Stavudine adverse effects

The adverse effects with which stavudine is most frequently associated are headache, diarrhea, skin rash, nausea, vomiting, insomnia, anorexia, myalgia, and weakness. Peripheral neuropathy consisting of numbness, tingling, or pain in the hands or feet is also common with higher doses of the drug. Significant elevation of hepatic enzymes may be seen in approximately 10 to 15% of patients. Lactic acidosis occurs more frequently with stavudine than with other NRTIs. Viral resistance to stavudine may develop, and cross-resistance to zidovudine and didanosine may occur. 

PHENYTOIN NUCLEOSIDE REVERSE TRANSCRIPASE INHIBITORS - DIDANOSINE, STAVUDINE, ZIDOVUDINE Possibly t adverse effects (e.g. peripheral neuropathy) with didanosine, stavudine and zidovudine Additive effect Monitor closely for peripheral neuropathy during prolonged combination... 

CHLORAMPHENICOL ANTIVIRALS-ST AVUDINE, ZIDOVUDINE Possible t adverse effects when coadministered with stavudine or zidovudine Uncertain Use an alternative antibiotic if possible otherwise monitor closely for peripheral neuropathy and check FBC regularly... 

ISONIAZID ANTIVIRALS-NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS t adverse effects with didanosine and possibly stavudine Additive side-effects Monitor closely for the development of peripheral neuropathy, but no dose adjustment is required... 

DIDANOSINE STAVUDINE t adverse effects, including pancreatitis and neuropathy Additive effect Monitor more closely, especially for pancreatitis and peripheral neuropathy. Relative risk of neuropathy stavudine alone 1.39 compared with didanosine combined use 3.5. Sometimes fatal lactic acidosis is reported in pregnancy... 

STAVUDINE NELFINAVIR Possibly t adverse effects Uncertain Warn patient that diarrhoea may occur... 

Adverse effects Didanosine Lamivudine Stavudine Zalcitabine Zidovudine... 

Stavudine is a nucleoside analogue reverse transcriptase inhibitor. Its most important adverse effects are peripheral neuropathy and increases in hepatic transaminases, both of which usually resolve on withdrawal. 

The most common adverse effect with stavudine is peripheral neuropathy which occurs in -12% of patients. Combining stavudine with zidovudine leads to increased risk and severity of peripheral neuropathy and potentially fatal pancreatitis, and these drugs shorrld not be used together under most circumstances. Lactic acidosis and hepatic steatosis also have been seen and are more common with stavudine than with zidovudine or abacavir. Of aU the nucleoside analogs, stavudine is most strongly linked to the HIV lipodystrophy syndrome, perhaps due to toxic effects on adipocytes. 

Hydroxycarbamide appears to increase the antiviral activity of NRTIs, particularly didanosine. However, the combination of hy-drosycarbamide and didanosine may carry a higher risk of adverse effects including neuropathy and pancreatitis, especially if stavudine is also given. 

A study in 10 HIV-positive subjects found that the addition of clarithromycin 500 mg twice daily to stavudine 30 or 40 mg twice daily had no significant effects on the pharmacokinetics of the stavudine and the incidence of adverse effects did not increase. No special precautions would seem necessary if both drugs are given. 

In vitro, stavudine had no significant effect on the intracellular activation ofzalcitabine. Both stavudine and zalcitabine have the potential to cause peripheral neuropathy and pancreatitis. Combined use of drugs causing these serious adverse effects should be closely monitored (see also NRTIs + Drugs that cause pancreatitis , p.797). US guidelines say that the combination of stavudine and zalcitabine should not be recommended at any time because of additive peripheral neuropathy. ... 

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