Zalcitabine

Zalcitabine Uses, Dosage, Side Effects, Food Interaction and all others data.

A dideoxynucleoside compound in which the 3'-hydroxyl group on the sugar moiety has been replaced by a hydrogen. This modification prevents the formation of 5' to 3' phosphodiester linkages, which are needed for the elongation of DNA chains, thus resulting in the termination of viral DNA growth. The compound is a potent inhibitor of HIV replication at low concentrations, acting as a chain-terminator of viral DNA by binding to reverse transcriptase. Its principal toxic side effect is axonal degeneration resulting in peripheral neuropathy.

Zalcitabine is an analog of 2'-deoxycytidine that is pharmacologically related to but structurally different from other nucleotide reverse transcriptase inhibitors (NRTIs). Zalcitabine inhibits the activity of HIV-1 reverse transcriptase (RT) both by competing with the natural substrate dGTP and by its incorporation into viral DNA.

Trade Name Zalcitabine
Availability Discontinued
Generic Zalcitabine
Zalcitabine Other Names 2',3'-Dideoxycytidine, DDCYD, Dideoxycytidine, Zalcitabine
Related Drugs Biktarvy, Truvada, tenofovir, ritonavir, Complera, Atripla, Stribild
Type
Formula C9H13N3O3
Weight Average: 211.2178
Monoisotopic: 211.095691297
Protein binding

Less than 4%

Groups Approved, Investigational
Therapeutic Class
Manufacturer
Available Country
Last Updated: September 19, 2023 at 7:00 am
Zalcitabine
Zalcitabine

Uses

Zalcitabine is a dideoxynucleoside used to treat HIV.

For the treatment of Human immunovirus (HIV) infections in conjunction with other antivirals.

How Zalcitabine works

Zalcitabine is a nucleoside reverse transcriptase inhibitor (NRTI) with activity against Human Immunodeficiency Virus Type 1 (HIV-1). Within cells, zalcitabine is converted to its active metabolite, dideoxycytidine 5'-triphosphate (ddCTP), by the sequential action of cellular enzymes. ddCTP interferes with viral RNA-directed DNA polymerase (reverse transcriptase) by competing for utilization of the natural substrate deoxycytidine 5'-triphosphate (dCTP), as well as incorpating into viral DNA. Due to it's lack of a 3'-OH group, the formation of a 5' to 3' phosphodiester linkage that is necessary for DNA chain elongation is inhibited, thus leading to the termination of viral DNA growth.

Toxicity

Acute overdose: Inadvertent pediatric overdoses have occurred with doses up to 1.5 mg/kg zalcitabine. Chronic overdose: in an initial dose-finding study in which zalcitabine was administered at doses 25 times (0.25 mg/kg every 8 hours) the currently recommended dose, one patient discontinued zalcitabine after 1½ weeks of treatment subsequent to the development of a rash and fever.

Food Interaction

  • Avoid multivalent ions. Magnesium and aluminum containing products can reduce the absorption of this medication.
  • Take on an empty stomach. Take at least 1 hour before or 2 hours after meals.

[Minor] Zalcitabine bioavailability may be decreased by 14% if taken with meals.

The mechanism and clinical significance are unknown.

Zalcitabine Cholesterol interaction

[Major] The reverse transcriptase inhibitors, didanosine (ddI), zalcitabine (ddC), stavudine (d4T) and lamivudine (3TC), may cause pancreatitis.

The incidence is generally low but is approximately 7% with ddI, and up to 15% in pediatric patients given 3TC.

Patients with a history of or known risk factors for pancreatitis, such as alcohol abuse or hypertriglyceridemia, should be monitored closely during therapy with these agents.

Therapy should be discontinued at the first signs or symptoms suggestive of pancreatitis (e.g., nausea, vomiting, abdominal pain, hyperamylasemia with dysglycemia, rising triglycerides, decreasing serum calcium), and preferably permanently discontinued if clinical pancreatitis develops.

Volume of Distribution

  • 0.304 to 0.734 L/kg

Elimination Route

Bioavailability is over 80% following oral administration.

Half Life

2 hours

Clearance

  • 285 mL/min [HIV-infected patients receiving 1.5 mg IV infusion for 1 hour]

Elimination Route

Renal excretion of unchanged drug appears to be the primary route of elimination, accounting for approximately 80% of an intravenous dose and 60% of an orally administered dose within 24 hours after dosing (n=19). Renal clearance exceeds glomerular filtration rate suggesting renal tubular secretion contributes to the elimination of zalcitabine by the kidneys.

Innovators Monograph

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*** Taking medicines without doctor's advice can cause long-term problems.
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