine, any other medications, or any of the ingredients in stavudine capsules or oral solution. Ask your pharmacist for a list of the ingredients or check the medication guide.

• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements and herbal products you are taking. Be sure to mention those listed in the IMPORTANT WARNING section and doxorubicin, hydroxyurea (Droxia, Siklos), ribavirin (Rebetol, Ribasphere), or zidovudine (Retrovir, in Combivir, inTrizivir). Your doctor may need to change the doses of your medications or monitor you more carefully for side effects.

• tell your doctor if you are receiving dialysis treatments or if you have or have ever had kidney disease, diabetes, or peripheral neuropathy (a type of nerve damage that causes tingling, numbness, and pain in the hands and feet).

• tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while taking stavudine, call your doctor. You should not breastfeed if you are infected with HIV or if you are taking stavudine.

• you should know that stavudine may cause side effects that must be treated right away before they become serious. Children who are taking stavudine may not be able to tell you about the side effects they are feeling. If you are giving stavudine to a child, ask the child's doctor how you can tell if the child is having these serious side effects.

• you should know that you may have a loss of body fat from your face, legs, and arms. Talk to your doctor if you notice this change.

• you should know that while you are taking medications to treat HIV infection, your immune system may get stronger and begin to fight other infections that were already in your body. This may cause you to develop symptoms of those infections. If you have new or worsening symptoms after starting treatment with stavudine, be sure to tell your doctor.

• if you have diabetes, you should know that there are 50 mg of sucrose in each teaspoon (5 mL) of stavudine oral solution.

What SPECIAL DIETARY instructions should I follow?

Unless your doctor tells you otherwise, continue your normal diet.

What should I do IF I FORGET to take a dose?

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

What SIDE EFFECTS can this medicine cause?

Stavudine may cause side effects. Tell your doctor if either of these symptoms is severe or does not go away:

• headache
• diarrhea
• rash

Some side effects can be serious. If you experience the following symptoms or any of those listed in the IMPORTANT WARNING section, call your doctor immediately:

• numbness, tingling, burning or pain in the hands or feet
• difficulty moving your hands and feet

Stavudine may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

What should I know about STORAGE and DISPOSAL of this medication?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store the capsules at room temperature and away from excess heat and moisture (not in the bathroom). Store the oral solution in the refrigerator and dispose of the unused portion after 30 days.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

What should I do in case of OVERDOSE?

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Symptoms of overdose may include the following:

• numbness, tingling, weakness, or pain in the hands or feet
• vomiting
• unusual or unexpected stomach pain
• weakness or tiredness
• shortness of breath

What OTHER INFORMATION should I know?

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

Keep a supply of stavudine on hand. Do not wait until you run out of medication to refill your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.

The American Society of Health-System Pharmacists, Inc. represents that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. makes no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. does not endorse or recommend the use of any drug. The information is not a substitute for medical care.

AHFS^® Patient Medication Information™. © Copyright, 2024. The American Society of Health-System Pharmacists^®, 4500 East-West Highway, Suite 900, Bethesda, Maryland. All Rights Reserved. Duplication for commercial use must be authorized by ASHP.

Selected Revisions: May 15, 2018.