Recommendations for the Use of Antiretroviral Drugs in Pregnant Women with HIV Infection and Interventions to Reduce Perinatal HIV Transmission in the United States

The information in the brief version is excerpted directly from the full-text guidelines. The brief version is a compilation of the tables and boxed recommendations.

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Nucleoside and Nucleotide Analogue Reverse Transcriptase Inhibitors

Stavudine (Zerit, d4T)

Last Updated: December 7, 2018; Last Reviewed: December 7, 2018

Excerpt from Table 10a
Generic Name
(Abbreviation)
Trade Name
Formulation Dosing Recommendations Use in Pregnancy
Stavudine
(d4T)
Zerit

Note: Generic products are available for all formulations.
d4T (Zerit)
Capsules:
  • 15 mg
  • 20 mg
  • 30 mg
  • 40 mg
Oral Solution:
  • 1 mg/mL following reconstitution
Note: Extended-release capsule formulation (Zerit XR) has been discontinued by the manufacturer.
Standard Adult Dosese
Body Weight ≥60 kg:
  • 40 mg twice daily without regard to meals
Body Weight <60 kg:
  • 30 mg twice daily without regard to meals

Dosing in Pregnancy:
  • No change in dose indicated.
PK in Pregnancy:
  • PK not significantly altered in pregnancy.
d4T is not recommended for pregnant women

High placental transfer.b

No evidence of human teratogenicity (can rule out 2-fold increase in overall birth defects).

Lactic acidosis, sometimes fatal, has been reported in pregnant women receiving ddI and d4T together.
a Individual ARV drug dosages may need to be adjusted in renal or hepatic insufficiency (for details, see the Adult and Adolescent Guidelines Appendix B, Table 8).
b Placental transfer categories—Mean or median cord blood/maternal delivery plasma drug ratio:
          High: >0.6
          Moderate: 0.3–0.6
          Low: <0.3
WHO recommends maximum dose of 30 mg regardless of weight.

Key to Acronyms: ARV = antiretroviral; d4T = stavudine; ddI = didanosine; PK = pharmacokinetic; WHO = World Health Organization

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