Anemia zidovudine

Adverse reactions associated with zidovudine include headache, weakness, malaise, nausea, abdominal pain, and diarrhea. Hematologic changes include anemia and granulocytopenia (low levels of granulocytes, atype of white blood cell, in the blood). 

Zidovudine (AZT, ZDV) Retrovi r 1 00-mg caps, 300-mg tabs, 1 0 mg/mF intravenous solution, 1 0 mg/mF oral solution 300 mg bid 1 00 mg tid in severe renal impairment or HD None Bone marrow suppression macrocytic anemia or neutropenia gastrointestinal intolerance, headache, insomnia, asthenia Glucuronyl transferase and renal... 

AIDS is associated with aberrant lymphocyte production and it has been proposed that Li+ may have a potential role in reversing this. Additionally, 3 -azido-3"deoxythymidine (AZT, zidovudine), an effective inhibitor of viral reverse transcriptase that reduces mortality in AIDS patients, induces hematopoietic suppression in patients resulting in anemia, neutropenia, and overall bone-marrow failure [220]. In murine AIDS, the coadministration of Li+ effectively moderates this toxicity of AZT in vivo [221,222]. There are several case reports where Li+ has been administered to help reduce the hematopoietic suppression in HIV-infected patients taking AZT (for example, see ref. 223). To date, the use of Li+ has been limited to a few weeks of treatment, and varying degrees of success have been achieved nevertheless the outlook in this field is quite hopeful. 

Twice daily, nausea and anemia with zidovudine... 

Treatment of anemia related to zidovudine therapy in HIV-infected patients To elevate or maintain the red blood cell level (as manifested by the hematocrit or hemoglobin determinations) and to decrease the need for transfusions in these patients when the endogenous erythropoietin level is less than or equal to 500 milliunits/mL and the dose of zidovudine is less than or equal to 4200 mg/week. Treatment of anemia in cancer patients on chemotherapy Jreatment of anemia in patients with nonmyeloid malignancies where anemia is due to the effect of concomitantly administered chemotherapy. It is intended to decrease the need for transfusions in patients who will be receiving chemotherapy for a minimum of 2 months. 

Zidovudine has been associated with hematologic toxicity, including neutropenia and severe anemia, particularly in patients with advanced human immunodeficiency (HIV) disease (see Warnings). Prolonged use of zidovudine has been associated with symptomatic myopathy. 

The most frequent adverse events and abnormal laboratory values reported in the placebo-controlled clinical trial of oral zidovudine were granulocytopenia and anemia. 

Zidovudine may result in hematologic toxicity (eg, neutropenia, severe anemia), especially in patients with advanced human immunodeficiency virus (HIV). 

Epoetin Alfa [Erythropoietin/ EPO] (Epogen/ Procrit) [Recombinant Human Erythropoietin] WARNING Use lowest dose possible may be associated w/1 CV, thromboembolic events /or mortality D/C if Hgb >12 g/dL Uses CRF associated anemia zidovudine Rx in HIV-infected pts, CA chemo -1- transfusions associated w/ surgery Action Induces ery-thropoiesis Dose Adul Peds. 50-150 Units/kg IV/SQ 3x/wk adjust dose q4-6wk PRN Surgery 300 Units/kg/d x 10 d before to 4 d after -I dose if Hct 36% or Hgb, T > 12 g/dL or Hgb t >1 g/dL in 2-wk pmod hold dose if Hgb >12 g/dL Caution [C, +] Contra Uncontrolled HTN Disp Inj SE HTN, HA, fatigue, fever, tach, NA Interactions None noted EMS Monitor ECG for hypokalemia (peaked T waves) t risk of CV thrombotic events OD May cause HA, dizziness, SOB and polycythemia symptomatic and supportive... 

Caution [B (D if near term), M] Contra Sulfonamide or salicylate sensitivity, porphyria, GI/GU obst avoid in hepatic impair Disp Tabs SE GI upset discolors urine dizziness, HA, photosens, oligospermia, anemias, Stevens-Johnson synd Interactions T Effects OF oral anticoagulants, oral hypoglycemics, MTX, pheny-toin, zidovudine X effects W/ antibiotics X effects OF digoxin, folic acid, Fe, procaine, proparacaine, sulfonylureas, tetracaine EMS T Effects of anticoagulants monitor EGG and BP for signs of hypovolemia and electrolyte disturbances d/t D skin urine may become yellow-orange may stain contact lenses T risk of photosensitivity Rxns OD May cause NA, drowsiness, HA, abd pain, skin Rxns, lactic acidosis, and jaundice symptomatic and supportive... 

The last potential mechanism to be discussed in this chapter is drug-induced altered receptor expression. Hematopoiesis is a very intricate process that is regulated by cytokines and cell-cell interactions. Interruption with any of these processes can result in hematotoxicity. For example, zidovudine (AZT) decreases Epo [27], GM-CSFaand to lesser extent IL-3 receptor expression [7]. Decrease in the expression of the above receptors seems to lead to anemia and neutropenia, by decreasing the number of CFU-E and CFU-GM, respectively. 

Caution should be exercised when zidovudine is administered to patients with preexisting anemia or neutropenia and to those with advanced cases of AIDS. Dosage adjustment is required for patients with significant renal impairment and may also be necessary in those with hepatic impairment. 

Indications Treatment of anemia associated with chronic renal failure. Treatment of anemia related to therapy with zidovudine. Treatment of anemia in cancer patients on chemotherapy. Treatment of anemic patients scheduled to undergo elec-... 

Erythropoietin has been used successfully to offset the anemia produced by zidovudine treatment in patients with HIV infection and in the treatment of the anemia of prematurity. It can also be used to reduce the need for transfusion in high-risk patients undergoing elective, noncardiac, nonvascular surgery to accelerate erythropoiesis after phlebotomies for autologous transfusion for elective surgery or for treatment of iron overload (hemochromatosis). 

Zidovudine NRTI1 200 mg tid or 300 mg bid3 Macrocytic anemia, neutropenia, nausea, headache, insomnia, asthenia Avoid concurrent stavudine and myelosuppressive drugs (eg, ganciclovir, ribavirin)... 

Erythropoietin has been used successfully to offset the anemia produced by zidovudine treatment in... 

The most common adverse effect of zidovudine is myelosuppression, resulting in anemia or... 

Anemia of chronic renal failure patients, zidovudine-treated HIV-infected patients and cancer patients on chemotherapy reduction of allogeneic blood transfusion in surgery patients... 

A 36-year-old HIV-positive man taking zidovudine, lamivudine, and indinavir was noticed to have a mild asymptomatic anemia (hemoglobin 10.2 g/1, white cell count 10.4 x 109/1 with a normal differential count, and platelets 237 x 109/1). The blood film suggested hemolysis. He had taken ecstasy 2 weeks earlier for the first time. The anemia was reportedly secondary to oxidative stress, probably due to drug toxicity. Three weeks later his hemoglobin returned to normal. 

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