Formulary
Zidovudine: Indications, Dosing, Side Effects and Interactions
Zidovudine clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 5 min read
Zidovudine: Indications, Dosing, Side Effects and Interactions
Zidovudine clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**HIV infection in combination with other antiretroviral drugs**
- **Adult** (By Mouth): 250-300 mg twice daily.
**Prevention of maternal-fetal HIV transmission**
- **Adult** (By Mouth, Or By Intravenous Infusion): Seek specialist advice (combination therapy preferred) (consult local protocol).
**HIV infection in combination with other antiretroviral drugs in patients temporarily unable to take zidovudine by mouth**
- **Adult** (By Intravenous Infusion): 0.8-1 mg/kg every 4 hours usually for not more than 2 weeks, dose approximating to 1.2-1.5 mg/kg every 4 hours by mouth.
**HIV infection in combination with other antiretroviral drugs for zidovudine**
- **Child** (By mouth): 180 mg/m2 twice daily (max. per dose 300 mg).
- **Child (body-weight 8-13 kg)** (By mouth): 100 mg twice daily.
- **Child (body-weight 14-20 kg)** (By mouth): 100 mg, to be taken in the morning and 200 mg, to be taken in the evening.
- **Child (body-weight 21-27 kg)** (By mouth): 200 mg twice daily.
- **Child (body-weight 28-29 kg)** (By mouth): 200-250 mg twice daily.
- **Child (body-weight 30 kg and above)** (By mouth): 250-300 mg twice daily.
**HIV infection in combination with other antiretroviral drugs (dose expressed in mg/kg) for zidovudine**
- **Child (body-weight 4-8 kg)** (By mouth): 12 mg/kg twice daily.
- **Child (body-weight 9-29 kg)** (By mouth): 9 mg/kg twice daily.
**Prevention of maternal-fetal HIV transmission for zidovudine**
- **Child** (By mouth, or by intravenous infusion): Seek specialist advice (combination therapy preferred) (consult local protocol).
**HIV infection in combination with other antiretroviral drugs in patients temporarily unable to take zidovudine by mouth for zidovudine**
- **Child 3 months-11 years** (By intravenous infusion): 60-80 mg/m2 every 6 hours usually for not more than 2 weeks, dose approximating to 9-12 mg/kg twice daily by mouth.
- **Child 12-17 years** (By intravenous infusion): 0.8-1 mg/kg every 4 hours usually for not more than 2 weeks, dose approximating to 1.2-1.5 mg/kg every 4 hours by mouth.
Cautions
Elderly; lactic acidosis; risk of haematological toxicity particularly with high dose and advanced disease; vitamin B 12 deficiency (increased risk of neutropenia) Cautions, further information Lactic acidosis Lactic acidosis associated with hepatomegaly and hepatic steatosis has been reported with zidovudine. Use with caution in patients with hepatomegaly, hepatitis, or other risk factors for liver disease and hepatic steatosis (including obesity and alcohol abuse). Manufacturer advises discontinue treatment if symptoms of hyperlactataemia, lactic acidosis, progressive hepatomegaly or rapid deterioration of liver function become apparent.
Contraindications
Abnormally low haemoglobin concentration (consult product literature); abnormally low neutrophil counts (consult product literature)
Side effects
For all nucleoside reverse transcriptase inhibitors Common or very common Abdominal pain; anaemia (may require transfusion); asthenia; diarrhoea; dizziness; fever; flatulence; headache; insomnia; nausea; neutropenia; skin reactions; vomiting Uncommon Angioedema; pancreatitis Rare or very rare Lactic acidosis Frequency not known Immune reconstitution inflammatory syndrome; osteonecrosis; weight increased Side-effects, further information Osteonecrosis has been reported in patients with advanced HIV disease or following long-term exposure to combination antiretroviral therapy. Side-effects For zidovudine Common or very common Leucopenia; malaise; myalgia Uncommon Bone marrow disorders; dyspnoea; generalised pain; myopathy; thrombocytopenia Rare or very rare Alertness decreased; anxiety; appetite decreased; cardiomyopathy; chest pain; chills; cough; depression; drowsiness; dyspepsia; gynaecomastia; hepatic disorders; hyperhidrosis; influenza like illness; nail discolouration; oral discolouration; paraesthesia; pure red cell aplasia; seizure; taste altered; urinary frequency increased Frequency not known Lipoatrophy Side-effects, further information Anaemia and myelosuppression If anaemia or myelosuppression occur, reduce dose or interrupt treatment according to product literature, or consider other treatment. Lipodystrophy syndrome Metabolic effects may occur with zidovudine; plasma lipids and blood glucose concentrations should be measured routinely.
Interactions
**Severe interactions:**
- A modest increase in C max (28%) was observed for zidovudine when administered with lamivudine, however overall exposure (AUC) was not significantly altered.
- Limited data from clinical trials do not indicate a significantly increased risk of adverse reactions to zidovudine with cotrimoxazole, aerosolised pentamidine, pyrimethamine and aciclovir at doses...
**Other interactions (21):**
- Limited data suggests that co-administration of zidovudine with rifampicin decreases the AUC (area under the plasma concentration curve) of zidovudine by 48% 34%.
- This may result in a partial loss or total loss of efficacy of zidovudine.
- The concomitant use of rifampicin with zidovudine should be avoided (see section 4.4).
- Zidovudine in combination with stavudine is antagonistic in vitro .
- The concomitant use of stavudine with zidovudine should be avoided (see section 4.4).
- Probenecid increases the AUC of zidovudine by 106% (range 100 to 170%).
Pregnancy
For all nucleoside reverse transcriptase inhibitors Monitoring in pregnancy Mitochondrial dysfunction has been reported in infants exposed to nucleoside reverse transcriptase inhibitors in utero; the main effects include haematological, metabolic, and neurological disorders; all infants whose mothers received nucleoside reverse transcriptase inhibitors during pregnancy should be monitored for relevant signs or symptoms.
Hepatic impairment
For all nucleoside reverse transcriptase inhibitors In general, manufacturers advise caution in patients with chronic hepatitis B or C (increased risk of hepatic side-effects). Hepatic impairment For zidovudine Manufacturer advises caution in moderate to severe impairment (increased risk of accumulation). Dose adjustments Manufacturer advises consider dose reduction in moderate to severe impairment-consult product literature.
Renal impairment
Dose adjustments See Prescribing in renal impairment . Reduce oral dose to 100 mg 3-4 times daily (300-400 mg daily) or intravenous dose to 1 mg/kg 3-4 times daily if creatinine clearance is less than 10 mL/minute. M
Medicinal forms
Capsule,Solution,Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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