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Zerit - stavudine - d4T

General Information Stavudine is almost always used as one component of a multidrug combination to suppress the human immunodeficiency (HIV) viral load.  This drug works by inhibiting the production of genetic material within the virus.  Specifically it is called a nucleoside reverse transcriptase inhibitor (NRTI) or "nuke" for short.

Stavudine is easy to take and reasonably well tolerated.


The usual dose is 40 mg twice a day.  If you have kidney problems, if you have nerve damage in your legs, or if you weigh less than 132 pounds, your dosage may be reduced.  There is a sustained-release formulation that is due to be released soon.

Stavudine may be taken with or without food.

(this refers to your willingness, ability, and actual performance in taking your medications)
As with any antiviral drug or antibiotic, try not to ever miss a dose.  If you miss a dose and notice that you have done so within a few hours of its scheduled time, you may take the dose as usual and take the next dose at its regular time.

You should not adjust or change the dosing of this medication without the advice of your healthcare provider or someone who is experienced with antiviral medications.

If you miss more than one dose, look at the reasons why you missed them and come up with a plan to avoid it in the future.  For example, if you fell asleep too early, take the medicine earlier in the evening, with your later meal, set an alarm, or have someone appointed to wake you up for your medicine.  

I would strongly recommend using weekly pill boxes and arrange all of your doses a week in advance.  Buy a small pill box so that you can carry a dose or two of your medicines with you in case you are away from home.

Possible Side Effects
The package insert for most drugs including stavudine is often overwhelming and scary with perhaps an overemphasis on side effects.  We have summarized the important and more common problems here.

Most people take stavudine without any side effects. 

Usually you will see a healthcare provider and have blood drawn in the first 2-4 weeks to look for the good effects of stavudine as well as any side effects.

Possible uncommon side effects include nerve damage to the feet, mild nausea (that usually gets better,) headache, muscle aches, liver problems, kidney problems, stomach upset, or problems with blood cells.

This nerve damage is referred to as peripheral neuropathy.  Peripheral neuropathy usually begins as mild discomfort on the soles of the feet and may gradually travel up the legs depending on the length of time that you take this medication.  In many cases stopping this medication under the supervision of your provider will allow this side effect to completely clear. 

Stavudine is also rarely associated with inflammation of the pancreas or pancreatitis.  The pancreas is an organ deep in the center of your abdomen that secretes insulin and digestive juices.  When the pancreas is inflamed, it essentially begins to digest itself.  As you might imagine, this process is characterized by abdominal pain, and nausea and vomiting.  It is rarely fatal.  Your provider will monitor you for this condition. 

All drugs of this class can cause or contribute to abnormal fat redistribution characterized by thinning of the face, arms, or legs.  In most cases this would be also accompanied by elevated cholesterol levels, elevated triglyceride levels, and perhaps a tendency to develop diabetes.

Rarely, a build-up of (lactic) acid may occur due to taking medications of this type.  Persons taking multiple nukes (NRTIs), those taking d4T (stavudine, Zerit), those on the combination of d4T (stavudine, Zerit) and ddI (didanosine, Videx), and those persons with hepatitis C are the most likely to encounter this rare, but potentially fatal problem.  The symptoms are vague but troublesome: nausea, vomiting, muscle aches, weakness, turning yellow with jaundice, and just feeling plain bad. 

Report to you healthcare provider or go to an Emergency Room if you have severe side effects, increasing side effects, shortness of breath, abdominal pain, uncontrollable diarrhea, weakness, jaundice (eyes and skin turn yellow,) muscle pain, nausea and vomiting so that you cannot hold down your food and liquids.
You can download this handout in PDF format by clicking HERE.