Zidovudine and stavudine, while effective against HIV, carry significant side effects. Monitor patients closely for hematologic toxicity, including anemia, neutropenia, and thrombocytopenia. Regular blood tests are crucial for early detection.
Hematologic Effects
Zidovudine’s major side effect is bone marrow suppression. This can manifest as decreased red blood cell production (anemia), leading to fatigue and shortness of breath; decreased white blood cell production (neutropenia), increasing infection risk; and decreased platelet production (thrombocytopenia), increasing bleeding risk. Stavudine also causes similar effects, though potentially less severe. Dose adjustments or discontinuation may be necessary.
Other Side Effects and Drug Interactions
Both drugs can cause gastrointestinal issues like nausea, vomiting, and diarrhea. Zidovudine can also affect the liver, potentially causing elevated liver enzymes. Stavudine carries a higher risk of peripheral neuropathy, causing numbness and tingling in the extremities. Careful monitoring for these side effects is essential.
Several drug interactions exist. For example, concurrent use with didanosine increases the risk of pancreatitis. Rifampin can accelerate zidovudine metabolism, reducing its effectiveness. Co-administration with drugs that affect bone marrow function, such as chemotherapy agents, further increases the risk of hematologic toxicity.
Summary of Important Interactions
| Didanosine | Increased risk of pancreatitis with Zidovudine and Stavudine | Careful monitoring and dose adjustment may be needed |
| Rifampin | Accelerated Zidovudine metabolism | Reduced Zidovudine effectiveness; dosage adjustment may be necessary |
| Bone marrow suppressive drugs (e. g., chemotherapy) | Additive hematologic toxicity | Increased risk of anemia, neutropenia, and thrombocytopenia; close monitoring required |
Monitoring and Management
Regular monitoring of complete blood counts (CBCs), liver function tests (LFTs), and neurological examinations are critical for detecting adverse effects early. Dose adjustments or treatment discontinuation may be necessary based on individual patient response and lab results. Patients should be educated about potential side effects and encouraged to report any new or worsening symptoms promptly. Careful consideration of potential drug interactions with concomitant medications is also paramount.
